Herbal Health

While there seems to be little doubt that hormone therapy can be beneficial in the treatment of osteoporosis in postmenopausal women, there are significant hazards that have to be considered. Oestrogen is a powerful chemical which has an impact on many systems in the body.

If you have had serious problems in the past with oral contraceptives, then oestrogen or hormone therapy should perhaps not be undertaken. Hormone therapy probably would not be prescribed if you are overweight, have high blood pressure, varicose veins, seizure disorders, diabetes, liver or gallbladder disease, undiagnosed vaginal bleeding, migraine headaches, or smoke heavily..

There is an increased risk of blood clotting. Since oestrogens are usually taken orally, they go immediately to the liver in a relatively high concentration, overstimulating this organ.

Oestrogens used in menopausal therapy and high-oestrogen birth-control Pills have both been linked to cancer of the endometrium. During the years you arc menstruating, one of the normal effects of natural oestrogen is stimulation of the lining of the uterus (endometrium), and in the menstrual cycle progesterone is produced as a counterbalance, triggering the shedding of the uterus lining. When the stimulation caused by oestrogen supplements is ‘unopposed’ by progestin, it can produce an overgrowth or thickening of the endometrium which can precede endometrial cancer, especially if you have never borne a child. This risk can be diminished, however, if oestrogen therapy is supplemented with progestin. If you have a family history of endometrial cancer, or if you are overweight (and producing oestrogens derived from your androgen hormones), or if you have a menstrual cycle that does not naturally produce progesterone, you would be at high risk when taking unopposed oestrogens.

If, on the other hand, your family has a medical history of heart disease, women’s natural hormones apparently give protection before menopause; but when hormone production stops, the rate of women’s heart disease quickly rises to equal that of men. And while oestrogen supplements appear to reduce heart disease risks, combined oestrogen/progestin therapy can erase the cardiovascular protection of oestrogen.

Another side effect may be tender swollen breasts and the possibility of breast cancer after long-term therapy (although this is controversial among medical researchers). If other female members of your family have had breast cancer, or if you have a tendency to have cystic breasts, you may have an increased danger of developing cancer of the breast if prescribed oestrogens. A Swedish study reported in 1989 showed that women taking a combination of oestrogen/progestin for more than six years were more than four times as likely as other women to develop breast cancer.

If you take hormones for more than a year, you may have a deficiency of vitamin B, which can give you a feeling of depression. This deficiency can be offset by eating organ meats, wholegrain breads and dark leafy vegetables, or taking a folate supplement.

Other drawbacks to hormone therapy can be weight increase, fluid retention and headaches, but a low-sodium diet can help in many cases. Your doctor may also mention other side effects of nausea, vomiting, abdominal cramps and dizziness.

Before starting hormone therapy, your physician will give you a thorough examination including tests for liver disease, hypertension or heart disease, existing breast or endometrial cancer that would rule out the taking of oestrogen supplements. There should be a Pap test of your cervix and a suction curettage of your uterus, with a biopsy to ensure there are no cancerous or precancerous cell tissues or pre-existing fibroids.

During therapy you will need to be under close surveillance by your physician, with examinations every six months. Mammography, Gravely jet-washing of the uterus or further biopsies may be necessary to ensure there is no development of cancer and for tests to evaluate your rate of bone loss. If undesirable thickening of the endometrium occurs, your doctor can reduce dosage or change the type of hormone. Any unusual blood spotting should immediately be reported to your physician. If therapy is begun while you are still menstruating, your usual bleeding pattern should continue, and may extend into your sixties.

Summary

If you decide on hormone replacement therapy, try to have the smallest possible dosage for the shortest possible time to avoid the possibility of cancer – but sufficient to maintain bone mass. The preferred method to minimize risks is to have natural oestrogens in conjunction with progestin on a monthly cycle, but there is as yet little information about the safety of long-term treatment.

With hormone treatment containing risks, it should not be considered routine for all women, but if you are at high risk of developing brittle bones, there is no doubt that it can be extremely valuable.

In April 1984, a US Government-sponsored Conference on Osteoporosis attended by eminent research specialists and physicians, issued a consensus statement: ‘Until more data on risks and benefits are available, physicians and patients may prefer to reserve oestrogen (with or without progestogen) therapy for conditions that confer a high risk of osteoporosis, such as the occurrence of premature menopause.’

If you decide not to have HRT, make sure you have dietary calcium up to 1500mg daily, with adequate vitamins D and C, and plenty of exercise to keep bones strong. If you are prescribed HRT, your doctor may consider that 1000mg of calcium, plus vitamins and exercise, is sufficient.

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An essential part of a human being is the skeleton. The word ‘skeleton’ comes from the Greek meaning ‘dried up’, because by itself, the skeleton looks like a completely dried up human, or a shrivelled mummy without skin (or so the Greeks thought). The skeleton is about 18 per cent of your weight – about 25 pounds (11 kg), made up of 206 separate bones to support and protect your body:

long, like the thigh bones, for example, short, like the wrist bones, flat, like your ribs, and irregular, like your vertebrae.

Almost every bone is designed to fit a particular need, with a notable exception being the coccyx, Man’s vestigial tail.

The common name for the bones that run down your back is ‘backbone’, which may sound like a single bone, although twenty-six articulated bones are involved in an adult, held together and kept upright by muscles and ligaments. Another common name is ‘spinal column’ or spine, which again suggests a single bone. But if the spine were a single bone, your back would be completely stiff and unable to bend – like your thigh bone, which is one long piece. The spinal column is composed of many bones, separated by discs of fibre and cartilage that act as shock absorbers, enabling your trunk to turn to either side, bend backwards or forwards, or even in small circular movements. It doesn’t bend at one point, like the elbow in your arm, but slightly at several points. Because the spinal column can bend in different directions, its formal name is vertebral column, from the Latin ‘vertere’, to turn. So each individual bone in the vertebral column is called a vertebra, which is how our division of the animal kingdom came to be called vertebrates.

At birth, there are two curves in the vertebral column as in typical land-vertebrates: a downward curve at the neck and an upward curve in the back. So babies crawl. But during the second year, a child rises on hind legs, finding it increasingly easy, comfortable and natural like that. The vertebral column gradually bends back in the hip region to form a new curve that is shaped towards the back. The human spine, though still straight when seen from behind, now has a kind of double-S shape when seen from the side. The curves of the spine make it easy to keep upright and give a springy balance. Other animals, such as bears and gorillas, do not have this spinal curve in the region of the hip, so they can’t maintain an upright position for long.

Bone tissue consists of tiny particles of calcium and phosphorus in a network of collagen fibres. The calcium gives strength and hardness to bones, without which your bones would be like jelly. The collagen gives a certain amount of flexibility. Your bones also naturally contain fluoride, sodium, potassium, magnesium, citrate, plus other trace elements – all helping to hold the calcium and phosphorus building-blocks together.

The body of a 154 pound (70 kg) man contains about 2,5 pounds (1.2kg) of calcium – between 1.5 and 2 per cent of his total body weight.

Bone tissue is a storehouse for your reserves of calcium, containing 99 per cent of the calcium in your body, to be added to or withdrawn from as needed to maintain a balance of calcium in the blood. The other 1 per cent of calcium is found in soft tissues and fluids throughout your body, with the level of calcium in the blood kept fairly constant, as required for muscle contraction, pulse rate and heart contractions, normal blood clotting and brain functioning. When blood levels of calcium become low, calcium is resorted from the bones to help keep up blood calcium. When blood levels of calcium return to normal, bone resorption slows down.

Bones manufacture blood cells; they are tissues with blood vessels, nerve fibres and fluid-filled channels.

like other body tissues, living bone is always being rebuilt, bone remodelling is constantly under way: new bone is formed on the outer surfaces while small quantities of old bone on the inner surfaces are lost through breakdown and resorbed by the body. A bone-making cell is called an osteoblast and in its mature form in the bone it is called an osteocyte, important in the nutrition and maintenance of normal bone. The bone-resorbing cell which is responsible for remodelling and reshaping bones dining growth and repair is called an osteoclast. The delicate balance maintained between these processes is your bone mass – the total amount in your skeleton – a balance that is always changing according to your body needs, affected by heredity, diet, drugs, physical activity, hormones, stress, injury and disease.

Basically, there are two different types of bone tissue: cortical and trabecular. Cortical bone is very solid and dense, and is mostly in the long hard bones of arms and legs. Trabecular bone looks rather like a honeycomb, though much more porous, and this type is mostly in the spinal vertebrae. Each bone has both types of material, with the solid cortical bone on the outside as a shell around the spongy trabecular kind in the interior. The proportions of cortical and trabecular bone vary, depending on which bone it is and which part of the bone. Normally, at the ‘neck’ of the femur it is about 50 per cent cortical, 50 per cent trabecular. The lower part of the radius is about 75 per cent cortical, 25 per cent trabecular. Vertebrae are about 10 per cent cortical, 90 per cent trabecular.

The spongy bone in the inside of long bones forms a system of great strength – sufficient to carry loads with an economy of material. If your bones were all completely solid, your skeleton would be impossibly heavy and yet not have much more structural strength than it actually does. But it is trabecular bone tissue which is most susceptible to changes that occur in bone remodelling.

Bone tissue is formed when the human embryo is only two months old, then built up through childhood and adolescence until you are about twenty-five to thirty years old. When you are young, the build-up of bone growth predominates over breakdown; your bones get larger and more dense up to maturity. In adulthood the two processes are in equilibrium. Peak bone mass for cortical bone is reached at about the age of thirty-five, earlier for trabecular bone. Finally, as you reach old age, the natural process of breakdown prevails more than regrowth. Adults have about 10 to 15 per cent of their bone replaced every year, according to estimates, in a cycle of three to four months, with the formation, maintenance and breakdown of cells. The average life span of bone tissue is about ten years in an adult.

If you live long enough, a certain amount of bone loss is normal – about 0.5 per cent annually. The decline of trabecular bone in the spine can start in the early twenties, particularly among women, with a slight loss in both sexes until the age of fifty. But the rate can be as much as 1 per cent or more a year, so that by the time a woman is fifty, she might have lost 30 per cent of her skeletal mass. Loss of cortical bone starts in the early thirties, mostly from arm- and leg-bones. Bone loss can be accelerated if muscles are inactive, as with paralyzed patients, by prolonged bedrest or being confined to a wheelchair. Certain diseases can also accelerate decline in bone mass.

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‘Get your calcium from food from the dairy or grocer and not from the chemist’ is the general advice, as your body absorbs dietary calcium more thoroughly than the calcium in supplements. However, for many people that is insufficient for their daily calcium needs. Are you:

pregnant or breast-feeding your baby?

convalescent after an illness or surgery?

on a medically supervised weight-control diet of less than

1000 calories per day?

a strict vegetarian who avoids all dairy products?

having dental problems as a result of periodontal disease?

suffering from a special malabsorption disease?

over fifty, and finding it difficult to eat sufficient dairy

products?

If you answer yes to any of these questions, you should discuss calcium supplements with your physician, to get the vital mineral without consuming more calories. Your doctor can advise you on your personal daily calcium needs, particularly if you are already taking antibiotics or a diuretic, have kidney disease or other intestinal disorders your NHS doctor or clinic may prescribe:

Calcium lactate gluconate with calcium carbonate (Sandocal 1000, 1 tablet daily)

Calcium carbonate (Titralac, 2 to 3 tablets daily)

Hydroxyapatite (Ossopan 800, 4 to 5 tablets daily)

Calcium carbonate (Calcichew, 2 to 3 tablets daily)

Calcium citrate (Cacit, 1 tablet daily)

The amount of calcium in a vitamin-mineral tablet is usually insufficient, since calcium is too bulky to be incorporated in amounts up to 500mg in a vitamin preparation. Supplements come in tablet, powder or liquid form, and are best taken between meals with small amounts of milk or yogurt, which have the lactose and vitamin D to help you absorb the calcium. Since more calcium is lost from your body while you are asleep, be sure to reserve some of the daily supplement for just prior to bedtime — the milk will also help you sleep.

Of the many non-prescription calcium supplements you can buy, most contain one of three calcium compounds (occasionally a combination of them), varying widely in the proportion of calcium they contain. To reduce cost, look for your chemist’s own label instead of brand names, and ask the pharmacist for information if the label is insufficient.

Calcium carbonate (40 per cent calcium). This is the highest available concentration of calcium, meaning that generally it is the least expensive because you need to take fewer tablets. This compound is often derived from oyster shells and may contain sweeteners and flavourings. (In Japan, this supplement is often made from tons of pearls, too flawed or tiny for jewellery.) The AMA Division of Drugs recognizes calcium carbonate as the preferred type of oral calcium supplement, although it can cause constipation or gas. Since calcium carbonate needs gastric acid for absorption, the elderly (or those who have had part of their stomachs removed) may find it a problem if their stomachs produce less acid. This compound is commonly used in antacids, and may cause rebound stomach acidity (a vicious circle of acid secretion, antacid, acid, antacid and so on). If you suffer from a chronic duodenal ulcer you may induce excess acid when taking high doses of calcium carbonate.

Calcium lactate (13 per cent calcium). A little more expensive, containing less calcium. Since this compound is usually derived from lactic acid or lactate salts (chemically unrelated to lactose), there should be no problem of lactose intolerance. Calcium lactate appears to be the least gastrically irritating and more soluble for older persons with low stomach acid output.

Calcium gluconate (9 per cent calcium). Because of the small percentage of calcium, it needs to be taken more often throughout the day. It has a very sweet taste.

You will also find in health-food stores or by mail order ‘chelated’ calcium tablets. Chelation is supposed to improve the absorption in the intestine, anchoring the calcium to other chemicals; it can, however, make the tablets more expensive.

Calcium chloride and calcium levulinate may also be in your health-food store or at the chemist: the first compound can irritate the stomach, and is more used in pickle recipes. The latter, with a low percentage of calcium, has a bitter, salty taste.

Several brands of calcium supplements have the addition of vitamin D to promote calcium absorption. However, D is a fat-soluble vitamin, and it is easy to overdose. Most people acquire sufficient vitamin D through exposure to sunlight, so ask the advice of your doctor on this point.

Bone meal and dolomite These products, usually available as tablets or powder, should be avoided. Bone meal supplements are usually produced from finely milled cattle bone. All bone meal contains a certain amount of lead, originating from the diet of the animal, and generally speaking, there is a greater quantity of lead as the animal gets older. Dolomite is a form of limestone, with a similar risk of lead contamination. The US Food and Drug Administration has issued a warning to doctors and the public about these products connected with the danger of lead poisoning. Since calcium supplements are frequently used by pregnant and nursing women, and by children unable to digest milk, doses of lead can be hazardous, causing effects ranging from anaemia to severe brain damage to death. The lead content in the different brands can be highly variable, according to tests done by the US Consumers

Union in 1982, and dolomite supplements were a little lower in lead than the bone meal products. Although the products are not dangerous by themselves at the recommended dosages, the conclusion was that these particular calcium supplements could add appreciably to the exposure people already have from lead in the air, water and food. If some people exceed the dose, on the principle that more is better, they would have an even higher risk of lead exposure. Even though the prices of bone meal and dolomite are usually somewhat lower than other calcium supplements, the variability of lead in them dictates that they should be avoided, especially as many forms of calcium are available.

How much calcium is too much?

Medical authorities consider that almost everyone can consume 1500mg of calcium daily — but no more than 2000mg — with little risk of adverse health effects, considering an intake both from diet and supplements, although no one yet knows the long-term effects of very high supplementation. Symptoms of calcium overdose include constipation, stomach upset, dry mouth, thirst and increased urination. Too much calcium can cause calcification of the arteries (arteriosclerosis) and can create kidney stones if you are predisposed to this problem.

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And how much is too much? When you have a cup of coffee, your body reacts to the caffeine by stimulating the nervous system, increasing heartbeat, basal metabolism and the secretion of stomach acid and an increase in urine. And studies have shown that heavy coffee-drinkers lose more calcium from their bodies than noncoffee-drinkers. As coffee may be a contributing factor in bone loss, it would be prudent to reduce consumption to no more than one cup a day. The key word is ‘moderation’. Health authorities advise pregnant women to avoid caffeine altogether because studies indicate it could cause skeletal defects in unborn children. Other studies are now focused on the effects of caffeine on children because of the large quantities of soft drinks, iced tea and chocolate they may consume. The problem is that caffeine is not only in many drinks but also in many common foods and drugs, both prescription and non-prescription.

Caffeine in coffee and tea can vary because of different methods of brewing, and whether it is from standard ground beans, instant or decaffeinated. Black tea has high caffeine, green tea very low; completely caffeine-free teas have recently been introduced. The effect of caffeine in tea is less than in coffee because tea has other ingredients that slow down the release of caffeine. Lovers of chocolate can change to carob powder to avoid caffeine, reduce phosphorus and boost calcium.

Herbal teas have not yet been studied extensively in Britain, so if you drink herbal tea to avoid the known effects of caffeine, you could expose yourself to other chemicals about which far less is known. Although the vast majority of herbs are safe in normal amounts, you should not conclude that all herbal teas are safe, nor that it is safe to drink large amounts of any herbal teas, for a length of time.

Because of growing concern, an increasing number of soft drinks are now produced without caffeine, but they can be high in phosphorus. Read the labels on cans and bottles carefully.

Discuss caffeine with your doctor before taking any drugs, including simple over-the-counter medicines such as painkillers and sleeping preparations. Similar products without caffeine are usually available.

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Protein is one of the building-blocks in your body, a vital daily nutrient needed among other things, for the formation of new tissue, the production of antibodies to resist infections and for normal blood clotting. Osteoporosis can develop from either a lack of protein or too much.

In the average British diet, 66 per cent of protein comes from animal sources and 33 per cent is derived from plants. Most people are brought up believing that plenty of protein builds strong bones, whereas studies indicate that vegetarians (particularly those eating eggs and dairy products) have denser bones. While children, pregnant women, athletes and convalescents under the care of dieticians have special requirements for daily protein, people on average eat twice as much protein as they really need. Large quantities can be harmful, accelerating extensive calcium loss in the urine, particularly in osteoporotic women or those at risk of developing it in later years.

Excess protein puts a strain on the kidneys, increases body fat, and makes your body lose calcium, weakening bones and tooth-supporting tissue. Absorption of calcium seems to be best when protein intake is moderate: for a moderately active woman, no less than the World Health Organization recommendation of 29 grams of protein, and no more than the D.H.S.S. recommendation of 54 grams of protein per day.

In a study at Creighton University, Nebraska, a group of women each with an average protein intake of 50 per cent more than the recommended amount had an increased daily loss of calcium in their urine – a deficit leading to an annual loss rate of 1 per cent of their bone mass.

Protein is found mostly in meats, poultry, fish and dairy products – but don’t cut back on dairy products as they are important sources of calcium. Many health experts suggest that, if you eat meat, have it no more than three times a week and keep portions small. By having hearty savoury casseroles of vegetable protein combinations, not only will you be counteracting bone loss, you’ll be increasing fibre and reducing intake of fats and phosphorus.

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