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LES SUPPLÉMENTS

Pills. Pills of all kinds. We all want the magic, long-life, anti-aging pill. We are offered pills and more pills as supplements. There are vitamin-only shops that are panacea profferers right out of a Harry Potter book. There are big sections of over-the-counter supplements in pharmacies. There are big homeopathic treatment and supplement sections in health food stores (the one in my New York neighborhood has a separate adjacent pill store to accommodate them all). Magic diet and pill ads abound in magazines and online. I get confused. I get tempted. I know that many of these magic potions can do little good and many can do harm.

If you practice what I have been preaching, mostly all preventive medicine, and if you eat a balanced, healthy diet with good variety and colors, why would you need more of something that nature provides? With advancing years, you might, but of what?

The best thing to do about this in your fifties and beyond (if not sooner) is to get your physician to prescribe a blood test that measures a long list of vitamins and minerals. If you turn up with a deficiency, perhaps you first should tweak your eating habits a bit. A little low in magnesium? How about adding a banana (a magnesium magnet) twice a week before rushing to a heavy dose of multiple vitamins or a specialized magnesium concoction?

SUPPLEMENTS OF A VITAMIN AND MINERAL KIND

Okay, a mild dose of a multivitamin probably will do you no harm and potentially a little good, especially if it is the new-generation variety designed for women only of a certain age. However, clinical study after clinical study has not produced evidence that taking multivitamins improves the health of an average person. They certainly do not cure any major diseases.

More alarming, however, is that study after study has shown that there are real risks from overdoses. All sorts of adverse effects may occur, and megadoses of, say, vitamins A, D, E, and K can interact negatively with some prescription drugs.

If you read the back of some vitamin, mineral, and supplement containers, you will often see the latest recommended daily amount from a government or research body. Then you see what percentage of that recommended amount is included in the pill or powder. And there are percentages like 250 percent, 500 percent, even 1,000 percent. Now who said ten times the recommended amount is ten times better for you…even twice as good? No one, not even the companies that produce them, and they don’t because it isn’t true, and there is paltry evidence to back up any claims that you will be healthier by taking them.

Also consider all the enriched milk, bread, pasta, and cereals we consume. They probably already bring us over the daily-recommended intake of various vitamins and minerals. Then add a megavitamin? You might set a day-in-day-out norm of 2,000 percent. And why must it be “mega” in our supersized world? You’ve heard that omega-3 oil is good for you and helps reduce the risk of heart attack, so you increase the amounts of oily fish you eat. Then you want to add fish-oil pills, which are yet to be proven they work? And perhaps throw in some herbs you’ve read about that come from a place and plant you’ve never heard of and a company you’ve never heard of, to pick up a little (is it cure or) protection you are thinking from something else?

Time for another reality check: it is safest to get your vitamins and minerals, your antioxidants and beyond, from fruits, vegetables, nuts and grains, dairy, fish, and meat.

But one of the fears of growing old is broken bones and osteoporosis, especially in women, so isn’t a calcium supplement good medicine? At least that’s what I ask myself when I should be asking a physician, especially the new class of physicians, gerontologists, who are most informed about the needs and latest practices associated with post-fifty patients. It is definitely important to get the right amount of daily calcium for our bones and more. From what I’ve read, calcium from food helps reduce heart attacks; supplements do not. However, it is equally important not to overdose on calcium. In fact, a recent study has found that women who consumed 1,400 milligrams or more of calcium a day had more than double the risk of death from heart disease, and if that is not enough, excessive calcium adds to the risk of kidney stones. Great. Have your bone density tested first, and ask your doctor. You may not need more calcium from supplements.

If exceptions prove the rule, let me return to vitamin D. I again confess, every few months it seems there’s another study that comes out claiming that a certain food or vitamin is the key to our health, and I get confused. The media doesn’t help, since every little study that proposes a “wonder” vitamin or nutrient or pill that promises better health gets its fifteen minutes of fame. But in the end, I come back to vitamin D, which just might be the supplement du jour to consider and reconsider.

This vitamin has gotten a lot of press claiming that many, many women are deficient in it. Now, again, for the average person, eating a correctly portioned diet that is richly diverse in whole foods (those are nutrient-rich, natural foods) will satisfy most of the body’s nutrient needs. And if you go outdoors in the sunshine daily, you should get your boost of vitamin D. But perhaps only half as much as you think. Yes, ultraviolet sunrays on our skin cause a chemical reaction that tells our body to make vitamin D. But if you use sunscreen (and you should), or you live in a northern region where you don’t see the sun every day, you’re unfortunately blocking your body’s ability to make the vitamin.

I stand by what I’ve always said and the French have always espoused: everything in moderation. But a little more vitamin D may well be an exception because more may simply be enough. And here’s why. Although our bodies are usually quite efficient in extracting what we need from food, we do not adequately absorb enough calcium, the nutrient that is essential to grow and maintain bone and teeth health. That’s where vitamin D comes in—it helps facilitate calcium absorption.

For years women have known that we face a much higher risk of osteoporosis and increased frailty as we age, especially when compared to men. To counterbalance this, many of us over the age of forty take between 500 and 600 milligrams of calcium twice a day for a total of 1,000 to 1,200 milligrams (our bodies cannot absorb the 1,200 milligrams all at once). (Again, more than this is overdosing, and it carries real dangers with it.) But this is what makes vitamin D so important: even if you are diligent in your calcium consumption, your body won’t reap the benefits if you lack the tools to absorb the nutrients!

Why we might be deficient in vitamin D is interesting (and convincing); it is a vitamin not found in most foods. In many parts of the world we fortify our cereals, milk, and orange juice with it, but they do little in satisfying our recommended daily allowance (RDA). To give you perspective, most women need about 1,000 International Units (IU) of vitamin D per day just to meet their baseline recommendation. (I’ve seen very conflicting numbers on this, but 1,000 IU seems to be the median and 200 the minimum.) The amount in your cereal bowl? Only about 115 IU. Most fruits, vegetables, and meats contain modest amounts or none. Wild fish, like sockeye and Alaskan salmon, have about half a day’s RDA, but let’s face it, no one can eat salmon twice a day, every day. In addition to salmon, milk, OJ, and eggs are rich in vitamin D. It’s not only food—or the lack thereof—that impedes our vitamin D intake, it is our twenty-first-century indoor lifestyle.

Today many calcium pills come with added D, too. So make sure to buy brands that contain at least 400 to 800 IU and specifically have vitamin D₃ (also known as cholecalciferol), the most potent vitamin D. Then you can get the rest from a balanced diet of good food and sunshine.

And while calcium absorption is essential to us women as we age, it’s not the only reason to increase your D intake. Many medical studies have proffered that not getting enough vitamin D can raise your risk of breast, colon, and ovarian cancers. It’s a major component of our immune systems—boosting respiratory health and reducing inflammation.

As we live longer (thanks to modern science), vitamin D is becoming increasingly important to the aging process. Deficiency in it can cause muscle weakness, aches, pains, and balance problems. In fact, people with low levels of vitamin D are three times more likely to have arthritis!

So, even if we have become accustomed to tuning out the latest health tip du jour, it seems that the vitamin D and calcium combo might be a notable exception worth paying attention to.

SUPPLEMENTS OF A HORMONE KIND

There is good news for us baby boomers. There is safety in numbers, and market and other conditions will generate more and more physicians devoted to helping us, and more and more companies researching and producing products that can help us. Some certainly do.

The most desired is a fountain-of-youth pill, but it is likely to be an injection or a cream. There are contenders already, but all come with significant dangers.

Estrogen, Progesterone, and Testosterone

As we know all too well, women’s ovaries produce estrogen, progesterone, and testosterone (only about 10 percent of the amount in men), and the levels peak in our late teens, twenties, and thirties, then decline. Thus comes menopause in our forties or fifties, and along with it, besides the notorious hot flashes and sweats, comes a host of other changes. Loss of sex drive, vaginal dryness, and increased risk for stroke, heart disease, and bone injury.

For decades now, hormone replacement has been practiced to ease one through menopause and recapture a bit more of youth. Moderate estrogen treatments are often combined with the steroidal hormone progesterone, which helps to keep the uterus lubricated and stems atrophy. Together, the hormones boost energy, mood, sex drive, concentration, sleep, and even reduce the risk of some diseases such as heart disease and osteoporosis. However, attitudes toward this hormone therapy have changed in recent years, as some of the risks of long-term use—mildly increased chances for breast and uterine cancers, for example—outweigh the benefits for some. Hormone therapy is no longer recommended for disease prevention, including Alzheimer’s, but short-or long-term use can still be a good choice as its benefits can be significant and a good risk-reward calculation for many.

That said, the jury for some is still out, especially on long-term usage. I am not a physician, and I don’t want to make a recommendation or even comment now on all the issues, risks, and benefits. As a woman of my generation, I have had a good personal experience with this “supplement.” However, I have also experienced changes in attitude, and when my gynecologist retired and I interviewed others, widely divergent attitudes had emerged among physicians who were not shy about giving their opinions. So study and learn, talk to a few physicians, and then make your own educated choice.

ESTROGEN AND MOI

Sometimes, you must decide what’s best for you and go against the flow. As my mother would say, “Do go countercurrent…only dead fish follow the current,” or, as I said in my business book, “Don’t be afraid to take calculated risks.”

Sometimes risk-taking involves a lot of weighing the pros and cons and then making the decision, aware of the potential risks and being ready to swallow the consequences. At age fifty, that infamous magic number that says “menopause phase,” I was being asked (at least as a French woman thinking, Life starts at fifty) to take risks with my health, a first and quite different thing from taking business risks!

At the time, I was CEO of Clicquot Inc., which meant long days, six days a week, lots of travel, jet lag, stress from all the joys and pains of growing the company, and more. No need to tell you that my first sweaty night was ill received, to say the least. I had heard countless stories of the suffering of women colleagues, and I was not ready to live with the physical impediments of menopause, night or day. For the time it was night only. Unpleasant, to put it mildly. Insupportable (unbearable) for no-nonsense moi.

I visited my gynecologist, a New York pro who was born and educated in Greece. At our first meetings he intimidated me by always starting the visit with a “So, how is your sex life?” No question he was a fully assimilated American. That would never happen in France. But he had seen and heard it all, and seeing my It’s none of your business look, he’d say, “You look like a woman bien dans sa peau…just checking” (he spoke French), and from then on we became pals and could joke easily about life, women, and, oui, sex.

At my first menopause visit, he recommended, rightly so it seems to me, a combo of estrogen and progesterone…with the pluses and minuses of taking the supplements all well described. And so I went for it, but quickly didn’t feel right, though the hot flashes vanished almost instantly. He felt it was the progesterone my body didn’t like (made sense to me), and although it’s usually not recommended to go estrogen solo, that’s what I picked, and his answer was “As long as we do a regular check with a sonogram, it’s okay.” (He was also an obstetrician and could take the sonogram in his office as part of the visit.) And from that day on, I once again felt terrific, physically, emotionally, and sexually.

But then, as happens regularly these days and confuses so many women, some risks were revealed through yet another study. And risks associated with the dangers of hormone therapy got doctors in the United States scared of being sued or of being accused of practicing “bad” medicine. So my doctor announced my estrogen plan would have to be nixed. “Impossible,” I said, as a stubborn French woman. Not for me. I told him I would bear the responsibilities and would sign anything to cover him, and so he agreed to let me continue the small dose of estrogen. In my pseudo-medical mind, I still don’t understand why we don’t all take a tiny bit of estrogen after fifty since we need it and don’t produce it anymore, but hey, what do I know? The fact was and is that I’ve never felt better.

An amusing development was that by the following year, he mentioned that I must be doing something right, as my bill of health was great and many of his patients felt lousy and were ready to go back to whatever therapy they had been on before the put-on-the-brakes study. Like me, they were ready to assume the risks. And in all my years with him and estrogen, only once did the sonogram turn up something (which, after a month off estrogen, disappeared). Many of his patients and I decided to pick what allowed us to live a normal life because all the side effects of menopause just did not make for a “quality of life” we were willing to bear (or inflict upon others). For me it was well worth the price of admission.

But my drama was not over. My gynecologist, getting on in years, retired and pointed out it would be hard to find another gynecologist who would agree to keep me on estrogen (though the dose had been reduced and reduced and was now close to the absolute minimum), and eventually (like soon!) I should get off. That’s when I told him the story of my aunt Mireille, who lives in the Ardèche in France and at eighty-five is still taking some estrogen…and looks and feels like a woman of fifty or sixty (her daughter confirms it). He was not surprised and just looked at me and said, “Ah, the Mireilles of the world, a heck of a womankind,” whatever that meant. It was the last time I saw him. And I should point out I am not being reckless.

The new gynecologist I now see is definitely not a Dr. Miracle type. After a lot of “discussions,” she lets me use estrogen, though she has been tweaking with the tiny yearly reduction of the dose in order to eventually get me off it, as she claims it’s mostly for osteoporosis and at this point in my life has no effect. I don’t believe her, and as of this writing we are at a point where I am unwilling to give up the speck of a dose completely. Why? you may ask. Because I just feel terrific and attribute it rightly or wrongly to the tiny dose of estrogen. Who knows how long she’ll let me stay on it or if I’ll be willing to change doctors once more to find one who is willing to let me continue on it. Plus, I recently consulted a gynecological oncologist who assured me a trace of estrogen is common and safe, and he has seen a ninety-five-year-old taking it. So, for now all is well with me…going against the current.

Testosterone

With a much shorter history and database of users, the addition of testosterone to the anti-aging arsenal is a bit risky and controversial. Another hormonal steroid, it generally produces an improved sense of well-being and a significantly improved sex drive. It augments the benefits of estrogen and progesterone when needed and may reduce the risk of certain diseases, but it has some undesirable side effects. And while it may be invaluable for many patients, it is a prescription drug that requires close monitoring by physicians and regular blood testing.

Also of note is that while testosterone may be part of a “Hollywood-style cure” for aging, beware from whom you seek advice and receive information (i.e., celebrities). But mostly understand that there is an emerging class of anti-aging physicians who are a subset of gerontologists, who have drunk the Kool-Aid, are true believers, and are aggressive in their recommendations (which, of course, are coincidentally in their own best financial interests). If you go to a house painter, you will get your house painted. If you go to an anti-aging physician, you will likely get hormone-replacement recommendations. I am no physician and think it may be best to wait and see more of the results of studies on this supplement.

Human Growth Hormone

Now we are really into the latest magic needle of aging celebrities…and a dream of eternal youth. Human growth hormone (HGH), designed as a treatment for stunted childhood growth and hormonal deficiency, is, of course, a powerful steroid, banned among athletes in most sports. It is not certified, nor has it been studied much as an anti-aging treatment for mature adults.

HGH is controversial. The claims are that it reduces body fat and enhances muscle tone and bulk, boosts sexual performance, firms one’s skin, and heightens one’s mood. The evidence among athletes and black market sales bear some witness to this.

However, the long-term effects are severely suspect and include heart disease and diabetes, and the medical community is clear that short-term risks of carpal tunnel syndrome, joint and muscle pain, and swelling of the arms and legs are real and significant.

What is also clear is that the list of what I might call rejuvenation medicines will grow longer, clearer, and better defined and detailed in the next few decades. But what I have learned over the last few decades is that there is a price to be paid for everything.

Aging is a natural process, and it is delusional to think that simply bringing hormone levels back to what they were at age twenty will turn the full body’s look and health back to one’s physical prime. Or not have consequences. I am not being delusional about taking a speck of estrogen or a periodic dose of vitamin D. Stay tuned: the risk-rewards game will only become clearer and more dramatic with the advances and challenges science will bring. But for now, each winter for six weeks I will continue to take what has worked for years at my hairstylist’s recommendation: a Nutricap supplement (from the US company of that name with a big global presence, notably in England and France), which is a pill, containing gelatin, walnut oil, carob, and lecithin, that is good for my hair and nails…until, of course, a definitive study of any sad consequences in mice appears.