Saturday, May 31, 2008

Duped again?

I get annoyed with a stock phrase in all the health and nutrition newsletters I subscribe to: “Talk with your healthcare professional.”

When I first moved to Snowflake I got an appointment with a woman gynecologist thinking she would be more in tune with my female concerns. I had been on hormone replacement therapy (HRT) at that time for about 15 years and was thinking of ending treatment. This was a year or two before the Women’s Health Initiative study blew the lid off the idea that HRT was the miraculous “cure” for menopause as well as a preventive for major ailments including cancer and heart disease.

When I told the doctor I was thinking of ending the hormone replacement therapy, her eyes opened with alarm. “What!” she blurted, “And ruin your bottom?”

Don’t you just hate it when doctors use medical jargon?

My current doctor is a pleasant, middle-aged man who wears a big turquoise bolo tie and matching watch band, and talks fondly of his 70-year-old-mother. (I look for clues that gynecologists like older women; it’s tough competing for attention against fecund young women about to engage in the miracle of birth.) He’s been my doctor for five years now, but that means I’ve only seen him five times. Despite the basically intimate nature of our relationship, it’s not a particularly warm or familiar one.

When booking my last annual check-up, I asked for a consultation with the doctor to talk about my bones. Four years previously he’d prescribed weekly doses of the bone-building drug Fosamax, after a baseline test registered a T-score (the standard measurement of bone density) of -1.3. This meant, he said, that I had osteopenia (thinning of the bones).

Ever eager to avoid bone loss, I took the meds, knocked back 1200 milligrams of calcium every day. And, at his urging, stayed with hormone replacement therapy as well. (It’s still reputed to be effective against bone loss.)

Despite these efforts, my last two scans were even worse (-1.8). And I wanted some answers.

So at the end of the physical, still in the examining room, me clutching closed the skimpy, open-fronted exam gown, Doctor T. flipped through my charts. “You wanted to talk about something?”

I repeated my litany of how I was doing everything possible for my bones. What more could I do? And why hadn’t my scores improved?

"Well," he replied, “they haven’t gotten any worse.”

End of consultation.

That did set me off. I began researching articles and buying and reading books about osteoporosis. While I’m probably guilty of confirmation bias (you know, only paying attention to information supporting your own point of view), I have become convinced that American women are being duped again. Just as with hormone replacement therapy, we are being hyped and herded into taking drugs, supplements, potions, and notions for osteopenia, a naturally occurring condition of age that is not a disease. And that actual, diagnosed cases of genuine osteoporosis, a disease marked by fracture, pain and disability are extremely rare.

I have stopped taking the Fosamax. Like most everyone, I want a magic bullet; it's so much easier to take pills than make lifestyle changes. But the causes of bone loss and the processes of rebuilding it are so complicated that researchers do not yet know enough to make any kind of accurate predictions or prescribe sure-fire "cures." At this point bone loss treatments are simply in the hypothesis stage. But there is one certainty: pharmaceutical companies are making big bucks.

So I address my bone health the hard way: exercise (the most protective thing you can do) plus a diet so healthy that I frighten people (less animal protein and lots and lots of fruits, veges and legumes). I take modest amounts (600 mg) of calcium but have added Vitamin D to my daily regime (400 IUs on the days when I don't go outside without sunblock). And I have given up Coke (sigh).


And now, the one exercise you need to do daily for the rest of your life:

Starting right this minute begin practicing Kegels, the exercise to strengthen your pelvic floor muscles. Maintaining these muscles will keep you from pee-peeing your pants (I like using medical jargon!) whenever you sneeze, cough, laugh or get a big hug.

I thought because I’d never had children this would not happen to me. Wrong. Embarrassingly wrong.

And things can get far worse than pink cheeks and dewy underpants. In extreme cases, beyond having to wear adult diapers, one or more of your body parts (bladder, small bowel, urethra, uterus, etc.) can drop into (or, even worse, out of) your vagina.

I asked at a woman’s seminar if anyone had recommendations of how many Kegels a woman should do every day. One of the attendees said that in Ayurvedic tradition it's recommended to do one each time you pass through a doorway. Whew.

I'm too clueless for that approach so I’ve ended up doing sets of ten here and there throughout the day (while driving or brushing my teeth, or sitting at the computer) until I’ve worked my way up to about forty. The results have been significant.

Here’s the little mantra I use: “Tight, tighter, tightest." (With a slow release of the muscle.)

Other news you can use:

Both Best Foods and Kraft have come out with low-fat olive oil mayonnaise. I’ve only tried the Kraft (on sale; I prefer Best Foods). And as you would imagine it’s a more vigorous taste than the ordinary low-fat, but not so much olive-oily as vinegary.

I guess I'm just finally used to regular low-fat mayo, and I prefer it to this new version. But the olive oil kind might be good with potato salad or other dishes where you’re looking for a bolder taste.

Whichever kind you use, here’s a tasty quick fix: Bean & veggie salad. Drain & rinse one can of red beans. Add a tablespoon or two each of finely chopped red onion, celery, carrot, peppers, or whatever veggies you’ve got hanging around the kitchen. Plop in a dollop or two of low-fat mayo mixed with a squirt or more of fresh lemon or lime juice, or a couple dashes of chipotle hot sauce, or herbs of choice, or just plain old salt & pepper. Mix well. Eat. Makes two one-cup servings, about two hundred calories each (or one 400 calorie lunch!)

Bye for now.

Aunt Rose

P.S. Part of my frightening move to eat more healthfully is a shift toward vegetarian dishes. I've mentioned this blog before, but for fun, and generally accessible, vegetarian recipes ("Black bean brownies" anyone?) visit: http://www.101cookbooks.com/