dr. phuli's blog

Bone Health and Digestion

Thursday, September 27th, 2007

Over 26 million women have osteopenia, or bone thinning. Another 24 million are estimated to have osteoporosis (a more severe form of bone loss). Most women don’t discover that they have a problem until their bone loss is advanced, and unfortunately most women with osteopenia are simply told “take some calcium” and “do some push-ups”. Now, calcium is great and so are push-ups, but there is so much more that you can do to prevent and reverse bone loss.

Let’s start with your digestion. Your gut, where digestion takes place, is key to good bone health. How? Well, good bones require the right amount of protein and minerals. Protein and minerals come from the foods we eat, so building bone requires a good diet and healthy digestion. You need enough stomach acid (Hydrochloric acid, HCl) and digestive enzymes to digest and absorb your food. In particular, you need protease and HCl to digest protein, and enough lipase to digest and absorb fats. If you have had your gallbladder removed you may even need a bile supplement.

Many vitamins important for bone health are fat-soluble, that is, they require adequate fat digestive enzymes (lipase) to be absorbed by your body. The fat-soluble vitamins are vitamins A, D, E, and K, all important to make bone. Without adequate fat digestion and absorption you can take all the vitamins in the world, but they won’t do you any good, since you may not be able to absorb them.

If you have bone loss that is not improving with optimal hormone support (estrogen, progesterone, testosterone, DHEA, and growth hormone- too much to explain here, see my book) ask your doctor to have your digestion evaluated to make sure you are absorbing fats optimally in your stool. If you are not, then use a digestive enzyme. If you don’t want to be tested, try adding a good pancreatic enzyme that contains lipase and protease and see how that works.

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Women and Heart Disease: What’s New?

Tuesday, September 25th, 2007

We women are most likely to die from heart disease. Using natural bioidentical hormones (transdermal estradiol and natural progesterone) in the first 10 years of menopause can reduce that risk.

First some interesting facts, then the updates.

  1. Heart disease is the leading cause of death in women in our country (that’s about 500,000 deaths each year). Every year since 1984 heart disease has claimed the lives of more women than men.
  2. Women are more likely to die from their heart attack than men.
  3. Women tend to have different symptoms of heart attack than men (more jaw pain, neck pain, back pain, fatigue, shortness of breath, anxiety and nausea). In fact 25% of women have no chest pain.
  4. Heart research studies predominantly men.
  5. High LDL (bad cholesterol) levels have never been shown to correlate well with heart disease in normal women. in other words, having a lot of cholesterol doesn’t necessarily indicate that you are at greater risk for heart disease. (Your LDL level is important if you have a history of diabetes, hypertension or prior heart disease).
  6. Important risk factors for women are low HDL (good cholesterol), low estradiol (the active form of estrogen made by our ovaries), and high CRP (cardio- reactive protein, a blood marker of inflammation).

So What’s New?

Still think that hormones are bad for the heart? That’s what the WHI study showed right? Wrong. The WHI study showed that using synthetic hormones in women over the age of 60 did not improve their risks of heart disease and maybe even put them at higher risk for a heart attack. But the story appears to be different for younger women.

Recently there have been some really interesting articles published about the younger women in the WHI study (women 59 years and younger). The take home message is: Hormones used in the first 10 years of menopause appear to reduce heart disease, stroke, bone fractures, and diabetes.

Here are some interesting snippets from recent journal articles:

  1. JAMA reported that women in the WHI study who used estrogen close to menopause (within the first 10 years) had less risk of heart disease than women who didn’t use hormones. This was not shown for stroke, (because hormones used orally cause an increase in clotting which predisposes to stroke, see below).
  2. The New England Journal of Medicine reported that women from the WHI study aged 50 to 59, who used estrogen had less plaque (hardening of the arteries) compared with women of the same age who did not use estrogen.
  3. Circulation published an editorial discussing the very well done French study, (the ESTHER study), which showed that using transdermal bioidentical natural estrogen (estradiol) did not increase clotting, but oral estradiol did. In addition, using natural bioidentical progesterone did not increase clotting but some forms of synthetic progesterone did.

The New England Journal of Medicine recently summarized many new findings from the WHI showing that women under the age of 60 using synthetic estrogen have a lower incidence of death, heart disease, stroke, bone fractures, breast cancer, and new onset of diabetes.


  1. Rossouw, JE, et al. Postmenopausal hormone therapy and Risk of Cardiovascular Disease by Age and years since menopause. JAMA 2007;297:1465-1477
  2. Manson, JE, et al., Estrogen Therapy and coronary Artery Calcification. NEJM 356:2591-2602
  3. Manson, JE, et al., Invited commentary: Hormone Therapy and risk of coronary Heart Disease-Why Renew the Focus on the Early Years of Menopause. American J Epidemiology Advance 2007;166: 511-517
  4. Brouwer, MA, et al., Estrogen Therapy and Coronary Artery calcification. NEJM 357:1252-1254.

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