Q. Our readers will be very interested in life enhancement, including maintaining the libido. It's healthy to be active sexually.

A. Like exercise, sexuality has a lot of health benefits as well. Many compounds are thought to be members of that class of life-extension or cognition-enhancing medicines. There are medical organizations assembled to research and bring this information to the forefront. The American Academy of Anti-Aging Medicine is one. A newsletter called Smart Drug News, published by the Cognition Enhancement Research Institute in Menlo Park, California, focuses on research into cognition-enhancing medicines, often called "smart drugs." What we don't realize in this country is that elsewhere in the world, patients have access to many medical compounds and pharmaceuticals that can actually increase intelligence and cognitive capacity. Had I known about this when I was going through medical school, Gross Anatomy would have been much easier.

Q. My mother gave my brother okra, which for whatever reason was considered a brain food. When he was at home, she would cook okra soup. He did excel and was at the top of his class at Annapolis. What are some brain foods?

A. One example that I will mention is a compound called dimethylaminoethanol (DMAE). You have probably heard the story that eating sardines makes you more intelligent. There might be some truth to this observation. Sardines have a higher level of this DMAE. In the past, DMAE was a prescription medicine. It is now available over the counter. Many people notice that DMAE helps improve their memory, visual-spatial skills, cognitive awareness, verbal ability, and so forth.

Q. If readers wanted to know more about these subjects, how would they subscribe to the newsletter?

A. They do have a website [www.ceri.com/sdnews.htm]. The newsletter is called Smart Drug News.

Q. We were pretty excited about Evista, Eli Lilly Company's recently approved drug to prevent osteoporosis. It seemed to be a good alternative for women who can't take estrogen, yet want to make sure that they don't have a hip fracture before they are 80 years old. Osteoporosis is a major problem. Maybe how much calcium you took as a child is important in building a bank of calcium. How do you prevent osteoporosis and hip fractures?

A. Osteoporosis is, unfortunately, a big problem in this country. In addressing osteoporosis, you have to look at the individual. Dietary considerations are very important, as is the hormone status. It is less clear that estrogen contributes much to overall bone density, whereas we know that some hormones that have a more anabolic quality- -like progesterone, DHEA, testosterone, and growth hormone--will increase bone density. My first approach would be to give the patient a global endocrine evaluation: What are levels of all the hormones, not just estrogen?

But there is a common-sense element to approaching the disease as well. We can have all the hormones on board and the nutritional component-the calcium, magnesium, and so forth--in place, but if you don't have the physiologic drive to enhance bone density, you only get so far. The physiologic drive for bone is to have a load placed on it, which comes back to weight-bearing exercise. This is a tough sell for many women. When you tell them that they need to go to the gym and pump iron, some think that they will end up looking like Arnold Schwarzenegger, which really isn't the case. It's not so much that they are striving to compete in a powerlifting competition or even a bodybuilding competition. It's using the load-bearing exercise to put stress on the bone and connective tissue, and thereby increasing its strength and bone density.

Q. How do you motivate your patients to get out there and do the right kinds of exercises?

A. What I encourage them to do is to take one day at a time. Set one simple, attainable goal, such as going to the gym tomorrow and working out for ten minutes. As people make a habit of exercise, they find that the more they get involved and engaged in the exercises, the better they start to feel. They then begin to crave feeling better, as opposed to craving some of the bad habits.

Q. Do you have personal trainers who help people get on track?

A. If exercise of that capacity is a new experience, it's definitely a good idea to work with a personal trainer who can help set up a program that meets a person's individual needs.

Q. Could you tell us how you investigate a thyroid deficiency?

A. Thyroid dysfunction is very common. It is unfortunate that many patients have this problem, but it is not recognized. In my practice, I frequently see patients who say that they are cold all the time; gain weight easily; don't lose weight easily; have poor exercise tolerance, decreased libido, poor concentration, dry skin, brittle nails, etc.- -basically, a textbook description of low thyroid function.

Q. Thinning outside eyebrows?

A. Lateral margins of the eyebrows are among the observations that can sometimes be made, as is lower-extremity edema and slow heart rate. The fatigue seems to be a common issue that is associated with a deficiency of thyroid hormone. We have thyroid tests that can measure hormone levels. That would probably be an adequate screen for a majority of people. However, there are many individuals who seem to have a subclinical hypothyroid picture. Their lab tests are normal, yet they have all the symptoms that we just talked about. With these individuals, a thyroid-replacement therapy is something definitely worth trying. In my clinical experience, I find that this can change someone's life dramatically. This goes back to the issue of depression, too. There are studies now that are looking at thyroid-replacement therapy to treat depression. In many cases, it works very well. It's unfortunate that thyroid deficiency is something that is not very commonly recognized in conventional medicine.

Q. It is an underdiagnosed affliction.

A. Certainly underdiagnosed.

Q. A lot of people are now on low-salt diets, and noniodized salt is probably cheaper in restaurants and canneries than iodized salt. Are some people possibly not getting enough iodine in their diets?

A. That is a real possibility. I don't think it is as common as it used to be. Goiters and iodine deficiency used to be endemic in some areas of the country many years ago. However, there are situations in which individuals have a higher-than-usual metabolic need for certain nutrients, and there are tests that determine this. Iodine is no exception. Iodine supplementation, itself, can be a very effective treatment for fibrocystic breast disease, certain problems of ovarian function, and so forth. We tend to think of iodine as only functioning for the thyroid, but actually it is also used in many other areas of the body. The ovaries are a good example. If I remember my physiology correctly, ovaries are the second most prolific users of iodine, as far as organs, in our body.

Q. In men, the prostate uses zinc. Where is the zinc pump in women?

A. What we know is that prostate tissue tends to have a lot of zinc in it. Exactly what the role might be is a little less clear, but we do know that zinc is involved in the hormonal regulations of the male androgens. It is also involved with hormonal regulation in women. Like many of the other trace minerals, we don't know all of the activities and how zinc is used. There are so many trace minerals- -such as vanadium, strontium, boron, and so forth--whose activities are less well defined, partially because we need such small quantities of these nutrients to maintain normal health that it is very difficult to delineate where it is functioning in the body.

Q. There is a Purdue man who has good evidence that for some people, copper is able to help with their arthritis. A. Copper bracelets do help a lot of people with their arthritis. Using a copper supplement can be helpful for some people. There is some research that would suggest that antiinflammatory drugs commonly prescribed to treat the pain associated with arthritis only work as they bind to a copper ion in the body. Copper seems to play a big role in our bodies. We know that it is used as an enzymatic cofactor for cross-linking collagen, which adds structural integrity to our connective tissues, circulatory system, and any place collagen is used. Although copper has many benefits, we don't want to overdo it, either, because copper is thought to be one of those ions like iron that generates free radicals. It's an example of balance. Everything is best in balance. If you get too low, there are problems. If you get too high, there are potential side effects as well.

Q. I have always wondered why they didn't put copper in the soles of their shoes where it wouldn't show, instead of wearing copper bracelets around their wrists and letting their skin turn colors.

A. That's a new marketing concept that could go over big.

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