Keeping Healthy throughout Menopause

KEEPING HEALTHY

Good nutrition and regular physical exercise are thought to improve overall health. Some doctors feel these factors can also affect menopause. Although these areas have not been well studied in women, anecdotal evidence is strongly in favor of eating well and exercising to help lower risks for CVD and osteoporosis.

Nutrition

While everyone agrees that a well-balanced diet is important for good health, there is still much to be learned about what constitutes "well-balanced." We do know that variety in the diet helps ensure a better mix of essential nutrients.

Nutritional requirements vary from person to person and change with age. A healthy premenopausal woman should have about 1,000 mgs of calcium per day. A 1994 Consensus Conference at the National Institutes of Health recommended that women after menopause consume 1,500 mgs per day if they are not using hormonal replacement or 1,000 mgs per day in conjunction with hormonal replacement. Foods high in calcium include milk, yogurt, cheese and other dairy products; oysters, sardines and canned salmon with bones; and dark-green leafy vegetables like spinach and broccoli. In calcium tablets, calcium carbonate is most easily absorbed by the body. If you are lactose intolerant, acidophilus milk is more digestible. Vitamin D is also very important for calcium absorption and bone formation. A 1992 study showed that women with postmenopausal osteoporosis who took vitamin D for 3 years significantly reduced the occurrence of new spinal fractures. However, the issue is still controversial. High doses of vitamin D can cause kidney stones, constipation, or abdominal pain, particularly in women with existing kidney problems. Other nutritional guidelines by the National Research Council include:

1. Choose foods low in fat, saturated fat, and cholesterol. Fats contain more calories (9 calories per gram) than either carbohydrates or protein (each have only 4 calories per gram). Fat intake should be less than 30 percent of daily calories.
2. Eat fruits, vegetables, and whole grain cereal products, especially those high in vitamin C and carotene. These include oranges, grapefruit, carrots, winter squash, tomatoes, broccoli, cauliflower, and green leafy vegetables. These foods are good sources of vitamins and minerals and the major sources of dietary fiber. Fiber helps maintain bowel mobility and may reduce the risk of colon cancer. Young and older people alike are encouraged to consume 20 to 30 grams of fiber per day.
3. Eat very little salt-cured and smoked foods such as sausages, smoked fish and ham, bacon, bologna, and hot dogs. High blood pressure, which may become more serious with heavy salt intake, is more of a risk as you age.
4. Avoid food and drinks containing processed sugar. Sugar contains empty calories which may substitute for nutritious food and can add excess body weight.

For people who can't eat an adequate diet, supplements may be necessary. A dietician should tailor these to meet your individual nutritional needs. Using supplements without supervision can be risky because large doses of some vitamins may have serious side effects. Vitamins A and D in large doses can be particularly dangerous.

As you age, your body requires less energy because of a decline in physical activity and a loss of lean body mass. Raising your activity level will increase your need for energy and help you avoid gaining weight. Weight gain often occurs in menopausal women, possibly due in part to declining estrogen. In animal studies, scientists found that estrogen is important in regulating weight gain. Animals with their ovaries surgically removed gained weight, even if they were fed the same diet as the animals with intact ovaries. They also found that progesterone counteracts the effect of estrogen. The higher their progesterone levels, the more the animals ate.

Exercise

Exercise is extremely important throughout a woman's lifetime and particularly as she gets older. Regular exercise benefits the heart and bones, helps regulate weight, and contributes to a sense of overall well-being and improvement in mood. If you are physically inactive you are far more prone to coronary heart disease, obesity, high blood pressure, diabetes, and osteoporosis. Sedentary women may also suffer more from chronic back pain, stiffness, insomnia, and irregularity. They often have poor circulation, weak muscles, shortness of breath, and loss of bone mass. Depression can also be a problem. Women who regularly walk, jog, swim, bike, dance, or perform some other aerobic activity can more easily circumvent these problems and also achieve higher HDL cholesterol levels. Studies show that women performing aerobic activity or muscle-strength training reduced mortality from CVD and cancer.

Just like muscles, bones adhere to the "use it or lose it" rule; they diminish in size and strength with disuse. It has been known for more than 100 years that weight-bearing exercise (walking, running) will help increase bone mass. Exercise stimulates the cells responsible for generating new bone to work overtime. In the past 20 years, studies have shown that bone tissue lost from lack of use can be rebuilt with weight-bearing activity. Studies of athletes show they have greater bone mass compared to nonathletes at the sites related to their sport. In postmenopausal women, moderate exercise preserves bone mass in the spine, helping reduce the risk of fractures.

Exercise is also thought to have a positive effect on mood. During exercise, hormones called endorphins are released in the brain. They are "feel good" hormones involved in the body's positive response to stress. The mood-heightening effect can last for several hours, according to some endocrinologists. Consult your doctor before starting a rigorous exercise program. He or she will help you decide which types of exercises are best for you. An exercise program should start slowly and build up to more strenuous activities. Women who already have osteoporosis of the spine should be careful about exercise that jolts or puts weight on the back, as it could cause a fracture.

Reprinted from the Archives of US NATIONAL INSTITUTES OF HEALTH, National Institute on Aging

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