Q&A: fortified milks; alternative colon cancer screenings; oral minoxidil for hair thinning; & how to taper off prednisone

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Feb 07, 2025

ICYMI 👉

📣 Join me TODAY, February 7, at 3 pm ET for a live chat in the Substack App. Paid subscribers can submit questions via the chat here! 📣

In this week’s reader-submitted Q&A, we’re tackling these questions:

Is calcium from fortified foods as effective as natural dietary sources?
Are there easer/safer options for colon cancer screening than a colonoscopy?
Should I take oral minoxidil to prevent hair thinning?
How can I safely taper off prednisone?

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nestle coffee mate french vanilla — Photo by Conor Brown on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: FORTIFIED MILKS

I've read that nutrients, such as calcium, are best when it's a dietary source rather than from supplements. If you drink fortified milks, such as almond milk, is that basically the same as taking a calcium supplement, or is it more equivalent to getting it from dietary sources? Thanks so much!!
-Lisa

Hi Lisa,

Great question! In general, getting nutrients from whole foods is ideal because they come packaged with other beneficial compounds that aid in absorption and overall health. Calcium from dietary sources—such as dairy, leafy greens, and certain fish—tends to be better absorbed than from supplements alone.

Fortified plant-based milks, like almond or oat milk, fall somewhere in between. The calcium added to these products is often in the form of calcium carbonate or calcium phosphate, similar to what you'd find in a supplement. While it does provide a bioavailable form of calcium, it may not be as efficiently absorbed as calcium from natural food sources, particularly if the fortified milk isn’t shaken before drinking (the calcium can settle at the bottom). Some studies suggest that calcium from fortified foods is absorbed nearly as well as from dairy, but individual factors like gut health, vitamin D levels, and dietary composition play a role.

That said, fortified milks can still be a useful way to meet calcium needs, especially for those who don’t consume dairy. The key is to pair calcium sources with other nutrients that aid absorption, like vitamin D, magnesium, and vitamin K2, all of which help direct calcium to the bones rather than soft tissues.

So, while fortified plant-based milks aren’t exactly the same as whole-food sources, they are a reasonable alternative for getting calcium—just be mindful of overall nutrient balance and dietary variety. I hope that helps!

Are we missing easer/safer opportunities for colon screening? I heard Joe Weiss MD speak recently (author of Got Guts?) and learned a lot about how women generally have significantly longer colons, often more twisted and difficult to scope, with more missed polyps etc on colonoscopy. He feels there is so much financial investment in regular screening colonoscopies that we are missing safer and more cost-effective options like FIT + ColoGuard 2. Also virtual colonoscopy or CT which appear to do a better job (at least lower risk) than traditional visual colonoscopy with its risks.
-LuAnn

LuAnn,

You raise an important point about colon cancer screening—there are indeed multiple options beyond traditional colonoscopy, and the best choice depends on an individual’s risk factors, comfort level, and access to care.

Colonoscopies are still considered the gold standard because they allow for both detection and removal of precancerous polyps in a single procedure. However, they are not without drawbacks—women do often have longer, more tortuous colons, which can make the procedure more challenging, increasing the risk of incomplete exams or missed polyps. There are also rare but real risks, including perforation, bleeding, and anesthesia complications.

Alternative screening methods do exist and may be a good option for some people:

FIT (Fecal Immunochemical Test) and Cologuard: These are stool-based tests that detect hidden blood and DNA changes associated with colorectal cancer. They are non-invasive, easy to do at home, and lower risk. However, they need to be repeated more frequently—FIT is done annually, while Cologuard is every three years. If results are abnormal, a follow-up colonoscopy is needed.
CT Colonography (Virtual Colonoscopy): This uses a low-dose CT scan to create a detailed image of the colon. It is less invasive but still requires bowel prep (the worst part of the whole thing, if you ask me), and if polyps are found, a traditional colonoscopy is needed for removal.
Sigmoidoscopy: A shorter scope examines only the lower part of the colon. It’s less invasive but doesn’t visualize the entire colon, so it’s not as comprehensive.

The challenge with moving away from colonoscopy is that it remains the most effective at finding and removing polyps before they turn cancerous. However, for those at average risk who prefer a less invasive approach, FIT or Cologuard are reasonable choices. The key is consistency—any screening is better than none, and the best test is the one you’re willing to complete.

If concerns about colonoscopy risks resonate, it’s worth discussing alternative screening strategies with your doctor to find the best plan for you.

QUESTION #3: ORAL MINOXIDIL FOR HAIR THINNING

I take an anti-estrogen medication for metastatic breast cancer. My hair not only has thinned but it has changed from naturally curly to straight and ugly. My dermatologist mentioned that there is an oral minoxidil that she thinks is effective, although she wants me to get approvals from my oncologist and PCP to see if it would interfere with any of my other prescriptions. Have you heard of this drug?
-Jane

Hi Jane,

Yes, oral minoxidil has been gaining attention as a treatment for hair thinning and loss. While traditionally used in its topical form (Rogaine), low-dose oral minoxidil is increasingly being prescribed for various types of hair loss, including hormone-related thinning.

Minoxidil was originally developed as a blood pressure medication, and its hair growth effects were discovered as a side effect. In low doses (often 0.25–2.5 mg per day), it can help stimulate hair growth by increasing blood flow to the scalp and prolonging the hair growth phase. Some studies and dermatologists report promising results, particularly for people who don’t tolerate or respond well to topical minoxidil.

However, since you’re on anti-estrogen therapy for metastatic breast cancer, your dermatologist is right to suggest getting approval from your oncologist and primary care doc. Minoxidil affects blood pressure—even in low doses, it can cause dizziness, fluid retention, or heart-related side effects, especially in people with cardiovascular conditions or those on other medications that impact circulation. Your cancer treatment regimen matters because some cancer medications can have cardiovascular side effects, so it’s important to ensure there are no interactions. Hair changes on anti-estrogen therapy are common—thinning and texture changes often happen due to the hormonal shifts caused by estrogen suppression. While minoxidil may help with regrowth, it won’t reverse the underlying hormone-related changes.

If your doctors approve, it could be worth trying. Many people see improvement with oral minoxidil, though results take time—typically three to six months. If you move forward with it, keeping an eye on blood pressure and any new side effects is a good idea. I’m glad to hear that your dermatologist is proactive. Hair loss and thinning can be very distressing, and there are a number of good, albeit imperfect, solutions out there.

QUESTION #4: TAPERING OFF PREDNISONE

I'm wondering if you could just discuss in general the side effects while on prednisone, and coming off it. It seems like everybody I know has been prescribed steroids for terrible coughs, etc, and this is STRONG MEDICINE! My rx did not include any tapering off. Two days, off of it, i feel awful: gained 6 lbs this week, among other things. Supposedly a 5-7 day course is no big deal, but ...?
-Rebecca

Rebecca,

You're absolutely right—prednisone is a powerful medication, and while short courses are commonly prescribed for inflammation, severe coughs, and respiratory issues, the side effects can be significant. Even a brief course can leave people feeling out of sorts, and for some, coming off it can be rough.

While on prednisone, common side effects include irritability, fluid retention, increased appetite, mood swings, insomnia, and a temporary rise in blood sugar. Some people also experience a burst of energy followed by fatigue as the medication wears off. The weight gain you mentioned is likely due to fluid retention and increased appetite rather than true fat gain, and it should resolve once the medication is out of your system.

Coming off prednisone, even after a short course, can sometimes cause withdrawal-like symptoms. This is because steroids suppress your body’s natural cortisol production, and when you stop suddenly, there can be a temporary imbalance. People often report fatigue, body aches, headaches, and feeling generally unwell for a few days. A longer course of prednisone requires a taper to allow the body to adjust, but for a short burst (5-7 days), most doctors don’t recommend tapering, as the adrenal glands are thought to recover quickly.

If your symptoms are lingering or severe, it’s worth checking in with your doctor. Staying well-hydrated, prioritizing rest, and eating balanced meals can help your body adjust. If you ever need prednisone again, it might be useful to discuss whether a short taper at the end would help ease the transition off the medication. You’re not alone—many people feel the aftereffects of even a short course more than they expect.