Bone weary in America: contraceptives, celiac disease & other osteo-hazards

You might want to start paying attention to your bones.

Even if you’re not an over-50 hard-drinking guy, or a post-menopausal former-smoker gal — even  if you are, say, just a light-complexioned skinny person, your bones want you to understand they might not be able to keep you together forever.

My bones sent that message not long ago by summoning a few other medical markers. Anemia and exhaustion got my attention and lo! we discovered celiac disease. Who knew? Celiac sprue is a genetic condition half the country seems to have, now that it’s gotten half the country’s attention — and confirmed diagnoses are relatively easy to make. Because I am an asymptomatic celiac person, in my case it was just the ol’ bones sending a signal that they would like a little calcium, please.

Yesterday’s New York Times reported another new finding:

Almost half of all women who use a popular injected contraceptive lose a significant amount of bone mass within two years, and researchers now say the greatest risk is to smokers, women who don’t consume enough calcium and those who have never gone through a pregnancy.

A study that followed women who used the birth-control method — a shot of depot medroxyprogesterone acetate, better known as DMPA or Depo-Provera, every three months — found that 45 percent of the users experienced bone mineral density losses of 5 percent or more in the hip or lower spine, researchers said. The study appears in the January issue of Obstetrics & Gynecology.

More than two million American women use DMPA, including about 400,000 teenagers.

Researchers said the bone loss was of “significant concern” because recovering bone mass can take a long time, and the hip is the most common site for fractures in women later in life.

“We can now tell our patients, ‘Don’t smoke, and take your calcium every day’ — those are modifiable risk factors,” said the senior author, Dr. Abbey B. Berenson, director of the Center for Interdisciplinary Research in Women’s Health at the University of Texas Medical Branch at Galveston. “The flip side is that if I have a patient who smokes, I’m going to be more concerned about giving her Depo-Provera.”

Your bones could be aching for attention even if you’re still none of the above. The World Health Organization now has a nifty new bone-health tool called FRAX to help you figure if you’re at risk for fractures. You can visit their site, plug in country and ethnicity for your personal profile. You can also go to (bones people are having a good time with titles and acronyms) and find out more about healthy bones and how to keep them thus.

Dem bones, as long as you help them, gonna walk around.

The aches & pains of medical marijuana

An article in Sunday’s New York Times details the struggle in Los Angeles to regulate the cannabis dispensaries which have proliferated around the  city over the past six or eight years, raising the old medical marijuana questions about how to control, whether to tax and how useful it is in the first place. Reporter Solomon Moore cites Oakland, California’s Harborside Health Center as the place to which many are looking for a model.

‘Our No. 1 task is to show that we are worthy of the public’s trust in asking to distribute medical cannabis in a safe and secure manner,’ said Steve DeAngelo, the pig-tailed proprietor of Harborside, which has been in business for three years.

Harborside is one of four licensed dispensaries in Oakland run as nonprofit organizations. It is the largest, with 74 employees and revenues of about $20 million. Last summer, the Oakland City Council passed an ordinance to collect taxes from the sale of marijuana, a measure that Mr. DeAngelo supported.

Mr. DeAngelo designed Harborside to exude legitimacy, security and comfort. Visitors to the low-slung building are greeted by security guards who check the required physicians’ recommendations. Inside, the dispensary looks like a bank, except that the floor is covered with hemp carpeting and the eight tellers stand behind identical displays of marijuana and hashish.

There is a laboratory where technicians determine the potency of the marijuana and label it accordingly. (Harborside says it rejects 80 percent of the marijuana that arrives at its door for insufficient quality.) There is even a bank vault where the day’s cash is stored along with reserves of premium cannabis. An armored truck picks up deposits every evening.

City officials routinely audit the dispensary’s books. Surplus cash is rolled back into the center to pay for free counseling sessions and yoga for patients. “Oakland issued licenses and regulations, and Los Angeles did nothing and they are still unregulated,” Mr. DeAngelo said. “Cannabis is being distributed by inappropriate people.”

I don’t know where Los Angeles will go with all this, or how well Harborside will continue to operate for how long. What I do know is that marijuana serves a real medical purpose. Probably serves a real recreational purpose too, and there’s the rub; but since I missed the pot party — thank heavens, as I am addicted to anything that comes down the pike, and please don’t try to tell me one cannot get addicted to marijuana — I can’t address that issue. Everything I know is anecdotal, but convincing.

Decades ago my beloved sister was suffering acute gastro intestinal distress, much later identified as a symptom of celiac disease but this was before anybody really knew anything about celiac sprue. One day she said, “You know, everybody at X High School either smokes pot or knows where to get it. Could you get me some so I could at least try it?” Well, even though the statute of limitations would probably protect the surviving players I think I won’t go into details of this adventure. But what I learned was: buying and selling illegal pot is a little scary for the novice, but the deal was easy and nobody went to jail. It did indeed give relief to my suffering sister. Though both of us wished she could have that relief on an ongoing basis, we reached a mutual conclusion that the risk was not worth the reward, and that was the end of that.

Fast forward to the 1990s, when everyone I knew with AIDS knew how marijuana could relieve some symptoms of the disease, and most had a supply. I was in San Francisco by then, and celiac disease pales in comparison to AIDS. I don’t even recall how legal it was for this relief; too many other issues were more important. But again, I saw its usefulness.

The Times article quotes Christine Gasparac, a spokeswoman for California Attorney General Jerry Brown, as saying his office is getting calls from law officials and advocates around the state asking for clarity on medical marijuana laws. I know that’s tough, and that the answer will in many cases be left to the courts. I also know that legalizing marijuana, whether here in woo-hoo California or elsewhere, raises a multiplicity of sticky issues.

But still. It’s a useful drug. If Big Pharma were producing and marketing it, it would probably come in a little pill that costs a fortune and would be covered by expensive insurance policies. Every governmental body in the U.S. needs money. Taxes raise money. Are there not some dots that could be connected here?

Food, Gluten & Lifestyle Changes

I have pretty much done it all, gustatorily or libationally speaking: alcoholism, teenage fad diets (well, a long time ago, but trust me, they are still the same), brief descents into the pit of fast food, and now — Celiac Disease. Celiac Disease, forheavenssakes. It’s genetic. Where has it been all these years? And who, suddenly, are all these other CD people? If you aren’t one, you probably know one.

Dietary seasons, I have come to believe, are like life cycles, the ebbs and flows of some immutable tide built into our systems. As a kid, I didn’t like oysters, an incredible stupidity when my cousins lived a short drive away on the Chesapeake Bay. Bush (the grown-up one) banned broccoli from the White House, although it is surely the side dish to oyster dinners at the tables of the goddesses; perhaps he has now gained understanding. My children, I am sorrowful to admit, grew up on Hamburger Helper and Chuck Wagon Casserole through cycles of their mother’s chaos. And here they are, fitness buffs and gourmet cooks with healthy families, looking fondly back on their culinary childhoods.

I have now entered the Celiac Age. This affliction does not necessarily correspond with the Golden Years, one of the least appealing and often inaccurate descriptives of aging. Celiac Disease is not even a respecter of age. A colleague of mine has a teenage daughter who was so severely celiac as an infant they thought they might lose her before the diagnosis was made. She now sings with a chorus that travels in Europe periodically, so Stewart can translate the diet into seven languages if you need him to.

Recent estimates are that as many as 1 in 100 Americans have CD, with a large percentage of them as yet undiagnosed. I won’t bore you with the symptoms, some of which are quite gastrointestinal and unpleasant; mine were just sudden weight loss and anemia. But what they all translate into is you can’t eat gluten. Gluten is found in wheat, barley, rye and oats and right away you can see donuts are out. CD is an autoimmune disease, so they’re out forever. On the other hand, we should all sign up for something that can be cured through the simple act of eliminating one thing from one’s diet. And if you consider what CD people can eat: meat, fish, vegetables, fruit, ice cream, chocolate candy, meringue cookies, frozen coffee drinks…

Still, we CD people have our moments of pitifulness. My latest was in a posh restaurant up the street at which I was told that everything on the dessert menu contained gluten, because they put gluten even into their ice cream so they can make fancy little plops. They have already received my e-mail about that 1 in 100 business. Actually, being asymptomatic now that I’m taking all these vitamins, I could eat that loaf of bread (it belongs to my husband) over there and never know the difference. But Dr. Yeo would know. Dr. Yeo watches the lab test results and they do not lie. And in truth, I need my bones, which don’t get their calcium if I cheat.

We try not to complain. Still, having given up pies, cakes, cookies, brownies, donuts and sticky buns I did manage to regain the lost weight and another uninvited 4 pounds. There is no justice. Tomorrow: a view of risk/benefit wine drinking.