Health Wanted: Menopause

The Episode

Ooh you ever get all hot and sweaty? You get that itch? You know you’re just gonna be up all night? Because you’re going through menopause.

In this episode of Health Wanted, from WABE and the Rollins School of Public Health, Laurel Bristow digs through the controversial history of menopause hormone therapy (MHT): 

• How does MHT help people going through menopause?
• What kind of risks come with MHT?
• Are there alternatives to MHT?

Listen now

The Listener Questions

I listened to your sugar episode and was delighted to hear Dr. Stanhope say aspartame is fine. Where did all the aspartame hate come from to begin with? I love Diet Coke and I’d rather die than stop drinking it but I was just curious because people keep talking about aspartame and cancer.

I hear you! I too am a Diet Coke girlie. And we are not alone! In fact, one CDC study found about a 5th of the U.S. population consumes a diet drink each day. And at a time when added sugar is coming under more scrutiny in our diets, a sugar-free option like Diet Coke SHOULD be the preferred alternative, right?

Diet beverages like Diet Coke are often marketed as healthier because they contain no added sugar. Instead, the sugar is replaced with artificial sweeteners, like aspartame, that provide you with all of the sweetness and few to none of the calories.

Aspartame has been widely used in foods and beverages since the 1980s. In addition to diet drinks, aspartame can be found in chewing gum, ice cream, yogurt, cereal, toothpaste, cough drops, and even some chewable vitamins.

The FDA first approved the use of aspartame in food and drinks in 1974, and with their approval established a safe level of consumption based on long-term toxicology studies. This approval, however, was met with objections to its safety, citing potential links to cancer, leading scientists to conduct hundreds of studies on aspartame’s safety over the next nine years. 

Through these years of research, in 1981 the United Nations, Food and Agriculture Organization, and the World Health Organization established an acceptable daily intake of 40 mg/kg of body weight for aspartame, and the FDA concluded with reasonable certainty that aspartame does not cause cancer.

That’s not to say that concern about aspartame went away after 1981. In fact, the FDA and other global health organizations have been continuously evaluating the safety of aspartame, so much so that aspartame is one of the most studied food additives in the human food supply. And, as we love comparing our food regulations to those abroad, I wanted to note that scientific authorities like Health Canada and the European Food Safety Authority also consider aspartame to be safe at current use levels.

In 2023 the WHO decided to classify aspartame as *possibly* carcinogenic to humans, basically because there wasn't strong enough evidence to conclusively say that it does or does not pose a risk.

As we've discussed in previous episodes, the dose makes the poisons and in the case of Diet Coke, the WHO still concluded that 40mg/kg was an acceptable limit below the potential threshold for any potential harm.

If a 12-ounce can of Diet Coke contains around 200mg of aspartame, a 150-pound adult would need to drink about 13 cans a day to exceed the limit ... which I know some of you do. So don’t worry too much about aspartame and definitely keep it under a six pack a day.

I saw a post on Instagram that said if you don’t want to give your baby the vitamin K shot at birth you can do oral vitamin K which is better for them and works just as well. Is that true?

First let’s talk for a second about why we give vitamin K shots to begin with. Vitamin K is one of those vitamins your body can’t produce enough of on its own. It needs to be supplemented by eating foods like leafy greens, meat, dairy and eggs that contain it.

Babies have very little of it when they are born and up until they start introducing solids. Vitamin K is essential to create blood clots. Without it, babies are at greater risk of uncontrolled bleeds, either externally, or internally, where they are harder to see.

These sorts of bleeds can happen any time before babies start eating solids, but babies who do not get a vitamin K shot at birth are 81 times more likely to develop Vitamin K Deficiency Bleeding between the ages of 1 week and 6 months: a time when the risk of serious adverse outcomes are higher, because the bleeds often start in the brain.

These sorts of bleeds are pretty rare, but still happen, and the vitamin K shot takes that risk to nearly zero. Vitamin K shots give infants a dose of the vitamin that’s stored in the liver and released over time to protect them.

Oral doses are available but babies don’t absorb vitamin K well through their intestines.
So the dose isn’t consistent, and it takes multiple administrations. The most effective oral administration plan is 2mg at birth and then 1mg every week until the infant is 3 months. And still, one shot of vitamin K at birth is still more effective.
It’s also important to note that there is no FDA -approved oral version of vitamin K for infants in the U.S. 

You may have heard that the vitamin K injection has a “black box” warning, reserved for medications with serious risks of adverse outcomes. But this warning is largely based on accounts of adults having adverse outcomes when they were getting IV infusions of vitamin K, not on infants getting a single intramuscular injection of 1 mg of vitamin k.
We’ve been using newborn injections of vitamin k since 1961. It is a very safe and effective way to prevent uncontrolled bleeds in babies. Unfortunately, the rates of people declining the vitamin K shot seem to be increasing, putting infants at unnecessary risk.
So, while some countries (not the U.S.) have an option for oral vitamin K, the shot is safe and much more effective.

I heard that some printers that use toner are effectively burning plastic to get the toner to stick to the paper. Is this true? Is this safe for us to be around?

Oh the printer. Despite living in a digital age we are all, somehow, still forced to fiddle with print settings and shake our fists at the sky trying to get them to connect over wifi.

There are two ways printers work: by using either ink or toner to produce prints. Unlike liquid ink, toner is a fine powder made from granulated plastics (uh-oh), and relies on heat to fuse the toner onto the paper to produce a print.  
Studies investigating the impact of toner on indoor air quality date back to the early 1990’s, and have documented the significant numbers of nanoparticles that are emitted during their use. 

Nanoparticles, as the name suggests, are tiny particles of matter that measure less than 100 nanometers in diameter. To put their size into context, the average strand of human hair is about 70 micrometers in diameter, making it 700 times larger than the largest nanoparticle. The size of these particles is important: the smaller a particle is, the easier it is to enter deep into your lungs and even your bloodstream when inhaled, and the greater the risk it poses to your health. 

Most recently, a study of the impact printer-emitted nanoparticles generated from toners during printing has on health, found that the exposure was associated with cardiovascular and inflammatory diseases as well as the activity of genes associated with cardiovascular, neurological, and metabolic disorders.

But this study was, of course, conducted among rats who were placed in a chamber with a printer running nonstop for five hours a day for 21 days.

For those of us who don’t frequently find ourselves trapped in a room with a continuously running printer for hours on end, the levels of nanoparticles from toners that we are exposed to are likely significantly lower than those used in this study.

But, nonetheless, this study is a start to help us understand the risks to health. Other research into the effects of short-term exposures to printer-emitted nanoparticles observed, among healthy adults, mild inflammatory responses but no genetic damage.

Epidemiological data also suggests that in current work environments, you’re unlikely to be inhaling enough toner dust to really hurt your respiratory system.All in all, you shouldn’t be huffing the toner-based printer in your home or office, but we don’t yet have enough evidence to suggest casual use is that impactful. If you are worried, I suggest distancing yourself from printers that are actively printing, handle toner carefully, and, heck, save a tree and avoid any unnecessary printing.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
• Watching on WABE's YouTube channel