For women ages 20-30
DIET:
- Consume enough calcium and Vitamin D. Many women's bone are thin because they never built their full complement of bone by age 25, and most women do not consume enough calcium and D to ensure bone health. 1000 mg of elemental calcium/day, in conjunction with Vitamin D, 1000 IU/day. are essential. Vitamin D has been associated with lowered rates of multiple sclerosis, cancer, diabetes, depression, and cardiovascular disease.
- Commit to undergoing periodic physicals and keeping up with vaccines. Women under age 26 should screen periodically for sexually transmitted diseases (STDs) such as chlamydia, and should complete the three series vaccine against warts, or HPV.
- Every woman should have periodic PAP smears, and everyone should be vaccinated against tetanus, diptheria, and whooping cough, the latter of which has experienced a resurgence and is both highly contagious and threatening to children in particular. Establish a good relationship with an ob/gyn or primary care physician, who in turn can screen you for conditions appropriate to your health and family history.
- Become familiar with your family health history, including grandparents, aunts, uncles, and cousins. A significant family history of heart disease or cancer may have bearing on your future.
- While only 3-5% of breast cancers are associated with already identified breast cancer genes, extensive family history merits more aggressive screening for breast or other cancers.
It is important to identify family members with diseases besides cancer.
- For example, a family history of thrombophlebitis or pulmonary embolism (blood clot to the lung) may mean a predisposition to life-threatening blood clots: more people die from complications of blood clots than from AIDS and breast cancer combined!
- Be sure your family is screened too! As mothers and spouses, women drive health care choices for families. Be sure you children are vaccinated, including teenagers who should receive a meningitis vaccination before residing in dormitory conditions, and girls who might need the HPV vaccine. If you are pregnant and bring your spouse to an ob visit, ask the nurses to check your partner's blood pressure too. Pregnant women undergo aggressive health screening, while a non-pregnant partner may be ignoring his/her own checkups!
- Adopt healthy lifestyle habits you can stick with for your lifetime. Learn to eat healthy, stop smoking, and drink lightly. More than 3 alcoholic beverages a week has been associated with an increased risk of breast cancer.
- Get enough sleep and watch the scale. Metabolism starts to slow around age 35, and the pounds can creep up. 5-6 hours of brisk walking/week can minimize weight gain.
- Check your blood pressure. Some women begin to develop high blood pressure in association with weight gain in thier '30s.
TESTING/CHECKUPS:
- Become pro-active about screening. Despite the recent controversy regarding mammograms, most experts recommend mammography every 1-2 years during your 40s, depending on your personal risk factors. Not having given birth, having a first baby at age 35 or older, and high body mass index are all independent risk factors for breast cancer that mandate annual rather than biennial screening.
- Maintain a relationship with an ob/gyn doctor who can help you if you experience peri-menopausal symptoms. While the average age of menopause is around 52, some women experience symptoms in their 40s, including abnormal bleeding, hot flashes, and worse PMS. Your doctor can both diagnose and treat you for these conditions, but the best treatment for flashes, PMS, and mood changes remains lifestyle: cut the carbs, increase exercise, avoid alcohol and tobacco.
- Keep current with your family health history and modify lifestyle and screening appropriately.
- Find out about diabetes. Type 2 diabetes becomes increasingly common after age 40. The American Diabetes Association says you should be checked at least eery 3 years starting at age 45.
TESTING/CHECKUPS:
- Have a 50,000 mile checkup! It is particularly important that women undergo a thorough checkup after menopause (ie, 1 year after last period).
- The majority of women have minimal difficulty with the menopause transition; and, if you do, a thorough discussion with your doctor about options including hormone therapy is a necessity.
- Even women whose transition is easy still need to follow up. Once a woman's estrogen level falls, cholesterol levels can rise, LDLs (the bad cholesterol) go up, and bones begin to thin. Your doctor can help you decide which screening tests are appropriate for you.
- Get a colonoscopy. 85% of colon cancers arise in polyps that can be identified and removed during a screening colonoscopy. Experts agree that most colon cancers can be prevented by screening, and if results and normal and you have no family history of colon cancer (it affects 1/16 Americans), colonoscopy may be performed once every 10 years.
- Heart health becomes critical. More women die from cardiovascular disease than all cancers combined, and 5x more women die from heart disease than breast cancer. Many women think that heart disease comes out of the blue, but 95% of people who experience heart attacks have one or more of the following risk factors: elevated cholesterol, elevated blood pressure, obesity, or diabetes.
- Undergo annual mammography. The rate of breast cancer at age 50 is 1/50, and at age 65 1/17.
- Be aware of ethnic-related risks. Caucasians should have periodic mole checks to identify malignant melanoma, a deadly skin cancer associated with sun exposure. African Americans seem to contract colon and prostate cancer at younger ages, and more African American women develop an aggressive form of breast cancer known as "triple negative breast cancer".
- Step up intake of vitamin D and calcium. Postmenopausal women require one-third more calcium per day, or 1500 mg elemental calcium, than pre-menopausal women. Vitamin D is also more poorly absorbed with age, so 1000-2000IU/day is an appropriate dose. A good multivitamin in addition to a healthy diet are critical. Some studies associate omega-3 fatty acids with lowered rates of sudden death in patients with cardiac disease.
- Exercise may determine how you live out your 'golden years.' 4 recent studies demonstrated that exercise improved cognitive and executive functions in individuals over 60. One study of 13,000 women showed that walking briskly for 5-6 hours/week limited cognitive, physical, and mental health decline, including 10 common illnesses.
- A recent Harvard study of 34,000 middle-aged women demonstrated that those who exercised the equivalent of walking an hour a day had minimal to no weight gain over a 13 year period, while other normal weight women gained 6 pounds on the average.
Another study showed that women who had lost weight through calorie restriction and exercise could maintain that loss by continuing the program, but those who failed to exercise regained weight, and preferentialy packed on those new pounds around the middle!
- An unpublished study suggests that just standing helps limit weight gain, as opposed to sitting. Besides limiting the risk of weight-related illnesses like diabetes and hypertension, moderate exercise also lower the rate of colon and other cancers.
- "Let food be your medicine". This quote from Hippocrates is critical as we age. Americans consume twice as much sodium as is safe, so sodium content should be limited to 1500 mg/day. The Mediterranean diet, rich in fruits, vegetables, and low fat dairy, also promotes longevity and cardiovascular health. And calorie restriction staves off diabetes and high blood pressure.
- Rely on pills, but not so much. In addition to calcium and vitamin D, older individuals must increase B12 intake, as absorption drops with age. Baby aspirin lower stroke risk in women and cardiovascular events in men, and colon cancer in all groups. While the US Preventive Task Force recommends baby aspirin (81mg) daily for individuals age 50-79, you should speak to your doctor to determine whether the treatment is appropriate for you, since aspirin can lead to stomach ulcers and upset.
Also, although multivitamins and omega-3s are being touted as panaceas for many illnesses, the data are by no means in. In January this year, the VITAL trials began, with 20,000 older adults taking Vitamin D and Omega 3s being followed as assessed regarding disease prevention.
- Don't be a statistic. 24% of older Americans are obese, and 23% of Americans over 60 are diabetic. 1 in 3 Americans has high blood pressure, only 1 in 3 of them has been identified, and only 1 in 3 of the identified individuals is on successful medication! Buy a home blood pressure cuff and measure your pressure and that of your spouse.
- Credible experts report that 90% of Americans will have hypertension in their older years....and any blood pressure above 120/80 is TOO HIGH. Recently the Institute of Medicine issued an indictment of the medical profession for neglecting hypertension. Uncontrolled hypertension leads to heart attack and stroke.
- Get vaccinated. At age 60, the shingles vaccine is recommended for men and women (Zostavax). The vaccine dramatically cuts the risk of developing this painful rash, and the more worrisome 'post herpetic neuralgia', an intractable nerve pain syndrome that can last a lifetime. At age 65, everyone should receive pneumovax, the vaccine against strep (pneumococcal) pneumonia. And by age 50, annual flu shots are a must.
- Get screened. As we age, we are more likely to develop life-threatening conditions detectable only through physical examination and laboratory testing. A bone density test, blood levels for cholesterol, blood pressure measurements, annual mammograms, annual physicals (including thorough skin checks), glaucoma checks, and hearing tests should all be performed.
- Women should be screened every other year for thyroid disease, and after age 70, an ultrasound (sonogram) of the abdomen should be performed to search for surgically correctable abdominal aortic aneurysms. And, finally, gynecological malignancies including breast, uterine lining, ovarian, and fallopian tube cancers all increase with age, so the ob/gyn doctor remains a must!!
Dr. Laurie Green is an OB-GYN at the Pacific Women's OB/GYN Medical Group in San Francisco.
