endocrinology

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Debating Vitamin D: Leading Docs Still Wrangling On Best Dose For Patients

(Suzanne Schroeter/Flickr)

(Suzanne Schroeter/Flickr)

The message on vitamin D is pretty clear if you talk to Dr. JoAnn E. Manson, M.D., chief of the preventive medicine division at Brigham and Women’s Hospital in Boston, who is leading the largest clinical trial in the world investigating the potential health benefits of vitamin D. It boils down to this: Curb Your Enthusiasm. At least for the time being. Even in the midst of a hellish winter when you may be tempted to take an extra dose of the so-called “Sunshine Vitamin” for a boost.

In a commentary piece published this week in the Journal of the American Medical Association, Dr. Manson urges caution. She says that even though the public has become smitten with vitamin D, its growing popularity has led to mega-dosing that’s not backed by the current evidence. “More isn’t always better, more is sometimes worse,” Manson said in an interview. “We don’t yet have the answers, so we shouldn’t make assumptions.” But, she adds, in a couple of years, gold-standard evidence on whether higher doses of vitamin D are good for you should be out.

But get on the phone with Dr. Michael F. Holick, Ph.D., M.D., a leading vitamin D proponent, endocrinologist at Boston Medical Center and professor at Boston University School of Medicine, and you’ll get a totally different, but equally clear message. Vitamin D deficiency and insufficiency are far more widespread than certain professional medical groups suggest, Holick says, and dosing at higher levels shows “no evidence of toxicity.”

How did we get here and what’s a patient to do?

Here’s a little background:

In debates over nutrition, vitamin D is one of those supplements that’s drawn both passionate supporters and equally aggressive skeptics over the years. And, like coffee, chocolate and red wine, it’s often the subject of studies that can make your head spin: it’s good for you…until it’s not.

The current vitamin D guidelines from the Institute of Medicine recommend 600 IU’s per day for adults up to 70 years old and 800 IU’s per day for those over 70. “This,” writes Manson in her JAMA piece “is equivalent to 3 to 4 daily servings of fortified foods such as milk, yogurt, soy beverages, orange juice, or cereal, plus fatty fish twice per week. These amounts are adequate for at least 97.5% of U.S. and Canadian residents, she says, and it’s good even in the bleakest, darkest season, “even if you’re in Antartica in winter.” Continue reading

Caution: ‘Acceptable’ Black Women’s Hairstyles May Harm Health

(U.S. Army)

(U.S. Army)

This spring, the Pentagon issued Army Regulation 670-1, which included bans on several hairstyles worn mainly by black women, including twists and multiple braids. After a major backlash that included accusations of racial bias, that grooming policy is now under review. Here, researchers at the Connors Center for Women’s Health at Brigham and Women’s Hospital argue that this is more than an issue of racial fairness; it could also cause harm to women’s health — and disproportionately impact black women, whose life expectancy is already five years less than white women’s.

By Tamarra James-Todd and Therese Fitzgerald
Guest contributors

We are encouraged by the news that the Pentagon is reviewing the Army’s grooming policy, Army Regulation 670-1, which many deemed to be racially biased because it banned hairstyles worn primarily by black women.

Such policies set unreasonable standards for what is appropriate or acceptable in our society, and promote the idea that natural “black” hair is somehow inappropriate and unacceptable.

But perhaps most disturbing is the growing evidence that the process involved in straightening curly hair and maintaining acceptable hairstyles is harmful to women’s health, disproportionately affecting black women and making the pervasive practice of banning “black” hair styles a major health equity issue.

Nearly half of black women and girls use hair products that contain endocrine-disrupting chemicals compared to just 8 percent of whites.

The military’s previous position on this reflects a precedent that unfortunately continues to exist in corporate and private sector settings throughout the country. Labeled as “grooming” issues, companies have fired employees for wearing dreadlocks and a private school in Orlando, Florida, threatened to expel a young girl if she refused to straighten or cut her natural black hair.

The public discourse around these biased policies should not only focus on the racism they perpetuate but also on the potential harmful health outcomes and health disparities they may leave in their wake now and for future generations.

In order to conform to the standards of appearance that these policies demand, black women and girls are often encouraged to straighten or otherwise change the texture of their natural “black” hair. Unfortunately, many of the hair relaxers, oils, creams and other products used to straighten or alter curly hair contain synthetic chemicals that disrupt the normal functioning of the human body’s endocrine system, which regulates and secretes hormones.

Based on hair product labels, nearly half (49 percent) of black women and girls use hair products that contain endocrine-disrupting chemicals compared to just 8 percent of whites, which could leave blacks with higher levels of these chemicals in their bodies compared to whites.

For example, phthalates, a class of endocrine-disrupting chemicals used in hair products, are known to be found at higher levels in blacks than whites. Research led by Dr. Tamarra James-Todd at the Connors Center for Women’s Health at Brigham and Women’s Hospital has revealed that higher phthalate levels are associated with a variety of poor health outcomes that disproportionately impact black women and girls including:

Type 2 diabetes, a condition twice as common among black women compared to white women, as well as insulin resistance and other associated conditions. Continue reading

Height, Hormones And Your Child’s Mental Health

I’m short — a hair over five feet tall. And my daughters, likely, will be too.

So, at some point in parenting, I briefly entertained the prospect of growth hormones. You might have too, thinking (with Randy Newman in the background) that maybe your petite child might be just a tad better off in life with a couple of extra inches.

And then, if you’re like me, you never acted on this thought: you kept your interventionist parenting ideas to yourself and simply told your daughters how smart, strong and beautiful they are.

(David Wheeler/flickr)

(David Wheeler/flickr)

A small, but compelling, report backs up this self-censorship. Research presented at the annual meeting of the Endocrine Society, by Dr. Emily C Walvoord of the University of Indiana School of Medicine, found that otherwise healthy children treated with growth hormones may have gained those extra inches, but they paid an emotional and psychological price. The tradeoff, researchers concluded, might not be worth it.

From the abstract:

“…children treated with GH [growth hormones] had worsening emotional symptoms over time when compared to children of the same age and height who were not treated with GH. Medical intervention with daily injections, frequent clinic visits and repeated discussions about height might exacerbate instead of improve psychosocial concerns for short, otherwise healthy children. This novel longitudinal study of both the cognitive and emotional effects of GH therapy in…children raises concerns that psychosocial benefits may not be achieved despite improvements in height.”

Obviously, this type of study is not definitive, and sometimes there’s a medical necessity for such intervention. But I found its basic “Whoa” approach to drugs for kids even more interesting given the principal investigator has financial ties to drug giant Eli Lilly.

Readers, parents, have you grappled with the growth hormone question? How did you weigh the pros/cons? Please tell us your story.

Wall Street Journal: Maverick Doctor Treats Athletes’ Thyroids

(Wikimedia Commons)

(Wikimedia Commons)

 

Say “underactive thyroid” and I picture an older woman who often feels tired and has trouble losing weight, until her hormone levels are measured and she’s prescribed pills to make up for her shortfall. But today a Wall Street Journal story — U.S. Track’s Unconventional Physician — paints the portrait of a maverick doctor who diagnoses hypothyroidism in elite athletes, and has handfuls of gold medals to bolster his case. It begins:

HOUSTON—On the wall of the medical office of Jeffrey S. Brown is a photograph of Carl Lewis, the nine-time Olympic gold medalist. Lewis is one of several former or current patients of Brown’s who have climbed the Olympic podium, including Galen Rupp, who won a silver medal in the 10,000 meters at the London Olympics.

“The patients I’ve treated have won 15 Olympic gold medals,” said Brown.

Among endocrinologists, Brown stands almost alone in believing that endurance athletics can induce early onset of a hormonal imbalance called hypothyroidism, the condition with which he diagnosed Lewis and Rupp. Brown said he knows of no other endocrinologists treating athletes for hypothyroidism, a fatigue-causing condition that typically strikes women middle-aged or older.

Several endocrinology leaders had never heard of hypothyroidism striking young athletes.

“To see large numbers of young, athletic males being treated for thyroid deficiency would be certainly considered unusual, if not a bit suspicious,” said Ian Hay, a Mayo Clinic endocrinologist who has practiced for 40 years. P. Reed Larsen, a Harvard Medical School endocrinologist, said, “I can’t remember hearing or reading on [thyroid disorders in athletics] and I tend to be more of an investigator-type physician.”

Hmmm. Read the full story here and judge for yourself.