2160 Tuesday 24 April 2001 ET Keep a cool head about hot flushes

'Natural' answers to the menopause, dealing with worsening eczema, mild anaemia and sore feet, plus cholesterol levels in nuts, by Dr Sarah Brewer

DEAR DOCTOR - I have been sent information about a wild yam cream containing natural progesterone. Is it as effective as "normal" HRT in reducing menopausal symptoms and protecting against osteoporosis?

The progesterone in these creams is synthetic, in that it is made in the laboratory from a steroid precursor (diosgenin) extracted from wild yam. It is described as "natural" as it has the same chemical structure as progesterone naturally found in the human body. At the menopause, levels of both oestrogen and progesterone fall, but menopausal symptoms are largely considered to result from lack of oestrogen. When applied to the skin, only small increases in circulating progesterone levels are seen, as the hormone tends to accumulate in subcutaneous fat cells; even so, many women seem to find the creams helpful.

In one study of 102 women, 83 per cent using progesterone cream for one year reported improvements in hot flushes, compared with only 19 per cent on a placebo. No difference in bone density was noted between the two groups. A previous study did show as much as a 10-25 per cent increase in bone mineral density after 12 months' treatment, but in this case women were also advised to include green, leafy vegetables in their diet, to exercise three times a week, reduce consumption of cigarettes, alcohol and red meat and to take supplements of calcium, vitamin D and vitamin C.

Some also took oestrogen for three weeks a month if appropriate, although the efA) are reduced in cell membranes, which might make it easier for bacteria to adhere. It's worth taking an EFA supplement such as evening primrose, flaxseed or omega-3 fish oils to see if this helps - it can certainly reduce itching and scaling but may take a few months to have maximum effect.

As the eczema is worsening, your doctor might consider referring your son for specialist advice on other treatment approaches, including emollients under occlusive bandages at night. Identifying environmental or dietary allergens to which he is sensitive will also help. For further advice, contact the National Eczema Society, tel: 0870 241 3604 (1pm to 4pm Monday to Friday); www.eczema.org.

Dear Doctor - I am a lacto-vegetarian and understand that nuts are high in cholesterol. Is this true?

Nuts do not contain pre-formed cholesterol. As the liver usually produces at least seven times more cholesterol in the body than that obtained pre-formed in the diet, cholesterol intake is no longer thought to be an important risk factor for coronary heart disease. As a vegetarian, you are likely to obtain plenty of the antioxidants (such as vitamins C and E, carotenoids and selenium) needed to protect circulating cholesterol from oxidation.

Dear Doctor - As a policeman, I'm on my feet a lot, and have developed a pain that my GP has diagnosed as plantar fasciitis. Can any complementary treatments reduce the need to take painkillers? [This is Old Git's foot problem]

Plantar fasciitis is an overuse syndrome leading to inflammation of the plantar fascia (connective tissue layer) where the sole of the foot joins the heel bone (calcaneus). This causes pain mainly under the heel in the midline. Ice packs, ultrasound, physiotherapy, orthotic supports and rest are often helpful, and you may need to have your work duties temporarily reassigned to clerical tasks, perhaps, to help the condition improve.

After the acute pain has settled, a chiropractor can manipulate the local joints, plantar muscles and fascia to relieve pain and help to restore normal myofascial movement. To find an accredited practitioner, contact the British Chiropractic Association, tel: 0118 950 5950 (www.chiropractic-uk.co.uk).

Acupuncture is another approach worth considering - in one study of 18 people with plantar fasciitis whose symptoms had not improved after an average of 25 months of conservative treatment, a significant improvement was seen within four weeks of acupuncture therapy. To find a qualified acupuncturist, contact the British Acupuncture Council, tel: 020 8735 0400; www.acupuncture.org.uk; or the British Medical Acupuncture Society, tel: 01925 730727; www.medical-acupuncture.co.uk

Dear Doctor - I have mild anaemia after heavy periods and need to take iron supplements. I've found them constipating, and wonder if there is a more natural source.

Studies suggest that up to 20 per cent of menstruating women are iron-deficient, although it is only severe enough to cause anaemia in less than 10 per cent. Iron intakes can be boosted by eating iron-rich foods such as shellfish, red meats, sardines, wheatgerm, wholemeal bread, egg yolk, green vegetables and dried fruit. The form of iron found in red meat (heme iron) is up to 10 times more easily absorbed than non-heme iron in vegetables, and overboiling vegetables decreases their iron availability by a further 20 per cent.

Vitamin C (found in citrus and berry fruits, blackcurrants, kiwi fruit and green leafy vegetables) increases the absorption of inorganic (non-heme) iron by keeping it in the more easily absorbed ferrous form. Phytate fibre, calcium, tea and coffee decrease iron absorption, so iron supplements are best taken on an empty stomach unless it causes irritation. Ferrous fumarate or ferrous gluconate are usually better tolerated and less constipating than ferrous sulphate. Iron-rich spa water is available as a liquid iron tonic (Spatone Iron+); this iron is at least twice as easily absorbed as that found in food and solid supplements.

Floradix Liquid Iron Formula and tablets provide iron-rich yeast combined with fruit concentrates to improve absorption. The supplement is usually well tolerated - and may be taken in pregnancy - but a yeast- and gluten-free form is also available for those with allergies. If you think you have anaemia, always seek medical advice before taking iron supplements, as the cause needs to be determined and iron supplements may mask iron deficiency.

If readers have any trouble in obtaining nutritional supplements, the Nutri Centre in London can supply them by mail order at a 15 per cent discount. Call 020 7436 5122

Letters should be sent to Dr Sarah Brewer, Features Department, The Daily Telegraph, Canada Square, Canary Wharf, London E14 5DT; fax 020 7513 2508. Letters cannot be answered personally. Before following any advice, please consult your GP. No responsibility can be taken for advice given in this column. Questions can also be sent by e-mail: drsarah@bizonline.co.uk

-- Anonymous, April 28, 2001