Medicare Advantage (MA) plans often advertise dental, vision, and hearing benefits as significant advantages over traditional Medicare (TM). However, a recent study published in JAMA Network Open by researchers from Mass General Brigham reveals that the reality does not match the promise (Cai, et al., 2025).1 Despite offering these supplemental benefits, MA beneficiaries do not typically receive more of these services than their TM counterparts, and out-of-pocket (OOP) spending remains comparable for most services. Researchers analyzed data from 76,557 Medicare beneficiaries between 2017 and 2021, sourced from the Medical Expenditure Panel Survey (MEPS) and the Medicare Current Beneficiary Survey (MCBS). The study’s goal was to evaluate whether MA plans deliver on their advertised advantages. How well were the supplemental services utilized? The study revealed that only 54.2% of MA beneficiaries were aware of their dental coverage, and only 54.3% knew about vision coverage. And the study found that MA enrollees were no more likely to receive eye examinations, hearing aids, or eyeglasses than TM enrollees. Cost-sharing structures and lack of awareness about benefits probably contribute to underutilization. How did out-of-pocket costs compare? While out-of-pocket (OOP) costs were slightly lower for MA beneficiaries, the differences were modest:
Nationally, MA plans spent $3.9 billion annually on vision, dental, and durable medical equipment. Beneficiaries themselves paid $9.2 billion OOP, while other private insurers covered an additional $2.8 billion. The study highlights a troubling inequality. MA plans receive $37.2 billion more annually from taxpayers than TM plans would have cost for the same beneficiaries. This funding is partly intended to enhance access to supplemental benefits. However, the findings suggest that these additional funds do not translate into significantly greater service utilization or reduced costs for beneficiaries. Dr. Christopher Cai, the study's lead author, points out that this raises questions about whether the increased taxpayer investment in MA is justified. "Our findings add to the evidence that this increased cost is not justified," Cai said. The findings challenge one of MA’s key selling points: better access to supplemental services. Senior author Dr. Lisa Simon emphasized that older adults and individuals with disabilities deserve more from Medicare, especially when choosing a MA plan based on advertised benefits. So the question is, "Why are MA benefits so poorly utilized?" That question was clearly answered by researchers from Mass General Brigham after they investigated and found significant deficiencies in dental coverage provided by Medicare advantage plans (Simon, Vugicic, and Nasseh, 2024, December 26).2 Despite Medicare Advantage being a privatized alternative to traditional Medicare, offering additional benefits like dental coverage, only a small fraction of plans meet quality standards. The findings, published in JAMA, raise concerns about the accessibility and adequacy of dental care for millions of beneficiaries (Simon, Vujicic, and Nasseh, 2024).3 The researchers found that only 8.4% of Medicare Advantage plans offered a dental benefit that met quality standards comparable to employer-sponsored plans, such as:
Many plans feature complex benefit structures, such as high co-pays, coverage caps, or limited inclusion of services like fillings and crowns. These complexities can make it difficult for consumers to evaluate plans during open enrollment. Regulatory oversight is obviously lacking. The researchers point out the need for stricter regulations to ensure that low-quality dental plans are not offered, thereby protecting consumers. Regulations could also mandate greater transparency, making it easier for beneficiaries to understand the scope and quality of dental benefits. With the current lack of adequate regulation, MA plans are reminiscent of bygone times when manufacturers could write ads for snake oil that promised the moon, but only delivered disappointment. References 1. Cai, C. L., Iyengar, S., Woolhandler, S., Himmelstein, D. U., Kannan, K., and Simon, L. (2025). Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021. JAMA Network Open, 8(1):e2454699. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829183 2. Simon, L., Vugicic, M., and Nasseh, K. (2024, December 26). Investigation Uncovers Poor Quality of Dental Coverage under Medicare Advantage. Mass General Brigham, Retrieved from https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/investigation-uncovers-poor-quality-of-dental-coverage-under-medicare-advantage 3. Simon, L, Vujicic, M, and Nasseh, K. (2024). Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County. JAMA, Retrieved from https://pubmed.ncbi.nlm.nih.gov/39724145/
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What, exactly, is the definition of pollution? Pollution is defined as the introduction of substances, energy, or agents into the environment in quantities or forms that cause harm or discomfort to living organisms, degrade natural ecosystems, or disrupt natural processes. To put things into perspective, note that humans are not the only species that are polluting this planet. But interestingly, we give all other species a free pass. By definition, we consider pollution generated by other species as "natural, and part of normal ecological cycles". Presumably, because the impact of other species' "pollution" is relatively insignificant, compared with the levels of pollution attributed to humans. By contrast, we don't cut humans any slack. We consider any effects on the environment that can be attributed to humans, as unnatural. This biased attitude is presumably further supported by the fact that we don't consider other species capable of even recognizing pollution, anyway, let alone capable of restricting it. Despite this bias, there are many examples of pollution by other species.
In contrast to most human sources of pollution, the pollution events that can be attributed to other species do not involve the addition of synthetic materials or chemicals that persist for hundreds of years. The effects of their pollution typically degrade rather rapidly. Ecosystems tend to recover or adapt over time without long-term degradation. Human pollution has developed in phases. Human pollution is closely tied to the development of human societies, from early hunter gatherer lifestyles to the rise of agriculture, industrialization, and modern consumption patterns. During early human evolution (2 million to 10,000 BCE), Hunter gatherer societies had minimal impact on the environment. Small nomadic populations left behind localized waste such as bones and fire residues. Campfires released smoke and soot, marking the earliest form of air pollution, and stone tool production generated small amounts of localized debris. As the old saying goes, one man's trash is another man's treasure. Interestingly, early evidence of trash left behind by our evolving ancestors is treasured by archaeologists, and considered to be valuable artifacts. By contrast, it's rather unlikely that the mountains of trash we're generating today will be viewed by future generations as "valuable artifacts". As agriculture began to be developed (about 10,000 BCE), deforestation began in order to accommodate farming and settlements. Livestock farming added to methane emissions from animals. Overuse of land eventually led to soil degradation, and early irrigation systems introduced water pollution as waste and sediment flowed into existing bodies of water. Early civilizations (10,000 BCE to about 500 CE), brought the development of early cities such as those in Mesopotamia, the Indus Valley, and ancient Egypt, resulting in the concentrated production of waste. The use of metals such as copper, bronze, and iron increased as tools and weapons were produced. Water pollution increased due to poor sanitation and untreated sewage. Air pollution increased from metal smelting and open fires. And soil pollution increased from waste accumulation and mining activities. During the tenure of the Roman and Greek empires (800 BCE to 500CE), the expansion of mining and metalworking, and increased trade spread pollution across regions. Lead contamination from mining and smelting was so extensive that evidence can still be found in ice cores and soil samples. Research suggests that exposure to lead from mining in the Roman Empire probably lowered I.Q. levels. In the cities, urban waste led to disease outbreaks that contributed to population decreases in some regions During the medieval period (500 to 1500 CE), deforestation intensified as land was cleared for farming and fuel, and the growth of towns and trade routes lead to increases in waste production. Air pollution increased from widespread use of wood and coal for heating and industrial production. Water pollution increased from tanning, dyeing, and similar early industries. Increased land degradation and soil erosion resulted from farming. As mining for silver, gold, and other metals increased in Europe and Asia, toxic runoff into rivers and lakes increased. Localized deforestation and habitat destruction occurred in the vicinity of mines. During the early modern period (1500 to 1750), global exploration and colonization introduced intensive agriculture and resource extraction to new areas. New colonies added to soil degradation and deforestation. And the introduction of invasive species disrupted ecosystems. The use of coal expanded for early industries, particularly in Europe, and air pollution from coal smoke became a significant problem in urban centers. Water pollution from early mills and factories increased. The Industrial Revolution (1750 to 1900), was fueled by the widespread use of fossil fuels such as coal, as the invention of the steam engine brought a big boost to the construction of factories. Severe air pollution from coal combustion brought urban smog. Waterways became heavily polluted with industrial waste and chemicals. The increased need for raw materials brought increased deforestation and habitat destruction. As cities grew rapidly, so did waste production and sanitation problems. Sewage and waste dumped into rivers caused public health crises such as cholera outbreaks. The 20th century brought the modern industrial and technological Era. With the post-World War II boom, advances were made in technology, transportation, and agriculture. Plastics and synthetic chemicals were developed. Air pollution and industrial emissions increased significantly. Plastic waste became widespread, accumulating in oceans, and soil chemical pollution from pesticides such as DDT and fertilizer became a long-term problem. Nuclear weapons testing and energy production led to long-lasting radioactive contamination in ecosystems, which was compounded from accidents like the 1986 Chernobyl incident. The 21st century Anthropocene brought globalization and mass consumption, which intensified industrial activities and global trade. The proliferation of single-use plastics led to microplastics in oceans, drinking water and human bodies. Air pollution remains a major health crisis with hot spots in India and China, and discarded electronics contributes to heavy metals in the environment. Greenhouse gases and climate change become a major problem due primarily to the burning of fossil fuels, and methane emissions from livestock and landfills add to the greenhouse effect. Rising CO2 levels have disrupted global climate patterns, and ocean acidification is negatively affecting marine ecosystems. The cumulative impacts of human pollution are worrisome. Air and water pollution contribute to millions of deaths annually due to respiratory, cardiovascular, and infectious diseases. Pollution has led to the extinction or population declines of many species. Agricultural runoff and industrial chemicals have rendered vast areas unsuitable for farming or drinking water. Human activities have accelerated global warming, causing rising sea levels, extreme weather, and ecosystem collapse. Throughout their evolution, humans have transitioned from minimal environmental impact to becoming the dominant force altering Earth's ecosystems. While early pollution was localized and relatively small-scale, industrialization and modern consumption have led to global challenges that threaten the planet's health and sustainability. And now were polluting space. Apparently we haven't learned much about preventing pollution during our evolution, because now we appear to be well on our way to polluting the universe. As of 2024, humans have left a staggering amount of space debris, commonly known as "space junk," in Earth's orbit. There are approximately 36,000 pieces of debris larger than 10 cm (4 inches) currently being tracked by global space surveillance networks, such as the U.S. Space Surveillance Network. There are an estimated 1 million pieces of debris between 1 cm and 10 cm (0.4–4 inches). Scientists estimate there are more than 100 million pieces smaller than 1 cm, including fragments from collisions, paint flecks, and particles from rocket fuel. Most space junk consists of:
Because objects in orbit tend to travel at speeds of up to 28,000 km/h (17,500 mph), even small particles can cause catastrophic collision damage. A mathematical analysis known as the "Kessler Syndrome" describes a scenario where cascading collisions exponentially increase debris, making space operations impossible. We're rapidly trashing space. Despite the relatively limited amount of time that we've spent exploring space, we've already filled it with so much debris that collisions are becoming an increasing problem. The International Space Station, for example regularly has to perform collision avoidance maneuvers. And although much of this debris in low Earth orbit may eventually burn up upon reentry into our atmosphere, debris in higher orbits can persist for centuries. The United Nations Office for Outerspace Affairs (UNOOSA) has issued guidelines for mitigating space debris. And technologies such as nets, harpoons, and robotic arms are being developed and tested to remove debris. Satellites are increasingly being designed to deorbit themselves at the end of their lifecycle. And space agencies and private organizations are enhancing debris tracking capabilities to prevent collisions. It's worth noting that:
We've even polluted much of the universe within reach of our space travels. On our moon: we've left a significant amount of debris from decades of lunar explorations that began in 1969 with the Apollo mission. We've left behind numerous lunar lander stages, rovers, scientific instruments, and personal items such as tools, flags, and cameras. Unmanned missions have also left debris where probes were deliberately crashed into the surface of the moon for the purpose of gathering scientific information. Mars: is littered with the remains of rovers, landers, and entry, descent, and landing hardware such as parachutes, and heat shields. Several unsuccessful missions left debris from incomplete landings. Venus: has debris such as atmospheric probes left from early Soviet and US exploration missions. Jupiter: contains the remains of the Galileo spacecraft which was deliberately crashed into Jupiter to avoid contaminating Europa (a moon of Jupiter). Saturn: contains the remains of the Cassini spacecraft which was deliberately deorbited into Saturn in order to protect its moons from contamination. Titan, Saturn's largest moon: contains the remains of the Huygens probe, left as part of the Cassini mission. Even certain comets and asteroids have been affected. NASA's Deep Impact mission in 2005 left an impactor on comet Tempel. Other spacecraft (such as Hayabusa and OSIRIS-REx) left components or spent materials during sample collection from asteroids. The Outer Space Treaty (UNOOSA, 1967) mentioned above was enacted to prevent harmful contamination. This was intended to be a treaty on principles governing the activities of states in the exploration and use of outer space, including the moon and other celestial bodies. Unfortunately the treaty has notable shortcomings in several critical areas (Roberds, 2016).1 One such issue is the development of anti-satellite (ASAT) technology, which undermines the principle that all nations have equal rights to explore space without discrimination. The destructive capabilities of ASAT, controlled by a limited number of nations, pose a potential threat to the space programs of countries lacking such technology. In the current geopolitical climate, a nation equipped with ASAT capabilities could significantly impair another nation's ability to conduct space exploration. Another area of concern is the treaty's inability to prevent the weaponization of space. While Section A, Article IV explicitly prohibits the placement of nuclear weapons and weapons of mass destruction in outer space, it provides no restrictions on the deployment of conventional or future technological weapons. This oversight creates a situation where only nations with advanced capabilities may dominate space militarization, further hindering the principle of equal access to space exploration. Additionally, the treaty has failed to address the growing problem of space debris. The lack of measures to prevent outer space from becoming cluttered with debris exacerbates challenges for exploration, including the threat of collisions, increased repair costs, and the financial burden of tracking debris. Most cities treat wastewater and place nonrecyclable trash in landfills. Wastewater treatment benefits us by reducing disease potential and obviously benefits the environment by reducing the pollution that would otherwise flow into rivers lakes and oceans. And although landfills are mostly used to concentrate (and hopefully decompose) nonrecyclable items (many of which may last thousands of years before deteriorating), at least it gets the trash out of our immediate environment so that we're not smothered in trash everywhere else. The downside is that some items may never deteriorate. For some items, we're able to reduce landfill accumulations by recycling.
Consider what isn't recycled. This is by no means a complete list, but items that cannot be recycled typically include plastic bags and wraps, styrofoam (polystyrene), mixed plastics, plastic utensils and straws, plastic with food residue, grease, or other contamination, coated or contaminated paper (such as paper cups), shredded paper, pizza boxes, contaminated paper (such as paper towels, tissues, napkins), ceramics, heat resistant glass, mirrors, window glass, paint cans, aerosol cans, metal with nonmetal attachments, electronics, household batteries, synthetic fabrics, mixed fabrics (such as cotton polyester blends), medical waste, chemically treated items, household hazardous wastes, bottle caps, rubber, disposable diapers, wax coated cartons, for example We seem to be inclined to pollute. Is that characteristic part of our DNA? We've managed to pollute not only the planet that supports us, but we're even polluting the universe around us, as far as we can reach. Human exploration has left a legacy of debris across the solar system, from the Moon to distant asteroids. While this debris serves as historical artifacts of exploration, it also raises concerns about planetary protection and space ethics. Will we ever change? Maybe, but the jury is still out on that. Fortunately, it's rather likely that the tendency to pollute everything around us is a negative side effect associated with our rapid rise in technology, rather than being a part of our DNA. So we aren't born to pollute, but on the other hand, we don't seem to be able to to prevent it from happening, either. Reference 1. Roberds, E. H. J. (2016). FAILURE OF THE OUTER SPACE TREATY. Canadian Forces College, Retrieved from https://www.cfc.forces.gc.ca/259/290/301/305/roberds.pdf&ved=2ahUKEwjsu8z42NmKAxW1IEQIHYtpGkEQFnoECAYQDQ&usg=AOvVaw3hvsaUtUJpQ7hm5RTl7dl9
According to recent research, most MC patients probably need more B12 than we realize. B12 is absorbed in the stomach, implying that anyone with compromised digestion is at increased risk of developing a B12 deficiency. And digestion is certainly compromised when MC or any other IBD is active. Interestingly, a B12 deficiency can cause many of the same symptoms as MC. A B12 deficiency can cause gastrointestinal symptoms such as bloating, constipation, diarrhea, gas, and nausea, for example. Is it possible that some of the cases where MC seems to be refractive to dietary treatment, despite careful attention to a restricted diet, might be associated with a B12 deficiency? That certainly appears to be a possibility. B12 deficiency seems to be associated with many autoimmune diseases. For example, B12 deficiency is common among diabetes patients (Kibirige, and Mwebaze, 2013).1 Published research has clearly shown that not only is neuropathy common among diabetics, but for patients who have diabetic neuropathy, the degree of neuropathy is inversely proportional to the level of B12 in their blood. In other words, diabetes patients who have the most serious levels of neuropathy. also have the lowest plasma levels of B12. New research questions the adequacy of adult B12 RDA. The possibilities discussed in the previous paragraphs gain substance in view of recent research led by scientists at the University of California, San Francisco (UCSF), 2025, February 19.2 The findings of the study challenge the long-held belief that maintaining vitamin B12 levels within the currently accepted "normal" range is sufficient to prevent neurological decline, particularly in older adults. Published in the Annals of Neurology, the study found that even individuals with B12 levels considered healthy by existing standards may be at risk for cognitive impairment and brain damage (Beaudry-Richard, et al., 2025).3 The study involved 231 healthy older adults with an average age of 71 years. Participants had an average blood B12 level of 414.8 pmol/L, well above the U.S. minimum standard of 148 pmol/L. Despite being within the normal range, individuals with lower B12 levels showed signs of neurological impairment and cognitive decline. Brain scans revealed the neurological effects of low "normal" B12 levels. MRI scans revealed increased white matter damage in participants with lower B12 levels. White matter lesions are associated with cognitive decline, stroke risk, and dementia. Participants with lower active B12 levels had slower reaction times and impaired visual processing speeds. Older participants were especially vulnerable, with age amplifying the negative effects of low B12. Elevated levels of Tau protein (a marker associated with neurodegenerative diseases like Alzheimer’s disease), were linked to high levels of biologically inactive B12 fractions (holo-haptocorrin). Vitamin B12 plays a vital role in:
A deficiency (even within the so-called normal range) may lead to brain damage through:
Notice that this research was based on measurements of active B12. B12 in food and cheap vitamins is in the inactive form (cyanocobalamin), which must be converted (by a methylation process) to the active form before our body can use it. About half the general population has one or more methylenetetrahydrofolate reductase (MTHFR) gene mutations which can limit our ability to convert vitamins into the active form. Some of us have major MTHFR gene mutations, which prevents our body from being able to use normal amounts of the B12 in our food, or most common vitamins. In such cases, a blood test may show our B12 level to be normal, or above the normal range, yet our body is screaming for the active form of B12. This deficiency can be resolved either by receiving regular B12 injections at our doctors office, or by taking an active form (methylcobalamin, for example) of B12. And according to the study cited above, our ability to absorb and/or convert B12 into the active form decreases as we age. MC depletes water-soluble vitamins. And since MC (and the other IBDs) deplete water-soluble vitamins, our chances of developing a B12 deficiency are much higher than someone who doesn't have a gastrointestinal disease that causes diarrhea. Considering our disease symptoms, and our general age bracket, it appears quite likely that B12 deficiency is common among MC patients. Long-term brain fog and fatigue are common symptoms of MC. Could a high prevalence of B12 deficiency be responsible for the brain fog and long-term fatigue associated with MC? Since the risk of deficiency increases with age, maintaining adequate vitamin B12 levels is particularly important for older adults. The decline is mostly due to a natural decline in the stomach’s ability to produce intrinsic factor (a protein required for B12 absorption from food). Disease-related malabsorption exacerbates the problem. For adults over 50, not only age-related changes, but diseases such as MC and other IBDs, lead to malabsorption of B12 from dietary sources. Low stomach acid (atrophic gastritis) or the use of medications such as proton pump inhibitors (PPIs) or metformin, can further reduce B12 absorption. As mentioned above, a deficiency in this vitamin can lead to serious health issues, including:
Fortunately, supplementation can help address this problem effectively. Instead of basing our B12 intake on the government's RDA guidelines, it appears that following the recommendations of the Linus Pauling Institute (LPI) may be more appropriate, especially for individuals such as us, who have MC, or some other IBD. Their recommendations state that adults over 50 should take 100–400 μg (micrograms) of supplemental vitamin B12 daily. These doses help overcome the body's natural decline in absorption by providing much higher amounts than would be possible through food alone. The good news is that most multivitamins already meet or exceed these recommendations, making it easy for most seniors to get the right amount through daily supplementation. The bad news is that a major caveat regarding multivitamins exists for MC patients, due to the fact that multivitamins tend to contain so many ingredients that most such products on the market pose a significant reaction risk for MC patients There are several forms of vitamin B12 available in supplements, although not all are equally effective for everyone:
These forms of B12 are available as:
Does a risk of overdose exist? No toxic effects have been associated with high vitamin B12 intake in healthy individuals, even at doses as high as 2,000 μg/day. This is because the body absorbs only a small fraction of large doses, with the rest excreted in urine. However, as is the case when taking supplemental magnesium, those who have compromised kidney function should consult their healthcare provider before starting high-dose cyanocobalamin (methylcobalamin bypasses this risk). In summary: For seniors, and especially those who have MC or some other IBD, the easiest and most effective way to maintain adequate B12 levels is:
This approach ensures that we can maintain healthy B12 levels, supporting brain function, nerve health, and energy metabolism well into our senior years. References: 1. Kibirige, D., and Mwebaze, R. (2013). Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? Journal of Diabetes & Metabolic Disorders, 12(1), p17. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3649932/ 2. University of California, San Francisco, (2025, February 19). 'Healthy' vitamin B12 levels not enough to ward off neuro decline: Experts call for new recommendations for older adults. Medical Xpress, Retrieved from https://medicalxpress.com/news/2025-02-healthy-vitamin-b12-ward-neuro.html 3. Beaudry-Richard, A., Abdelhak, A., Saloner, R., Sacco, S., Montes, S. C., Oertelm F. C., . . . Green, A. J. (2025). Vitamin B12 Levels Association with Functional and Structural Biomarkers of Central Nervous System Injury in Older Adults. Annals of Neurology, Retrieved from https://onlinelibrary.wiley.com/doi/10.1002/ana.27200
A large-scale Swedish study analyzed data for over 900,000 women aged 50-58, including 77,000 hormone therapy users, to compare cardiovascular risks associated with different types of hormone therapy (Johansson, et al., 2024).1 The study assessed the risks of myocardial infarction (MI), ischemic heart disease, stroke, composite cardiovascular disease (CVD), and venous thromboembolism (VTE). The study showed that:
The clinical indications of the study suggested that: Transdermal estrogen has a better cardiovascular safety profile compared to oral estrogen, particularly for women with cardiovascular risk factors. Hormone therapy (oral or transdermal) remains a reasonable option for healthy women in early menopause with bothersome symptoms, but clinicians should prefer transdermal forms for those with increased CVD risk. Hormone replacement therapy and IBD. Research data show that hormone replacement therapy (HRT) may improve inflammatory bowel disease (IBD) symptoms, and reduce the risk of moderate to severe disease in post-menopausal women (Freeman, et al., 2023).2 Of course there are no official research data available regarding HRT and microscopic colitis (MC), but we can probably safely assume that the effects of HRT will be relatively similar for all forms of IBD (until proven otherwise). The research (published by Freeman, et al.) shows that postmenopausal women who took HRT were 82% less likely to have active IBD in the postmenopausal period, and the risk of surgery was reduced. Obviously, an 82% improvement with the use of HRT, is a huge advantage. There's no research comparing oral with transdermal HRT for IBD patients. Therefore, we can only speculate that in view of existing research showing the significant advantages of transdermal over oral HRT treatments, those advantages will almost surely carryover to IBD patients. It appears that the primary advantage of transdermal HRT is associated with its reduced impact on the liver, which likely lowers the risk of exacerbating IBD symptoms. Oral HRT can affect the liver during its first-pass metabolism, and potentially influence inflammatory processes in the gut. Our own experiences show that transdermal HRT is safer than oral HRT. And although the study cited above didn't consider any effects that hormone replacement theory (HRT) might have on IBD symptoms, our own experiences (as evidenced by the epidemiological data shown by the posts in the archives of the discussion and support forum associated with our website) show that transdermal patches are far less likely to trigger a microscopic colitis (MC) reaction, than oral HRT treatments. What about the sexual side effects? A Study of 670 healthy women aged 42 to 58 Years, within three years of their last menstrual period showed that transdermal estradiol significantly improved sexual satisfaction and the physical aspects of sexual function, compared with placebo (Taylor, et al., 2017).3 By comparison, oral estrogens modestly improved overall satisfaction, with the primary benefits seen in the physical aspects. All in all, transdermal delivery showed better results than oral treatments in the study. According to Dr Sharyl Magnuson (on our Board of Directors) the topical form of estrogen that's normally the most helpful for sexual functioning is the vaginal cream preparation (Premarin or Estrace creams). These help maintain a healthy vaginal mucosa, prevent vaginal atrophy and sexual discomfort. In conclusion: Research data show that transdermal HRT treatments typically provide more benefits and are less likely to create problems when compared with oral HRT treatments, especially for IBD patients. And the epidemiological evidence based on our shared experiences, recorded in the archives of the discussion and support forum associated with our website, agrees with those findings for MC patients. References 1. Johansson, T., Karlsson, T., Bliuc, D., Schmitz, D., Ek, W. E., Skalkidou, A., . . . Johansson, Å. (2024). Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial. BMJ, 387, e078784. Retrieved from https://www.bmj.com/content/387/bmj-2023-078784 2. Freeman, M., Lally, L., Teigen, L., Graziano, E., Shivashankar, R., and Shmidt, E. (2023). Hormone Replacement Therapy Is Associated with Disease Activity Improvement among Post-Menopausal Women with Inflammatory Bowel Disease. Journal of Clinical Medicine, 13(1), p 88. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10779540/ 3. Taylor, H. S.,Tal, A., Pal, L., Li, F., Black, D. M., Brinton, E., A., . . . Harman, S. M. (2017). Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function in Early Postmenopause. JAMA Internal Medicine, 177(10), pp 471–1479. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5710212/
A recent Medscape online article points out some interesting observations regarding the health benefits and risks associated with caffeine, based on recent studies (Spriano, 2024, October 11).1 And although the article doesn't mention how microscopic colitis (MC) patients might be affected by caffeine, we can certainly coordinate the information in the article with the vast amount of epidemiological evidence available in the shared experiences that have been posted to the database of our discussion and support forum over the last couple of decades in order to fill in the blanks. Looking at the chemical characteristics and pharmacokinetics of caffeine. Caffeine is a methylxanthine that is completely absorbed (within 45 minutes) and peaks in the bloodstream between 15 minutes and 2 hours after ingestion. Its half-life in adults is generally 2.5-4.5 hours, but several factors can extend or reduce this time, such as smoking (reduces half-life) and the use of oral contraceptives (doubles the half-life). Caffeine crosses the blood-brain barrier, where it blocks adenosine receptors, increasing alertness and reducing fatigue, but also having broader impacts on brain function. Caffeine has Cognitive and Neurological Benefits. 1. Caffeine is widely used to enhance alertness and work productivity by reducing fatigue and improving reaction times. 2. It may also have antidepressant-like effects by reducing the risk of depression in some populations. 3. Caffeine enhances the effectiveness of painkillers such as acetaminophen (paracetamol), aspirin and other NSAIDs, and opioids, in treating headaches and other types of pain. This effect is especially beneficial in treating headaches, migraines, and post-surgical pain, where combinations of caffeine and painkillers are sometimes used. It enhances the effectiveness of painkillers by: 1. speeding up the absorption of certain medications, allowing for faster and sometimes stronger effects 2. blocking adenosine receptors, which helps to reduce the perception of pain For us, boosting the efficacy of safe painkillers can be a huge benefit. The antidepressant-like effects (for some individuals) can certainly be considered beneficial for MC patients, considering that MC tends to be a very depressing disease. But the available options of safe painkillers are so very limited, with acetaminophen being the number one choice for most of us, when treating our routine aches and pains, that the benefits of boosting the efficacy of painkillers can be a huge benefit for most of us when our situation causes us to reach for a painkiller. Caffeine has cardiovascular benefits. Despite early concerns about its impact on blood pressure (BP), moderate coffee consumption has not been linked to increased long-term risk for hypertension and may even reduce the risk of developing it. Studies also show that regular coffee consumption is not associated with an increased risk of atrial fibrillation (AF) or cardiovascular events, and in fact, it may reduce the risk of AF in a dose-dependent manner. Caffeine reduces all cause mortality risk for type 2 diabetes patients. At least that statement is true for Japanese diabetes patients, since Japanese patients were used in the study. In fact, the study showed a dose response relationship for the reduction in all cause mortality. And the beneficial effects of caffeine were even greater when coffee was consumed along with green tea. These benefits must be weighed against possible adverse effects. 1. Caffeine can at least temporarily affect blood pressure levels. While caffeine can acutely raise BP somewhat after 200-300 mg), these effects are temporary and typically do not last longer than three hours. In patients who consume coffee regularly, this effect tends to diminish due to tolerance. Occasional coffee drinkers, however, may experience a more significant hypertensive response. 2. Caffeine can affect cholesterol levels. There's evidence suggesting that unfiltered coffee, due to its high cafestol content, can raise cholesterol levels, particularly LDL cholesterol and triglycerides. However, filtered coffee and instant coffee have much lower cafestol levels, thereby reducing this effect. Results from studies on coffee’s impact on cholesterol levels remain inconsistent. 3. Caffeine can increase anxiety and cause sleep disturbances. High caffeine intake (for example, 400 mg per day, or more) can lead to anxiety and sleep disruptions, although individual responses vary due to genetic factors and caffeine metabolism rates. Some individuals are more susceptible to these effects than others. 4. Caffeine overdose can lead to toxic effects. Caffeine overdose rarely occurs due to traditional consumption methods (for example,, coffee or tea), but it can occur when using caffeine tablets or energy drinks, particularly in young people, or those consuming caffeine along with alcohol, or engaged in intense exertion. The article referenced in the first paragraph points out that consuming large amounts of energy drinks (around 1 liter, containing 320 mg of caffeine, for example) can cause acute cardiovascular problems such as elevated BP, QT-segment prolongation, and palpitations. 5. Caffeine can be addictive. When consumed regularly, caffeine tends to cause users to develop a tolerance, which leads to a dependency, and therefore, suddenly avoiding caffeine can lead to withdrawal symptoms, including headaches, fatigue, decreased attention, and mood disturbances. 6. Caffeine can be a major concern for migraine sufferers. Because regular caffeine consumption can lead to dependency, if caffeine levels drop suddenly, the withdrawal symptoms can not only trigger headaches, but they can trigger migraines. For some individuals, even one missed or delayed dose of caffeine can lead to withdrawal symptoms. Caffeine can contribute to rebound headaches, particularly if used frequently in combination with pain relief medications, and this can make migraines more challenging to manage, possibly leading to a cycle of morning headaches. This can happen because caffeine constricts blood vessels, which tends to initially relieve migraines. But once the caffeine wears off, blood vessels may dilate again, which can trigger a rebound migraine. Note that in many cases, published research shows that magnesium deficiency (which is associated with MC) may be the cause of migraines, and for these patients, magnesium deficiency would probably be a much more likely cause of migraines than caffeine. But this is a two-way street. In small doses, caffeine can actually help stop a migraine in progress by constricting blood vessels and enhancing the effectiveness of painkillers such as aspirin, or in the case of MC and other IBD patients, acetaminophen. This is why caffeine is included in some over-the-counter migraine medications. Therefore, for some people, occasional caffeine intake can alleviate migraine symptoms, but it’s generally advised against regular use for chronic migraine sufferers due to the risk of dependency and rebound headaches. Certain consumer products are concerning. Energy drinks are particularly concerning due to their high caffeine content and potential to cause adverse cardiovascular effects when consumed in large quantities or combined with alcohol. Energy drinks also pose a risk due to the lack of tolerance developed from occasional use, making young people especially vulnerable to their stimulant effects. Many weight loss supplements contain high concentrations of caffeine along with other ingredients intended to boost metabolism. These products can be easily misused, especially given their easy availability and marketing claims, leading to adverse health outcomes. How do various products that contain caffeine compare? Coffee The average cup of coffee contains approximately 95 milligrams of caffeine. However, this amount can vary depending on several factors, such as the type of coffee bean, the brewing method, and the serving size. Here’s a breakdown of the typical caffeine content in different types of coffee:
These values serve as general estimates, but individual variations in brewing strength can influence caffeine content. And note that coffee contains more than just caffeine. Note that coffee contains over 1, 000 chemical compounds. So not just caffeine, but a huge number of other chemical ingredients contribute to its aroma, flavor, and effects on the body. And it's certainly likely that some of these other ingredients may contribute not only to coffee's beneficial attributes, but also to some of its negative attributes, such as withdrawal symptoms, anxiety risks, and possible sleep disruptions.. While these compounds may have negative health effects, moderate coffee consumption (usually 1-3 cups per day for most people) is generally considered safe. As is often noted in posts on our MC discussion and support forum, if coffee didn't bother us before we developed MC, then it's probably still safe to drink (in moderation) after we developed MC. However, individuals with specific health concerns, like acid reflux, high cholesterol, or kidney stone susceptibility, may benefit from moderating their coffee intake or choosing filtered coffee to minimize exposure to some of these compounds. Although we can't be sure, because there's no published research to back this up, it's likely that the gastrointestinal distress (sometimes referred to as "coffee gut") that sends some people to the bathroom soon after they drink a cup of coffee is probably not due to caffeine. It's more likely to be caused by some of the natural acids in coffee, such as chlorogenic and quinic acids. These acids can not only cause gastric discomfort, but they can also contribute to acid reflux, and heartburn, especially for people with sensitive stomachs or gastroesophageal reflux disease (GERD). Tea The average cup of tea contains approximately 20 to 60 milligrams of caffeine, depending on the type of tea and how it is brewed. Here's a general breakdown of caffeine content for different types of tea (per 8-ounce cup):
As with coffee, the brewing time and tea variety can affect the exact amount of caffeine in your cup. For example, brewing tea for a longer period can increase its caffeine content. Colas The average cola-type soft drink contains approximately 30 to 40 milligrams of caffeine per 12-ounce (355 mL) can. Here's a general range for some popular cola drinks:
In comparison with coffee or tea, the caffeine content in cola is significantly lower. However, many energy drinks or specialized sodas may contain much higher amounts of caffeine. Energy drinks The caffeine content in energy drinks varies widely, but it typically ranges from 70 to 300 milligrams per serving. Here are examples of popular energy drinks and their caffeine content:
The caffeine content can vary depending on the brand, serving size, and specific product line. Some energy drinks, especially those marketed for extreme energy or performance, can have significantly higher caffeine levels. It's important to check the label to know the exact amount. Guidelines for keeping caffeine beneficial, and minimizing the risks: Caffeine brings both benefits and risks, and understanding the context of use, dose, and individual susceptibility is critical in managing its impact on health. Moderation is the key. Most of the risks are associated with high doses of caffeine, particularly from energy drinks or caffeine tablets. Encouraging moderate consumption of coffee or tea can help mitigate these risks while still offering some health benefits. Specific patient considerations (such as hypertension, anxiety disorders, or pregnancy) should guide the decision on whether and how much caffeine consumption is advisable. And as MC patients, caffeine may convey a special benefit when we desperately need a painkiller. Since the safe choices of painkillers typically boil down to acetaminophen, taking the acetaminophen with a cup of coffee may help to make it a much more effective painkiller. And the antidepressant -like effects of the caffeine in that cup of coffee may help to provide another much-needed benefit for many of us as we continue to deal with this depressing disease. Reference 1. Spriano, P. (2024, October 11). Ready for a Jolt? Caffeine Brings Benefits and Risks. Medscape, Retrieved from https://www.medscape.com/viewarticle/ready-jolt-caffeine-brings-benefits-and-risks-2024a1000ilx
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AuthorWayne Persky Archives
November 2025
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