Osteoporosis prevention should start in childhood, and there are a number of things that can be done to build stronger bones. These include encouraging children (boys as well as girls) to eat foods rich in calcium such as milk, cheese, yoghurt and fish with bones, and to take regular exercise. Sadly, many older women now suffering from osteoporosis were brought up at a time when there was little emphasis on a well-balanced diet and regular weight-bearing exercise. Many took as gospel the misguided words of the Duchess of Windsor, ‘You can never be too thin or too rich’.

More than 50 per cent of Australian women (and 30 per cent of Australian men) consume less than the recommended dietary intake of calcium. For teenagers it’s no better, with nearly a third of fifteen-year-old girls getting less than half the calcium they need, according to a national dietary survey of Australian schoolchildren aged from ten to fifteen years.

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The idea of prescribing HRT for women solely to keep them receptive to their partners’ advances is outrageous, as Germaine Greer has argued. Unfortunately this seems to have happened in the 1970s. ‘Because they desire the preservation of cosmetic youth and the unflagging libido of patients, physicians have championed estrogen [oestrogen] replacement therapy in the hope of attaining a maximal quality of life for their patients,’ the US medical researchers Dr Harry Ziel and Dr William Finkle said in 1976. Equally objectionable were the pharmaceutical advertisements of this era that promoted HRT ‘for the menopausal problems that bother him the most [our emphasis]‘.

Yet there are many middle-aged and older women wanting to have genital sex with partners who feel the same. If the way their vaginas feel prevents this, they should consider the use of substances including oestrogen, either as a cream, tablet or pessary applied directly to the vagina, as pills to be swallowed, or in some other form. The crucial difference is that they understand and accept the therapy, with all its pros and cons, and use it to meet their own needs rather than the needs of others.

If you are wondering whether the direct application of oestrogen to the vagina has identical effects to that of oestrogen by pill, patch or implant, the answer is a conditional yes. Oestrogen-containing vaginal creams have the disadvantage of being messy, but they do increase lubrication and vaginal tone, and they may improve libido and feelings of wellbeing. They also impinge minimally on other body tissues when used as directed, thus reducing the chances of unwanted effects.

Testosterone implants to increase energy and sexual appetite are an appropriate option for some women. These can be used on their own or in addition to oestrogen.

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To make a significant impact on the risk of osteoporosis, you will require HRT for at least ten years, ideally starting therapy within about two years of the last menstrual period. It does appear that the longer a woman remains on HRT, the stronger her bones. Another factor to consider, if you are a smoker taking oestrogen to avoid osteoporosis, is the importance of quitting because smoking reduces oestrogen’s protective effect on bone.

Various studies show a 50 to 75 per cent reduction in the risk of fracture from osteoporosis after extended HRT. An adequate hormone dose is vital. The minimum daily oral dose of oestrogen required for prevention of bone loss is 0.625 mg of Premarin, 1.25 to 2.5 mg of Ogen, 2 to 4 mg of Progy-nova, or 0.02 mg of Estigyn. Some women prescribed HRT primarily for symptom control have more than an adequate dose to maintain their bone strength. In other cases, the prescribed dose is insufficient to prevent bone loss: some women have a low tolerance of hormones and are on the minimum, others smoke or have dietary imbalances that interfere with oestrogen uptake, and others again have such a fast rate of bone loss that even maximum hormone doses cannot keep pace.

For example, Premarin protects bones in most women at a dose of 0.625 mg daily, but studies tracking women’s bone density over a number of years indicate that 15 per cent need twice this amount to gain protection. Yet other studies show that half this amount, as little as 0.3 mg of Premarin a day, is effective if combined with a daily intake of 1500 mg of calcium. Women whose menopause occurred many years previously may need to start at a lower hormone dose to minimise possible unwanted effects like breast tenderness. Dosage levels may then be increased gradually if prevention of bone weakness is a major reason for taking HRT.

Oestrogens can be used in pill, implant or skin patch form. If you still have your uterus you will need to take a progestogen as well to protect its lining from an increased risk of cancer. The chances of this cancer developing are about one in 25 000 for women before menopause, and one in 1100 for women not on oestrogen after menopause or women with a uterus receiving both oestrogen and progestogen. The risk of endometrial cancer for women with a uterus who use oestrogen alone in pill, patch or implant form for five years or more after menopause increases to approximately one in 200. However, with an adequate dose and duration of progestogen, the risk falls again to one in 1100 or less.

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During the fertile years progesterone is produced within the ovaries as a result of ovulation. It dampens down oestrogen’s effect on the growth and thickening of the endometrium, the lining of the uterus. When the levels of oestrogen and progesterone decline towards the end of the menstrual cycle, the endometrium is shed as a menstrual bleed. The term progestogen is used to describe any manufactured substance that has similar chemical effects on the body to those of progesterone.

PROGESTOGENS USED IN HRT Although all the progestogens used in HRT have properties similar to those of progesterone, the body breaks them down in rather different ways. They are all more powerful than progesterone too, having more pronounced effects when given at doses comparable to the levels of progesterone found in the body. (For a detailed description of the varieties of progestogen used in HRT see page 176.) The main reason for including progestogen in HRT is to protect the endometrium, the lining of the uterus. If the endometrium is exposed to constant oestrogen without progestogen, the endometrium may become

too thick. This condition is known as hyperplasia, which occasionally develops into cancer.

It follows that, if you have had a hysterectomy, endometrial hyperplasia is not something for you to be concerned about. The way is clear for you to use an oestrogen-only form of HRT. This seems to be an option with few side effects or risks, but you must be carefully monitored.

Some women cannot tolerate the progestogen component of HRT as it can produce unwanted results such as breast tenderness, increased blood pressure, mood swings, depression, acne, backache, bloating and abdominal cramps. These symptoms resemble those of premenstrual syndrome. ‘I hate progestogen,’ said thirty-year-old Mardi, whose diseased ovaries were removed two years ago. She has since tried various combinations of oestrogen and progestogen, partly because of her mood changes. ‘The progestogen makes me snappy and irrational and I get fed up with it. Some months I’m a bit naughty: I don’t take the progestogen at all.’

At those times when Mardi has both progestogen and oestrogen she has regular withdrawal bleeds, that is, bleeding for a few days at a predictable time of the month. Withdrawal bleeds are usually indistinguishable from short menstrual bleeds (they tend to be two to four days long) but, of course, they come about in different ways, being induced by hormone therapy. If you are taking progestogen you may also experience unpredictable bleeding, which is known as breakthrough bleeding. Understandably, such withdrawal bleeds and breakthrough bleeds deter some women from embarking on HRT or persevering with it, since an advantage of menopause for many women is an end to the bother of tampons and pads. A number of women appear to be happy to continue having withdrawal bleeds. The particular combination and timing of oestrogen and progestogen in HRT have a major influence on whether and when women experience bleeding.

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George was in his mid-forties when his joints began to feel painful and stiff. The affected joints were red and swollen and he also felt feverish at times. After running some blood tests, his doctor diagnosed rheumatoid arthritis. George was a landscape gardener, who had always done a lot of the hard physical work himself, and the gradual loss of mobility affected his business badly. Although the drugs he was given helped a little the disease gradually got worse and by the time he was 50 simply getting out of bed in the morning was difficult. His shoulders were so stiff that he could not comb his hair or put on a tie, and gripping a tea mug was difficult because of the stiffness in his hands. At this stage, his doctor suggested that George might like to try an elimination diet, which was said to help some people with rheumatoid arthritis. She told him to cut out grains, dairy produce, eggs, citrus fruit and other

common foods, but this produced little improvement. In fact, his symptoms got slightly worse in the first few days, but he stayed on the diet anyway. By the end of the second week he began to feel better in himself, and some of his joints were less swollen and painful. Over the next week, things improved noticeably every day, and after three weeks he was almost back to his former good health. When he tried reintroducing foods, George found that milk, potatoes and yeast triggered off his joint symptoms again. By avoiding these he is fairly well, although he still has a few aches in his joints and his shoulders are a little stiff. He suspects that some of the foods he is still eating may be at the root of this, but rather than restrict his diet further he relies on low doses of an anti-rheumatoid drug to reduce the inflammation. His gardening business is expanding again and he feels better than he has done for years.

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Many years later I was living among the carefree inhabitants of a small South Sea island. I was curious about the cause of their happiness and found that they subscribed to gratitude without thinking. They never forgot to express gratitude for all the many little and greater joys the Creator gave them day by day. Without tiring they felt grateful for the sunshine, the warmth, the blue sea with its abundance of food, the coconut trees, various other fruit trees and many other things. Gratitude not only transmits warmth, it also produces contentment, which in turn awakens happiness. It stimulates the endocrine glands, promotes good circulation, and thus influences the metabolism for better health, with all the important body functions being activated. The German poet Schiller once described joy as an animating spark, believing that joy in fact makes the world tick. With two world wars behind us, and all the subsequent wars, we realise that the spring in the world clock can be equally well wound by destructive powers. However, since these powers are never able to rob us entirely of the divine gifts of light, sunshine, air and others, we have reason enough to express our joy about them daily.

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When a young person first starts smoking, how unpleasant he or she usually finds it. To be honest, it is far from enjoyable. On the contrary, the young person must fight all the way through nausea, disgust, nervous shock, dizziness and a general feeling of natural aversion in order to overcome the ill effects the learner smoker is subject to.

As with all harmful practices, the person trying to enjoy smoking insists that the pleasure outweighs the risks involved and that it can’t be all that bad anyway. He may even point to his grandfather who, although an inveterate smoker, lived to be eighty years or more. It is true that a person with a strong constitution may be able to stand poisons without any apparent damage to his health. However, if there are people who can take drugs and grow old in spite of doing so, that does not mean that everyone has the same strong powers of resistance. On the contrary, millions of people have died prematurely because of tobacco or nicotine, narcotics, alcohol and other drugs.

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Another product for daily use is the seasoning sauce Swiss Alpa-mare, also called Kelpamare. This product is made from the juices of fresh vegetables and herbs and is also manufactured by means of a special fermentation process. For this purpose suitable herbs are fermented in accordance with old Chinese and Japanese methods, using edible fungi (mushrooms), which develop in an absolutely natural organic way. When fermentation comes to an end we have a seasoning sauce similar to the soy sauce found in Japan and China.

Instead of having to extract the salt using hydrochloric acid, which destroys a number of vital elements, the natural method makes for quite a different product that is far superior in taste and content to the products made according to our old-fashioned methods. Furthermore, Swiss Alpamare (Kelpamare) also contains seaweed, which is added during the manufacturing process and therefore integrally mixed and blended with the herb extracts.

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It has always pleased me when, here and there on my travels, I have been served with bread as it was once made in my own country – from the whole grain. I found that the North American Indian women prepared their bread from grain that they had ground themselves with a stone mill. Arabs, Bedouins and other African people still keep up the custom of making their bread from wholegrain cereals. Some use wheat, some rye, others barley and each of these breads tastes good and provides the body with all the goodness of the whole grain, because whole cereals contain most of the elements needed to build up the organism and maintain it in a healthy condition. They abound in minerals, enzymes, vitamins and other essential factors.

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I have often been asked how much an adult should eat. Should we adopt the system of calories as a measure of our need or is there another way of knowing how much food will prevent us from becoming undernourished?

Like most systems, reckoning in terms of calories is not the perfect system, and should therefore be considered as a purely theoretical guide. An exact method of calculation is not possible because an individual’s need for food depends upon so many different and constantly varying circumstances, so that the adoption of a strict and definitive system can do more harm than good. True, a person’s body weight or build plays an important part in determining how much food one should eat. Theoretically speaking, a stout and tall person should require more food than a slim one. It is possible, however, that the slim person has a more vigorous nature and burns up more energy than the fat, placid, calm person and in this case our theory already ceases to be valid. A happy, jolly type needs less food than a discontented, unhappy person, because cheerfulness promotes better glandular function and consequently better digestion and improved assimilation. The happy person gets more out of his food. There is much truth in the old saying that one does not live on what one eats but on what one digests.

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