Did your doctor tell you to see your dentist before starting to take Fosamax or any other oral bisphosphonate? If not, he did you a great disservice.

An expert panel from the American Dental Association (ADA) recommends you have a comprehensive evaluation of your teeth before taking any of this class of drugs designed to prevent osteoporosis. Or, at the very least, right after you begin taking it.

In 2003, dentists started to see patients with a serious bone disease, bisphosphonate-associated osteonecrosis of the jaw (BON). In simple language, this means that the jawbone is dying.

And dental treatment involving the jawbone, such as extractions, dental implants, periodontal surgery, root canals, and even simple fillings can trigger this condition in some women taking Fosamax.

What happens is that bisphosphonates apparently reduce the blood supply to the jawbone, which inhibits the normal re-growth of bone. This dramatically slows down the healing process and increases the risk for infections.

So while Fosamax and other bisphosphonates may increase bone density in your hip, they could contribute to loss of bone in your jaw.

Originally, researchers thought that BON was caused only by intravenous bisphosphonates used in some cancer treatment protocols. While these do pose the greatest risk, we're now seeing that it occurs spontaneously in some women who take only the oral medication to prevent osteoporosis.

The symptoms of BON include pain, swelling, infection, loose teeth, gum infections, numbness, and an exposed jawbone. This condition can occur spontaneously, due to dental disease or secondary to dental therapy, in a patient who has been taking oral bisphosphonates for one year or longer.

But one huge problem is that you could feel nothing for months and be diagnosed with BON only after your jawbone has become exposed.

Increasing risk

Although the ADA says that the risk of getting BON from Fosamax is low, dentists have noticed an increase in cases since 2003. This coincides with a rising number of women who take Fosamax and other osteoporosis-lowering drugs. In 2003, more than 23 million women in this country took oral bisphosphonates! That number has undoubtedly risen in the past three years. Even a small percentage of millions of women suggests that many thousands of them may experience serious dental problems.

The ADA's reassurance of bisphophonates' safety reminds me of the hormone association with breast cancer some years ago. You may remember that we women were assured that our risk for getting breast cancer from taking hormone replacement therapy was very small. Yet I personally saw dozens of women in my nutritional practice taking hormone therapy who later contracted estrogen-receptive positive breast cancer. So have doctor friends of mine. And today, we know this risk is higher than what we had been told. A small risk means absolutely nothing if it's your health that's being compromised.

How much of a risk do bisphosphonates really pose? Enough for the ADA to recommend that dentists consult with their attorneys to design an informed consent form for their patients who are taking bisphosphonates explaining the risks associated with them!

The risk for developing BON while taking oral bisphosphonates appears to increase the longer you've been taking them. One study indicated that BON symptoms occurred after using Fosamax for three years. Another found symptoms after only one year.

Treating BON

Prevention is the best treatment. If you haven't started taking Fosamax and are considering it, have a thorough dental evaluation first. Even if you have no symptoms at all, have a baseline oral evaluation as soon as you can to rule out any necrosis of your jaw or hidden infections. Get any infection treated and healed before beginning any bisphosphonate therapy. Continue to be monitored by your dentist regularly if you decide to take oral or IV bisphosphonates.

Don't take bisphosphonates during oral surgery.

See your dentist immediately if you already take Fosamax or another bisphosphonate and have any pain in your jaw, or if you have any other symptoms of BON. It's easier to treat an oral problem when it's a minor infection than after it escalates into full-blown bone jaw-destroying disease.

Treatment usually includes both surgery and antibiotics. The damaged part of the jawbone must be cut away, and any infection has to be treated aggressively with antibiotics. Expect this treatment to be lengthy. You see, when blood vessels that feed your jawbone are destroyed, the healing process can take up to five times as long as normal. Your jaw just can't heal quickly with a decreased blood supply.

Remember that while bisphosphonates may increase bone density, there are no studies to suggest that they increase bone flexibility. Brittle bones are more predictive of future fractures than is bone density. Magnesium increases bone flexibility. Fosamax doesn't.

There are natural alternatives to bisphosphonates for osteoporosis prevention that I've written about extensively in past issues of this newsletter. Discuss them with your health care practitioner. You can find many of them in my new book, The Health Detective's 456 Most Powerful Healing Secrets. The book will be available in bookstores this fall. But you can get a copy free with your subscription renewal right now. See the enclosed insert for details.

Two New Reasons to Eat Organic Foods

Its critics maintain they're no better than conventionally grown foods, but Wal-Mart didn't listen. They decided to double the amount of organic foods on their shelves. They already sold more organic milk than any other store in the country. Now they've added organic pickles and other products to an organic line of baby food, juice, produce, and pasta sauce. By the time you read this, twice as many organic foods will be in their stores. Sounds like Wal-Mart knows more than critics of organics.

No one can deny that organic foods are better for the environment. We can't continue to foul up our soil and water supplies without upsetting the balance of nature. But are they better for you? Yes, say several new studies. They not only lower your body's toxic burden, they support your health in two other ways. Still, lowering your intake of toxins may be the singular most helpful step you can take to improve your health.

The Pesticide problem

There's no way to escape toxins. They're everywhere. And low-level pesticide exposure can lead to health problems including cancer, Parkinson's, and an impaired immune system. Our bodies all contain pesticides, and the heavier you are, the more you're likely to have. That's because pesticides are stored in fat tissues.

Pesticides that have been banned in this country are still getting into our food supply whenever we eat foods grown in other countries. It makes little sense to detoxify and re-toxify at the same time. To get rid of some of your stored toxins, you have to reduce the amount of toxins you keep putting into your body.

Recently, a group of children, aged 3-11, were evaluated for pesticide exposure from foods. When the children ate conventional food, several carcinogenic pesticides linked to breast cancer were found. When they switched to organics, these pesticides were almost undetectable.

Whether they lead to breast cancer, a lowered immune system, or just prevent you from recovering from an illness that can't be explained, pesticides affect your health. But organic foods are not only lower in harmful substances, they're higher in beneficial chemicals.

Higher in antioxidants

Antioxidants reduce free radicals. They, in turn, reduce inflammation. Antioxidants also protect against heart disease, cancer, and aging. Organic foods have more antioxidants than conventionally grown foods. A recent Swedish study compared the antioxidants in organic vs.The book will be available in bookstores this fall. But you can get a copy free with your subscription renewal right now. See the enclosed insert for details. non-organic strawberries. Both vitamin C and the total antioxidants were highest in the organic berries.

More recently, Italian researchers compared the antioxidant levels of both organic and non-organic oranges. The organic oranges had significantly higher amounts of antioxidants. The researchers then made extracts from both. Once again, the organic fruit had higher amounts of several different antioxidants, and higher total antioxidant activity.

A surprising bonus

But there's more.

Organic foods may not only protect against cancer. They may be a new way to help fight cancer. Researchers in the Swedish study made extracts from organic and non-organic strawberries. Then they tested these extracts against colon and breast cancer cells. The organic extracts reduced the proliferation of both types of cancer cells. Scientists believe there's a synergistic effect between vitamin C and other cancer-fighting antioxidants.

Strawberries are one of the most heavily sprayed foods you can eat. While the toxins in conventionally grown strawberries may contribute to cancers, it looks like organic strawberries help fight cancer in a dose-dependent way.

What about taste?

Do organic foods taste better than those that are conventionally grown? Some people insist that they do, but the jury is still out. One study found that people preferred drinking organic orange juice, but couldn't tell the difference between organic and conventional milk. And taste is subjective. I know people who insist that organic tomatoes always taste better than those that are conventionally grown. But last year we grew a variety in our organic community garden that was tasteless. Variety has a lot to do with taste. So for now, the superior taste of organic foods is an individual preference.

Always wash organic foods well

The biggest problem I see with organic fruits and vegetables is that they tend to have more bacteria and molds when they're grown on soil that has been amended with manure. This can pose a problem to anyone with a suppressed immune system.

Fortunately, the solution is simple: water. An organic lettuce mix had more microorganisms than a non-organic mix — until they were both washed. Then, they came out with the same counts. You can either wash your produce in water, or, if you prefer, with one of several products designed to clean fruits and vegetables found in many health food stores and supermarkets. When I researched them years ago, I found they really did remove pesticides and bacteria from the surface of produce.

What to Do When Western Medicine Is Not an Option

Before I left for a two-week vacation in China, I was warned by numerous people, "Be very careful. You don't want to get sick there. Chinese health care is not up to par with the U.S."

So I packed a wide variety of supplements, homeopathic remedies, and antibiotics just in case I should need them. The first day of our trip, one of our group — a veteran world-traveler — mentioned that if you get sick in China you'd better watch out. They don't have a lot of sophisticated drugs. You're likely to be given roots and herbs instead. She wasn't happy about this. I was. I know and have experienced the benefits of Oriental medicine.

Four days later, when my legs became painful and swollen from the heat and humidity, I was glad I was familiar with and open to Chinese medicine. It was probably just water-retention, but nothing in my arsenal of medications was appropriate to treat it. I told our tour leader, Richard, that I needed to see a doctor. I didn't know at the time that there was no doctor in the vicinity who practiced Western medicine. Richard made an appointment for me with Dr. Liu, a doctor of Oriental medicine, and served as our interpreter. I was excited. I've had acupuncture treatments in the U.S. for decades and responded well to them. Now I was about to be treated by a doctor who was trained exclusively in China.

Although Dr. Liu spoke no English, and my Chinese was limited to a few phrases, I found her to be a caring and knowledgeable doctor. She asked Richard to explain to me that she was confident that acupuncture would help.

"I know it will!" I answered. "I get acupuncture treatments often at home. I love acupuncture."

So Dr. Liu began to give me a 45-minute treatment that included acupuncture, massage, cupping, and moxabustion. It was one of the best treatments I had ever had. My legs began to look normal after a few hours. The next morning the swelling had disappeared.

There are many roads to health

In this country, we take a diuretic for water-retention, but there are other methods that work as well, if not better. A diuretic acts on the symptom — edema — but it doesn't address the cause. Oriental medicine looks at illnesses as being caused by blocked energy. In my case, to the kidneys. By inserting tiny needles, or gently directing heat from a burning herb (moxa) into specific points, or gates, any blocks causing this stuck energy can be removed. I was familiar with specific acupuncture points, so I understood why Dr. Liu chose the particular points she treated on my legs.

Cupping is another method used to move stagnant energy. Here's how it works: The oxygen in small glass cups is removed with heat from a candle, and the cups are then placed on various parts of the body. The gentle suction from the cups increases circulation and decreases stagnation. In my case, the cups were placed over my kidneys.

Then there's massage — one of three important aspects of acupuncture (needling and nutrition are the others). Massaging specific areas on the body in particular directions also helps remove stagnation, allowing the body to heal itself.

After her treatment, Dr. Liu instructed me on some self-massage techniques that included foot reflexology. And she explained the importance of drinking large amounts of water, something I knew and had ignored. Insufficient water intake had contributed to my problem.

At the end of our session, Dr. Liu charged me for only half of the treatments. Her generosity was an example of how we were treated throughout China by all of the Chinese people we met.

Take the opportunity to experience more

Imagine what it would be like to be in need of medical attention in a foreign country and being unable to communicate directly with a doctor. Would you be eager to experience something from a practitioner well versed in an alternative kind of treatment? If you were more familiar with the treatment, perhaps you'd be more at ease.

I usually travel with a bag-full of "stuff" to help keep my traveling companions and myself healthy. But I'm also willing to consider options because I'm familiar with many other modalities. Whether or not you travel internationally, I'd like to suggest that you expand your horizons and consider other forms of healing.

Each culture throughout the world has its own methods of treating illness. Some of them may appear to be primitive to us at first, like herbal medicine. But that doesn't mean they won't work. After all, many drugs are synthetic versions of compounds found in plants. When you have a simple problem like water-retention, heat exhaustion, or sore muscles from over-exertion, local doctors in a foreign country — or here — may have an answer you've never considered that can work safely and well. Massage or an herb tea may be just what you need. So open yourself up to other possibilities. Not only in another country, but here, as well.

There's much more available to you than Western medicine. In addition to acupuncture and other aspects of Oriental medicine, there's also osteopathic and chiropractic manipulations, foot reflexology, homeopathy, herbal medicine, nutritional supplements, massage, acupressure (stimulating points without needles), hypnotherapy, and much more.

It's an incredible experience to try healing methods from another culture. You may find they work beautifully. And, who knows? If you're really fortunate, you may be treated by someone as knowledgeable and compassionate as Dr. Liu.

References are available at www.womenshealthletter.com.

Health Detective

Toxic Chocolate

With all the media attention surrounding the health benefits of flavonoids in chocolate, no one is talking about how toxic conventional chocolate can be.

Most of our cocoa beans come from Brazil or Malaysia. Women in Brazil are hired to spray cocoa trees with pesticides. These chemicals are so toxic that they frequently cause birth defects. The women must often show proof of sterilization before they're allowed to do this work.

Conditions are no better in Malaysia. Eighty percent of the people who spray cocoa trees are women who put pesticides and herbicides (such as paraquat) in pumps they carry on their backs. They often mix these by hand and blow out any blockages in the sprayers with their mouths. The workers rarely wear any protective clothing other than occasionally rubber gloves (although U.S. safety regulations suggest protective clothing, respirators, goggles, and gloves), so the deadly chemicals drip over them as they work.

These women know what they're doing because drinking pesticides is the most popular way of committing suicide in these countries. And paraquat, an herbicide used to kill weeds around cocoa trees, is responsible for more deaths than any other weed killer. Why aren't these chemicals banned? Because they produce more cocoa beans. Although the Malaysian Health Minister has asked plantation owners to improve the health conditions of their workers, the Minister of Agriculture is not willing to ban chemicals that are cheap and effective.

A very small percentage of today's chocolate is organic. It's expensive to produce, but it doesn't contain the toxic chemicals found in ordinary chocolate. One British chocolate company I contacted, Green & Black's, gets cocoa grown in Togo and Belize. When Hershey's helped fund a program to plant hundreds of acres of cocoa trees in Belize, paying $1.75 a pound for the beans and suddenly dropping the price to 55 cents a pound, this company stepped in and helped re-form the cocoa growers into an organic collective that could again make a living from a product that was not poisoning them. That, and its taste, makes Green & Black's my favorite organic chocolate.

Ask Dr. Nan

Q: I noticed that PectaSol Chelation Complex contains magnesium stearate as a binder, and have heard that it is not a healthy ingredient. Some supplement companies and doctors are warning people about this. Is it safe or not? — E.W., Santa Fe, NM

A: Magnesium stearate is a substance used as a filling agent and lubricant in the manufacture of some drugs and nutritional supplements. It is considered to be completely harmless.

A researcher in the field of nutritional supplement manufacturing explained to me how and why magnesium stearate is safe. I hope this explanation is reassuring to you.

We certainly know that magnesium is safe. In fact, it's one of the most important minerals you can take. Stearate is safe, also. It is, in fact, stearic acid, a fatty acid that your body converts to oleic acid, an unsaturated fat. Stearic acid is found in evening primrose oil, meat, and various cooking oils like olive, corn, and sunflower. In fact, all of these sources are higher in stearic acid than in the PectaSol formula you mention. Two tablespoons of olive oil have about as much stearic acid as a full bottle of PectaSol.

I don't know why some people are claiming that magnesium stearate is harmful. It's a normal ingredient found naturally in many foods in a healthy diet.

Q: I have hypertension and enjoy having a single cup of coffee in the morning. My doctor says I should avoid all caffeine. Do I have to give up this one little daily pleasure? — J.G., e-mail

A: Not if you believe a large study published in the Journal of the American Medical Association (November 9, 2005). It looked at the association between caffeine and hypertension in two huge groups of women in the Nurses' Health Studies I and II over a period of 12 years. More than 155,500 women answered periodic questionnaires on a variety of subjects associated with health. They didn't find a problem with coffee. A different beverage seemed to contribute to hypertension. And caffeine had nothing to do with it.

Here are the surprising results of this long, large study including the amount of caffeine in each beverage. Caffeinated coffee (137 mg/cup) had no effect on blood pressure, even in women who drank five to six cups a day. Nor did decaf coffee. Caffeinated tea (47 mg/cup) raised blood pressure in a few younger women in one of these studies. The problem was with colas (46 mg/cup). Women who drank either diet or sugared colas with caffeine had a highly significant increase in hypertension in both studies.

In the past, a few small experiments over a short period of time suggested that there was a connection between caffeine and hypertension. But this large study couldn't find an association. Researchers are now speculating that it's not the caffeine in colas that's the problem, but some other compound. Perhaps some day we'll be able to identify it. Until then, enjoy your morning coffee. Just stay away from colas. And keep monitoring your blood pressure just to be on the safe side. You could be one of the rare people who is ultra-sensitive to caffeine.

Winkelmayer, W.C., MD, et al. "Habitual caffeine intake and the risk of hypertension in women," JAMA, November 9, 2005.