Q: I am a premenopausal woman and have recently been diagnosed with osteopenia. My doctor wants to put me on medication, but I?m hesitant.
A: I think physicians can be too quick to start drug therapy. The lessons from hormone replacement therapy should be a cautionary tale. As is now well-reported, there is a significant downside to HRT in terms of long-term increased risk for breast cancer and heart disease. While HRT does improve bone mass, many women and their doctors are now understandably reluctant to start down that road.
In regard to prevention and treatment of osteoporosis, a class of drugs called bisphosphonates (Fosamax is the most common brand name) are commonly accepted as a first-line approach. While bisphosphonates are indicated for use in postmenopausal women, many pre- and perimenopausal women are being prescribed this drug as well. This ?extrapolation? causes me some concern.
Bisphosphonates clearly slow bone breakdown, but bone biopsies from patients taking these medications also show significant reduction in the bone formation rate. The drug is deposited in the bone and will accumulate for years. Additionally, we only have a maximum of 10 years of human data for bisphosphonates. It is possible that many years of taking these drugs would make bones more brittle or impair their ability to repair damage. While the data thus far suggests reasonable long-term safety,1, 2 I think given the recent history with HRT, we should be a bit cautious. Certainly premenopausal women at increased risk (osteopenia) should be followed closely and encouraged to make lifestyle changes that we know have benefits.
Q: My asthma symptoms are always worse after I exercise. Are there any natural therapies that may help?
A: You are describing a very common trigger in asthmatics. The technical term for this is exercise-induced bronchoconstriction, and it actually occurs in up to 90 percent of individuals with asthma and approximately 10 percent of the general population without asthma. EIB is the result of inflammation within the lungs and bronchi, which causes airway constriction.3
Basic research suggests that omega-3 oils have anti-inflammatory activity in lung and bronchi cells. But not much clinical work has been done on the omega-3/EIB connection. There has been only one controlled study on fish oil supplementation and exercise-induced asthma. This small trial of 20 people showed that fish oil supplements produced no significant change in the severity of exercise-induced asthma over 10 weeks.4
However, more recently, another small, three-week, placebo-controlled trial looked at 10 nonasthmatic athletes who had EIB. Researchers found these individuals did much better with fish oils?3.2 g of eicosapentaenoic acid and 2.2 g of docohexaenoic acid per day—than without.5 I would say that supplementing fish oils may decrease overall inflammatory tendencies and be useful in individuals who are prone to EIB.
Q: I?ve heard there are some new nutritional strategies for migraines. What are these?
A: You may be referring to the relatively recent work looking at coenzyme Q10 and riboflavin (vitamin B2). Co-Q10 at a dose of 150 mg per day was administered in an unblinded trial to 32 people suffering from chronic migraine headaches. After three months of treatment, almost two-thirds of participants had a greater than 50 percent reduction in number of days with migraines.6
In another trial, riboflavin at a dose of 400 mg/day was administered in an unblinded trial to 49 people suffering from chronic migraine headaches. After three months, average overall improvement was more than two-thirds.7 A follow-up, three-month trial compared riboflavin (400 mg/day) and placebo in 55 patients with migraines. Fifty-nine percent of the riboflavin group improved by at least 50 percent compared with 15 percent for placebo.8 A more recent unblinded trial assessed riboflavin treatment for six months. Headache frequency was reduced by 50 percent.9
In all four trials, no significant adverse effects were noted. It is possible that both these nutrients may be increasing mitochondrial energy efficiency, which may be a problem in individuals who suffer from migraines. A placebo-controlled trial on Co-Q10 would be important, and follow-up trials with riboflavin versus standard drug therapy would also be useful, but these initial studies suggest the nutrients may be helpful in reducing migraine pain.
1. Rodan G, et al. Bone safety of long-term bisphosphonate treatment. Curr Med Res Opin 2004;20(8): 1291-300.
2. Miller PD. Efficacy and safety of long-term bisphosphonates in postmenopausal osteoporosis. Expert Opin Pharmacother 2003;4(12): 2253-8.
3. Mickleborough T, Gotshall R. Dietary components with demonstrated effectiveness in decreasing the severity of exercise-induced asthma. Sports Med 2003;33(9): 671-81.
4. Arm JP, et al. Effect of dietary supplementation with fish oil lipids on mild asthma. Thorax 1988;43(2): 84-92.
5. Mickleborough TD, et al. Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med 2003;168(10): 1181-9.
6. Rozen TD, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002;22(2): 137-41.
7. Schoenen J, et al. High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study. Cephalalgia 1994;14(5): 328-9.
8. Schoenen J, et al. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998;50(2): 466-70.
9. Boehnke C, et al. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol 2004;11(7): 475-7.
Natural Foods Merchandiser volume XXVI/number 2/p. 46