When Herbal Remedies Can Ruin Your Health

Sanjay Gupta / M.D.

We've all heard about herbal supplements that have worked for someone we know. People swear by them: echinacea for a cold, ginkgo biloba for memory or the peppermint in the salve your aunt believes can ease chest congestion. Over the past decade, use of herbal supplements has jumped 83%, going from $12.2 billion in U.S. sales in 1996 to a whopping $22.3 billion last year. While many of those users may be skeptical, they figure, Hey, these things are natural; what harm could they do?

As it turns out, in some cases they can do a lot of harm, and a surprising number of people are putting themselves at risk by using herbal supplements without being informed about their actual benefits and potential dangers. A new study conducted at the University of Iowa and published in the June issue of Mayo Clinic Proceedings reveals just how widespread the problem has become.

Researchers found that the most common mistake users of herbal remedies make is believing that the substances they take actually work. An earlier National Institutes of Health study showed that about 19% of Americans take herbal supplements and more than half the time they're using the substances to treat a specific health condition instead of just for general well-being. That's fine, provided the supplements treat those conditions, but in more than two-thirds of cases, the preparations have never been clinically proved to be effective for those uses. And as any scientist will tell you, clinical proof--a randomized, controlled trial--is the gold standard for establishing a drug's usefulness and safety. So a lot of dollars--not to mention medical faith--are being spent on potentially useless treatments.

Aside from making you think you're doing something to alleviate your health problem (and not really treating the ailment at all), herbal supplements present other possible pitfalls. "If a supplement is not effective and not harmful, most physicians probably won't have a problem with it," says Aditya Bardia, an internist at the Mayo Clinic and lead author of the study. "It's when it's not effective and also harmful that it's going to be a cause of concern."

Certain supplements can have adverse effects ranging from nausea and vomiting to life-threatening conditions like liver or kidney dysfunction. For example, in 2002 the U.S. Food and Drug Administration (FDA) released a warning about potential liver damage from kava root, then one of the 10 most popular herbal supplements sold in the U.S. And in 2004 the FDA banned ephedra, a Chinese weight-loss herb, after it was linked to more than 100 deaths. Equally troubling, some Ayurvedic supplements, medications based on Indian and South Asian practices, may be adulterated and thus could be contaminated with dangerous heavy metals, including lead and mercury.

Perhaps the greatest potential risk, however, lies in possible interaction with pharmaceutical drugs you are already taking. Saint-John's-wort, which has been shown to help in treating mild to moderate depression, is also known to reduce the effectiveness of some HIV medications and heart drugs such as digoxin and warfarin--life-and-death meds that it doesn't pay to fool with.

To avoid such complications, ask your doctor before you decide to try an herbal supplement, and be sure to disclose any supplements you're taking even if you're not asked. That can be particularly important when you're being prescribed a new medication. The message here is not to avoid all herbal supplements. Increasingly, Western medicine is improving because of discoveries about these alternative treatments. However, it's important to remember that they are essentially drugs, and the best way to use them is to separate fact from fiction first.

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Jehovah's Witnesses Have High Survival Rate After Surgery

Dan Oakes

The Age

SURGEONS could save lives by treating people as if they were Jehovah's Witnesses, a visiting US specialist told a conference yesterday.

Addressing the the annual scientific meeting of the Australian and New Zealand College of Anaesthetists, cardiothoracic specialist Bruce Spiess said blood transfusions hurt more people than they helped.

Jehovah's Witnesses refuse to accept blood transfusions, but Professor Spiess said a study in Sweden of 499 Witnesses showed their survival rates were higher than people who received transfusions.

He described blood transfusions as "almost a religion", because physicians practised them without any solid evidence that they helped.

"Blood transfusion has evolved as a medical therapy and it's never been tested like a major drug," he said. "A drug is tested for safety and efficacy, blood transfusion has never been tested for either one.

"There's a number of people around the world who are coming to these same conclusions and it's becoming more obvious that the old risks of hepatitis and AIDS have been defeated by blood bankers, and now what we're dealing with are events that make patients worse."

Transfusions increased the probability of post-operative complications, including pneumonia and wound infections.

"I think we need to focus on every possible mechanism we can to keep your own blood," Professor Spiess said.

"If you come to surgery, we should ethically treat every patient as if they were a Jehovah's Witness and say, my goal is to not to transfuse you and to use every other technique I possibly can, and then only as a very last result transfuse you."

He emphasised that in cases of severe trauma, blood transfusions were necessary, but pointed out that the majority of transfusions were of comparatively small amounts of blood.

Another area in which Professor Spiess is prominent is that of synthetic blood, which is composed of teflon-like fluorocarbons that carry oxygen far better than our own blood.

"We've just completed a study with traumatic brain injury — you're talking motor vehicle accidents and guns and head trauma — and we've just had a dramatic breakthrough with head trauma using the fluorocarbons as a way to deliver oxygen to the traumatised brain."

Professor Spiess is also researching the use of synthetic blood as a cure for decompression sickness, on behalf of the US Navy.

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How To Reduce Stress

“AMERICA’S #1 Health Problem.” So reads the headline of an article published by the American Institute of Stress that claims the biggest threat to health today is neither cancer nor AIDS. The report says: “It has been estimated that 75-90 percent of all visits to primary care physicians are for stress related problems.”

It is no exaggeration to say that people today are being assaulted by stress. According to the National Consumers League, “work is the top source of stress for adults who have problems and stress in their lives (39%), followed by family (30%). Other sources include health (10%), concern about the economy (9%) and concern about international conflict and terrorism (4%).”

However, stress is hardly unique to the United States. A British survey in 2002 estimated that “over half a million individuals in Britain believed in 2001/2 that they were experiencing work-related stress at a level that was making them ill.” As a result of “work-related stress, depression or anxiety,” there are “an estimated thirteen and a half million reported lost working days per year in Britain.”
The picture is no less bleak in mainland Europe. According to the European Agency for Safety and Health at Work, “work-related stress has been shown to affect millions of European workers across all types of employment sectors.” One survey revealed that there are “about 41 million [European Union] workers affected by work-related stress each year.”

What about Asia? A report issued by a conference held in Tokyo concluded: “Job stress is a common concern among many countries in the world, both developing and industrialized countries.” The report observed that “several countries in East Asia, including China, Korea and Taiwan, have rapidly industrialized and economically grown. These countries now have a lot of concerns on job stress and its adverse effects on worker health.”
However there are a few things you can practically do to reduce Stress:
* Give your body sufficient rest each day
* Maintain a reasonable diet. Avoid overeating
* Engage in proper and regular exercise, such as brisk walking
* If something worries you, talk to a friend about it
* Spend more time enjoying your family
* Delegate or share household chores
* Know your own physical and emotional limitations
* Set realistic goals; do not be a perfectionist
* Be organized; have a balanced, reasonable schedule
* Cultivate godly qualities such as mildness and patience
* Set aside some time for yourself

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Identifying Different Types of Natural Healing Methods

Excluding regular medicine, the various types of natural healing includes all types of methods that contribute essentially to good health.

Now, the common and more popular ones are:
-Chiropraction
-Reflexology
-Hypnotherapy
-Reiki
-Ayurveda
-Massage

And this is naming just a few.

Still, natural healing can be classified into five major domains of practice: alternative medical systems, mind-body techniques, biologically based therapies, body-based therapies, and energy therapies and under each category, one will be able to find some common natural healing methods as indicated.

*Alternative Medical Systems:

-Traditional Chinese Medicine
-Ayurveda
-Homeopathy
-Naturopathy

Mind-Body Techniques

-Meditation
-Relaxation Techniques
-Guided Imagery
-Hypnotherapy
-Biofeedback

Biologically Based Therapies

-Herbal Medicine
-Orthomolecular Medicine

Body-Based Therapies

-Chiropractic
-Massage Therapy
-Rolfing
-Reflexology
-Postural Reeducation

Energy

Therapies

-Bioelectromagnetic-based Therapies
-Reiki
-Therapeutic Touch

So there you have it, the various forms of popular natural healing methods categorized under their parent categories.

At this point, it is safe to say that the plethora of choices does depict that indeed all of these methods are quite popular and documented statistics are showing that they are all indeed more or less effective, so suffice it to say one may be missing out by not looking into the several options.

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5 Ways To Identify The Best Diet

“Saying there’s one best diet for everyone is a little like saying there’s one best type of music for everyone,” Michael Dansinger, M.D., director of obesity research at the Atherosclerosis Research Laboratory at Tufts-New England Medical Center, says. People should consider a broad spectrum of options.

1) Cut The Easiest Calories First.

Eliminating the nonnutritive foods that are least important to you can have a major effect. Avoiding sugared soft drinks and juices and outsized baked goods, such as mega-bagels, alone could eliminate 500 to 1,000 calories a day from your body.

2) Choose A Safe Dietary Plan.

If you have any kind of medical condition, check with your doctor before starting a weight loss attempt, especially if you’re drawn to one of the more nutritionally extreme diets such as Atkins. Don’t strive for rapid weight loss. Losing more than 1 to 2 pounds a week can cause undesirable health effects, with the Medifast weight loss plan being the exception. Increase fiber intake gradually and drink a lot of water to avoid digestive upsets. Also, consider taking a multivitamin pill while you’re cutting the calories.

3) Consider Personal Preferences.

Someone who doesn’t like red meat will find Atkins very difficult to follow, and someone who does will probably find the vegetarian Ornish diet intolerable. Those who like variety may tire of the limited menu of a meal replacement diet.

4) Follow the Rules.

If the diet says to eat one half cup of rice, be sure to measure it in a measuring cup. If you’re supposed to eat a snack at 3 p.m. then eat it. The more faithfully people adhere to a diet, the more successful they will be.

5) Be Ready To Switch.

”You have to ‘date’ the diets and be ready to fail a few times before you find the right one that you can stick with. If after three weeks, you find a diet too difficult or unpleasant to follow or you are not losing weight then try another.

Whatever option you choose it’s very wise to seek personal support and encouragement. Surveys show that a counselor was second in effectiveness only to devising their own personal diet and exercise plan. Whether support is one-on-one or in group support behavioral support can help people lose weight. One of the largest diet studies ever conducted, involving more than 3,200 overweight people at high risk for diabetes, found that intensive counseling to support diet and exercise changes worked better than a drug to prevent diabetes and induce consistent weight loss.

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10 Slimming-Down Tactics You Cant Ignore

Rebecca Webber

The devil is in the details -- and nowhere is the cliché truer than with weight loss. It's the small decisions that add up to change, and that's a good thing, says William Dietz, MD, PhD, at the CDC: "If you can count it, you can change it." The 10 countable steps that follow will add up to victory over unwanted pounds. But don't try them all at once. "It's like renovating a house; most people do better taking one room at a time," says John Jakicic, PhD, director of weight management at the University of Pittsburgh. "Start with the easiest tactic. Once you master it, move on."

1. Weigh yourself one time per day
Why It Works
Weekly weigh-ins are a staple of many popular diet programs, but studies now show that daily weighing is the key to lasting loss. When researchers at the University of Minnesota monitored the scale habits of 1,800 dieting adults, they found that those who stepped on every day lost an average of 12 pounds over 2 years (weekly scale watchers lost only 6) and were less likely to regain lost weight. The reason: "The more often you monitor your results, the quicker you can catch the behavioral slip that causes weight gain," says Jakicic.

Who It Helped
Heidi Hurtz, 29, of Los Angeles: "I was in denial about my size, so I never used a scale. When I started weighing daily, I lost 7 pounds in 2 weeks. I loved the immediate gratification, and eventually lost 77 pounds."

Add It In
Step on the scale first thing every morning, when you weigh the least. Expect small day-to-day fluctuations because of bloating or dehydration, but if your weight creeps up by 2 percent (that's just 3 pounds if you weigh 150), it's time to pass up the bread.

2. Watch no more than 2 hours of TV a day
Why It Works
TV junkies miss out on calorie-burning activities like backyard tag with the kids; instead, they become sitting ducks for junk-food ads. One recent study found that adults who watch more than 2 hours of TV per day take in 7 percent more calories and consume more sugary snacks than those who watch less than an hour a day.

Who It Helped
Christy Taylor, 27, of Sylacauga, Ala: "TV was one reason I weighed 220 pounds. I watched it constantly. My blood pressure skyrocketed during pregnancy, and when it didn't come down after my son was born, I decided to try to limit myself to one show a day. That was 10 months ago, and I've since lost 32 pounds."

Add It In
Wean yourself off the tube by introducing other activities into your life. Eliminate the temptation to watch between-show filler by recording your must-see programs so you can fast-forward through the ads. Or subscribe to a mail order DVD service like Netflix, and make a movie the only thing you watch all day.

3. Contact a friend three times per week
Why It Works
"Long-term weight loss requires support," says Marion Franz, RD, a nutrition consultant in Minneapolis. Her study review found that people who met regularly with a dietitian or attended groups like Weight Watchers were more likely to maintain their losses than those who didn't.

Who It Helped
Maggie Ramos, 39, of Houston: "When I plateaued for months, my friend Nancy stepped in and cheered me on until I lost it all."

Add It In
If you can't attend group meetings, announce your weight loss intentions so friends can support you, says Franz. And add a dieter pal to your regular call or e-mail list, too.

4. Eat four grams of fiber in every meal or snack
Why It Works
A high-fiber diet can lower your caloric intake without making you feel deprived. In a recent Tufts University study, women who ate 13 g of fiber or less per day were five times as likely to be overweight as those who ate more fiber. Experts see a number of mechanisms through which fiber promotes weight loss: It may slow down eating because it requires more chewing, speed the passage of food through the digestive tract, and boost satiety hormones.

Who It Helped
Monique Hester, 41, of North Richland Hills, Texas. "I started a diet that had me consuming more than 25 grams of fiber daily, and before I knew it, I'd lost 23 pounds. I don't even like white bread anymore. I want something I can crunch and chew."

Add It In
To get 25 grams of fiber a day, make sure you eat six meals or snacks, each of which contains about 4 grams of fiber. For instance, Hester started her day with grapes (1 cup = 1.4 grams of fiber) and cracked wheat toast (two slices = 6 grams) or oatmeal (1 cup = 4 grams). She often had a cup of black bean soup for lunch (4.4 grams) with a slice of cracked wheat bread. One good trick: For to-go snacks, buy fruit; it's handier than vegetables, so it's an easy way to up your fiber intake. For instance, one large apple has just as much fiber (5 grams) as a cup of raw broccoli.

5. Take five (thousand) extra steps a day
Why It Works
A typical person takes about 5,000 steps per day between going to work, running errands, and doing chores around the house. Doubling that number can have significant health benefits: higher "good" HDL cholesterol levels, lower blood pressure, improved glucose control, and yes, a lower number on the scale. Walking more steps per day also leads to a lower percentage of body fat and slimmer waists and hips, reports a recent University of Tennessee study of 80 women. An earlier University of South Carolina study of 109 people showed that those who took fewer than 5,000 steps per day were, on average, heavier than people who took more than 9,000.

Who It Helped
Joanna Webb, 34, of Queen Creek, Ariz.: "I started walking when my daughter was 2 months old. I couldn't even make it around the block without stopping. I kept at it until I could walk 6 nights a week with my husband, our 5-year-old, and the baby. Now I've lost 35 pounds."

Add It In
Wear a pedometer to make sure you log your 5,000 extra steps, or aim for about 50 minutes of extra walking (2 1/2 miles) per day. In the Tennessee study, "Some of the women walked with friends; others increased their steps by taking the stairs and parking farther away," says lead researcher Dixie Thompson, PhD.

6. Log it six times per week Why It Works
"Monitoring your eating and exercise every day will let you know if you're reaching the 500-calorie daily deficit you need to lose about a pound a week," says Robert Carels, PhD, a psychology professor at Bowling Green State University. His study of 40 obese adults found that those who recorded their food and exercise over 6 months lost more than 20 pounds. That was nearly twice the amount shed by less consistent notetakers.

Who It Helped
Julie Fugett, 29, of Lawrence, Kan.: "Journaling was an important part of my program. I chronicled food intake using the Weight Watchers Points system and also printed out a monthly calendar to schedule workouts in advance. I'd mark each successful day of exercise with a purple smiley face, and eventually those stick-on grins added up to a 25-pound weight loss that I've maintained for over 2 years."

Add It In
Carry a small notebook or PDA to record what you eat and use a pedometer to estimate the calories you burn. Although you should try to keep a daily log, it's realistic to give yourself a break one day a week and allow time off for holidays and houseguests. "Then get back on track," says Carels.

7. Sleep seven hours a night
Why It Works
A University of Chicago study found that people deprived of Zzzs had lower levels of the hormones that control appetite. "The research suggested that short sleep durations could be a risk factor for obesity," says James Gangwisch, PhD, an epidemiologist from Columbia University Medical Center. Sure enough, his follow-up study of 9,588 Americans found that women who slept 4 hours or less per night were 234 percent more likely to be obese.

Who It Helped
Julia Havey, 44, of St. Louis: "I used to stay up late watching movies and eating ice cream. I'd have to wake up at 6AM, so I always felt exhausted and bloated. Now I make it a point to be in bed by 11PM. The extra sleep makes it easier for me to stick to my diet and exercise routine because I have more energy and fewer cravings."

Add It In
The key number for most people is 7 hours or more a night, says Gangwisch, so set an early bedtime and stick to it.

8. Drink eight glasses of water per day
Why It Works
Water is not just a thirst quencher --it actually speeds the body's metabolism. Researchers in Germany found that drinking two 8-ounce glasses of cold water increased their subjects' metabolic rate by 30 percent, and the effect persisted for 90 minutes. One-third of the boost came from the body's efforts to warm the water, but the rest was due to the work the body did to absorb it. "When drinking water, no calories are ingested but calories are used, unlike when drinking sodas, where additional calories are ingested and possibly stored," explains the lead researcher, Michael Boschmann, MD, of University Medicine Berlin.

Who It Helped
Paige Tomas, 25, of Corpus Christi, Texas: "I used to have a five-can-a-day Dr Pepper addiction. To stop, I'd make myself drink a whole glass of water before allowing myself a soda, and now I'm down to just two Diet Dr Peppers a day."

Add It In
Increasing water consumption to eight glasses per day may help you lose about 8 pounds in a year, says Boschmann, so try drinking a glass before meals and snacks and before consuming sweetened drinks or juices.

9. After a nine hour day (lunch included!), go home
Why It Works
A University of Helsinki study of 7,000 adults found that those who'd packed on pounds in the previous year were more likely to have logged overtime hours. Lack of time for diet and exercise is most likely the cause, but it's also possible that work stress has a direct effect on weight gain through changes in hormones like cortisol.

Who It Helped
Nicole Bruni, 36, of Milwaukee: "I gained about 35 pounds in my first year at my law firm, so I started making it a point to wrap up the day in time for a 6PM spinning class, and I've since lost 40 pounds."

Add It In
Set firm limits on your workday so that when you're done, you still have the oomph to take a bike ride and broil fish for dinner. To help you stay productive enough to finish on time, set an hourly alarm; when it goes off, deal with your most pressing duties.

10. Shave 10 points off your glycemic load
Why It Works
Foods high on the glycemic index --including sugars and refined carbohydrates -- cause blood sugar to spike. "The body uses insulin to bring down blood sugar," says Yunsheng Ma, MD, PhD, an assistant professor of medicine at the University of Massachusetts Medical School. The body stores the excess sugar as fat. But that leaves blood sugar levels low, so we feel hungry again and eat more -- an unhealthy cycle. Ma studied the eating patterns of 572 people and found that those who ate foods high on the glycemic index weighed significantly more than those who did not. "There's about a 10-pound body weight decrease for every 10-point drop in the glycemic index of all the food a person eats each day," he says.

Who It Helped
Jessica Seaberg, 28, of Minneapolis: "I eradicated most refined sugars from my diet and lost 65 pounds. I stick to whole grain bread, slow-cooking brown rice, and whole wheat pasta."

Add It In
Read labels to avoid added sugars, or better yet, eat fresh produce. Healthy swaps include a baked sweet potato (48 on the glycemic index) instead of a russet potato (94); grapes (49) instead of dates (103); pasta (45) instead of pizza (60); and Nutella (30) instead of jelly beans (80). And skip the liquid glucose known as juice.

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10 Slimming-Down Tactics You Cant Ignore

Rebecca Webber

The devil is in the details -- and nowhere is the cliché truer than with weight loss. It's the small decisions that add up to change, and that's a good thing, says William Dietz, MD, PhD, at the CDC: "If you can count it, you can change it." The 10 countable steps that follow will add up to victory over unwanted pounds. But don't try them all at once. "It's like renovating a house; most people do better taking one room at a time," says John Jakicic, PhD, director of weight management at the University of Pittsburgh. "Start with the easiest tactic. Once you master it, move on."

1. Weigh yourself one time per day
Why It Works
Weekly weigh-ins are a staple of many popular diet programs, but studies now show that daily weighing is the key to lasting loss. When researchers at the University of Minnesota monitored the scale habits of 1,800 dieting adults, they found that those who stepped on every day lost an average of 12 pounds over 2 years (weekly scale watchers lost only 6) and were less likely to regain lost weight. The reason: "The more often you monitor your results, the quicker you can catch the behavioral slip that causes weight gain," says Jakicic.

Who It Helped
Heidi Hurtz, 29, of Los Angeles: "I was in denial about my size, so I never used a scale. When I started weighing daily, I lost 7 pounds in 2 weeks. I loved the immediate gratification, and eventually lost 77 pounds."

Add It In
Step on the scale first thing every morning, when you weigh the least. Expect small day-to-day fluctuations because of bloating or dehydration, but if your weight creeps up by 2 percent (that's just 3 pounds if you weigh 150), it's time to pass up the bread.

2. Watch no more than 2 hours of TV a day
Why It Works
TV junkies miss out on calorie-burning activities like backyard tag with the kids; instead, they become sitting ducks for junk-food ads. One recent study found that adults who watch more than 2 hours of TV per day take in 7 percent more calories and consume more sugary snacks than those who watch less than an hour a day.

Who It Helped
Christy Taylor, 27, of Sylacauga, Ala: "TV was one reason I weighed 220 pounds. I watched it constantly. My blood pressure skyrocketed during pregnancy, and when it didn't come down after my son was born, I decided to try to limit myself to one show a day. That was 10 months ago, and I've since lost 32 pounds."

Add It In
Wean yourself off the tube by introducing other activities into your life. Eliminate the temptation to watch between-show filler by recording your must-see programs so you can fast-forward through the ads. Or subscribe to a mail order DVD service like Netflix, and make a movie the only thing you watch all day.

3. Contact a friend three times per week
Why It Works
"Long-term weight loss requires support," says Marion Franz, RD, a nutrition consultant in Minneapolis. Her study review found that people who met regularly with a dietitian or attended groups like Weight Watchers were more likely to maintain their losses than those who didn't.

Who It Helped
Maggie Ramos, 39, of Houston: "When I plateaued for months, my friend Nancy stepped in and cheered me on until I lost it all."

Add It In
If you can't attend group meetings, announce your weight loss intentions so friends can support you, says Franz. And add a dieter pal to your regular call or e-mail list, too.

4. Eat four grams of fiber in every meal or snack
Why It Works
A high-fiber diet can lower your caloric intake without making you feel deprived. In a recent Tufts University study, women who ate 13 g of fiber or less per day were five times as likely to be overweight as those who ate more fiber. Experts see a number of mechanisms through which fiber promotes weight loss: It may slow down eating because it requires more chewing, speed the passage of food through the digestive tract, and boost satiety hormones.

Who It Helped
Monique Hester, 41, of North Richland Hills, Texas. "I started a diet that had me consuming more than 25 grams of fiber daily, and before I knew it, I'd lost 23 pounds. I don't even like white bread anymore. I want something I can crunch and chew."

Add It In
To get 25 grams of fiber a day, make sure you eat six meals or snacks, each of which contains about 4 grams of fiber. For instance, Hester started her day with grapes (1 cup = 1.4 grams of fiber) and cracked wheat toast (two slices = 6 grams) or oatmeal (1 cup = 4 grams). She often had a cup of black bean soup for lunch (4.4 grams) with a slice of cracked wheat bread. One good trick: For to-go snacks, buy fruit; it's handier than vegetables, so it's an easy way to up your fiber intake. For instance, one large apple has just as much fiber (5 grams) as a cup of raw broccoli.

5. Take five (thousand) extra steps a day
Why It Works
A typical person takes about 5,000 steps per day between going to work, running errands, and doing chores around the house. Doubling that number can have significant health benefits: higher "good" HDL cholesterol levels, lower blood pressure, improved glucose control, and yes, a lower number on the scale. Walking more steps per day also leads to a lower percentage of body fat and slimmer waists and hips, reports a recent University of Tennessee study of 80 women. An earlier University of South Carolina study of 109 people showed that those who took fewer than 5,000 steps per day were, on average, heavier than people who took more than 9,000.

Who It Helped
Joanna Webb, 34, of Queen Creek, Ariz.: "I started walking when my daughter was 2 months old. I couldn't even make it around the block without stopping. I kept at it until I could walk 6 nights a week with my husband, our 5-year-old, and the baby. Now I've lost 35 pounds."

Add It In
Wear a pedometer to make sure you log your 5,000 extra steps, or aim for about 50 minutes of extra walking (2 1/2 miles) per day. In the Tennessee study, "Some of the women walked with friends; others increased their steps by taking the stairs and parking farther away," says lead researcher Dixie Thompson, PhD.

6. Log it six times per week Why It Works
"Monitoring your eating and exercise every day will let you know if you're reaching the 500-calorie daily deficit you need to lose about a pound a week," says Robert Carels, PhD, a psychology professor at Bowling Green State University. His study of 40 obese adults found that those who recorded their food and exercise over 6 months lost more than 20 pounds. That was nearly twice the amount shed by less consistent notetakers.

Who It Helped
Julie Fugett, 29, of Lawrence, Kan.: "Journaling was an important part of my program. I chronicled food intake using the Weight Watchers Points system and also printed out a monthly calendar to schedule workouts in advance. I'd mark each successful day of exercise with a purple smiley face, and eventually those stick-on grins added up to a 25-pound weight loss that I've maintained for over 2 years."

Add It In
Carry a small notebook or PDA to record what you eat and use a pedometer to estimate the calories you burn. Although you should try to keep a daily log, it's realistic to give yourself a break one day a week and allow time off for holidays and houseguests. "Then get back on track," says Carels.

7. Sleep seven hours a night
Why It Works
A University of Chicago study found that people deprived of Zzzs had lower levels of the hormones that control appetite. "The research suggested that short sleep durations could be a risk factor for obesity," says James Gangwisch, PhD, an epidemiologist from Columbia University Medical Center. Sure enough, his follow-up study of 9,588 Americans found that women who slept 4 hours or less per night were 234 percent more likely to be obese.

Who It Helped
Julia Havey, 44, of St. Louis: "I used to stay up late watching movies and eating ice cream. I'd have to wake up at 6AM, so I always felt exhausted and bloated. Now I make it a point to be in bed by 11PM. The extra sleep makes it easier for me to stick to my diet and exercise routine because I have more energy and fewer cravings."

Add It In
The key number for most people is 7 hours or more a night, says Gangwisch, so set an early bedtime and stick to it.

8. Drink eight glasses of water per day
Why It Works
Water is not just a thirst quencher --it actually speeds the body's metabolism. Researchers in Germany found that drinking two 8-ounce glasses of cold water increased their subjects' metabolic rate by 30 percent, and the effect persisted for 90 minutes. One-third of the boost came from the body's efforts to warm the water, but the rest was due to the work the body did to absorb it. "When drinking water, no calories are ingested but calories are used, unlike when drinking sodas, where additional calories are ingested and possibly stored," explains the lead researcher, Michael Boschmann, MD, of University Medicine Berlin.

Who It Helped
Paige Tomas, 25, of Corpus Christi, Texas: "I used to have a five-can-a-day Dr Pepper addiction. To stop, I'd make myself drink a whole glass of water before allowing myself a soda, and now I'm down to just two Diet Dr Peppers a day."

Add It In
Increasing water consumption to eight glasses per day may help you lose about 8 pounds in a year, says Boschmann, so try drinking a glass before meals and snacks and before consuming sweetened drinks or juices.

9. After a nine hour day (lunch included!), go home
Why It Works
A University of Helsinki study of 7,000 adults found that those who'd packed on pounds in the previous year were more likely to have logged overtime hours. Lack of time for diet and exercise is most likely the cause, but it's also possible that work stress has a direct effect on weight gain through changes in hormones like cortisol.

Who It Helped
Nicole Bruni, 36, of Milwaukee: "I gained about 35 pounds in my first year at my law firm, so I started making it a point to wrap up the day in time for a 6PM spinning class, and I've since lost 40 pounds."

Add It In
Set firm limits on your workday so that when you're done, you still have the oomph to take a bike ride and broil fish for dinner. To help you stay productive enough to finish on time, set an hourly alarm; when it goes off, deal with your most pressing duties.

10. Shave 10 points off your glycemic load
Why It Works
Foods high on the glycemic index --including sugars and refined carbohydrates -- cause blood sugar to spike. "The body uses insulin to bring down blood sugar," says Yunsheng Ma, MD, PhD, an assistant professor of medicine at the University of Massachusetts Medical School. The body stores the excess sugar as fat. But that leaves blood sugar levels low, so we feel hungry again and eat more -- an unhealthy cycle. Ma studied the eating patterns of 572 people and found that those who ate foods high on the glycemic index weighed significantly more than those who did not. "There's about a 10-pound body weight decrease for every 10-point drop in the glycemic index of all the food a person eats each day," he says.

Who It Helped
Jessica Seaberg, 28, of Minneapolis: "I eradicated most refined sugars from my diet and lost 65 pounds. I stick to whole grain bread, slow-cooking brown rice, and whole wheat pasta."

Add It In
Read labels to avoid added sugars, or better yet, eat fresh produce. Healthy swaps include a baked sweet potato (48 on the glycemic index) instead of a russet potato (94); grapes (49) instead of dates (103); pasta (45) instead of pizza (60); and Nutella (30) instead of jelly beans (80). And skip the liquid glucose known as juice.

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Use of Local Estrogen for Treatment of Vaginal Atrophy in Postmenopausal Women

An evaluation of the safety and effectiveness of local vaginal estrogen therapy for the treatment of vaginal atrophy, a frequent complaint of postmenopausal women, has just been released by The North American Menopause Society (NAMS). Entitled "The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society," the document was developed by an Editorial Board of five clinicians and researchers expert in this area of women's health, then approved by the NAMS Board of Trustees.

"Although hot flashes typically accompany the loss of ovarian estrogen production at menopause, they usually abate over time regardless of whether estrogen therapy is used," said Gloria A. Bachmann, MD, Associate Dean for Women's Health, Professor of Obstetrics and Gynecology and Professor of Medicine, UMDNJ, Robert Wood Johnson Medical School, New Brunswick, NJ, and Chair of the Editorial Board. "In contrast, vaginal symptoms (eg, vaginal dryness, vulvovaginal irritation and itching, and painful intercourse) are usually progressive and unlikely to resolve spontaneously. Left untreated, vaginal atrophy can result in years of discomfort, with a significant impact on quality of life. An estimated 10% to 40% of postmenopausal women have symptoms related to vaginal atrophy, yet only about 25% of symptomatic women seek medical help."

The new position statement represents the most authoritative state-of-the-science summary. Significant findings include:

-- Estrogen therapy, used either locally (ie, vaginally) or systemically (eg, orally, through the skin), is considered the therapeutic standard for moderate to severe vaginal atrophy.

-- Local vaginal delivery of estrogen is available in North America in government-approved therapies via cream, tablet, and ring--with fewer systemic effects than estrogen by topical, parenteral, or oral delivery.

-- Randomized controlled trials, although limited, have shown that low-dose, local vaginal estrogen delivery is effective and well tolerated for treating vaginal atrophy.

-- All the low-dose vaginal estrogen products approved in the United States for treatment of vaginal atrophy are equally effective at the doses recommended in labeling. Choice of therapy should be guided by clinical experience and patient preference.

-- Progestogen is generally not indicated when low-dose estrogen is used locally for vaginal atrophy.

-- Data are insignificant to recommend annual surveillance of the endometrium (lining of uterus) in asymptomatic women using vaginal estrogen.

-- Vaginal estrogen therapy should be continued for as long as symptoms that are distressing to the patient remain.

-- For women treated for non-hormone-dependent cancer, management of vaginal atrophy is similar to that for women without a cancer history.

-- For women with a history of hormone-dependent cancer, management recommendations are dependent upon each woman's preference in consultation with her oncologist.

The position statement is published in the May/June 2007 issue of the Society's official journal, Menopause. It has been designated a NAMS CME activity (print/online). A PDF of the paper, as well as a set of nine slides that summarize the paper's contents, are available without charge from the NAMS Web site (http://www.menopause.org/aboutmeno/consensus.htm).

NAMS is grateful to Novo Nordisk, Inc., for its educational grant that supported development of this statement.

The Mission of NAMS, a nonprofit scientific organization, is to promote the health and quality of life of women through an understanding of menopause. The Society's membership of 2,000 professionals representing a variety of disciplines--including clinical and basic science experts from medicine, nursing, pharmacy, anthropology, sociology, psychology, and complementary/alternative medicine--makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause. (www.menopause.org)

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Eating Fruits And Veggies To Reduce The Risks Of Cancer

Daisy Whitney

Remember when your mom told you to eat your vegetables? When you couldn't get up from the table until you'd finished your broccoli, peas and carrots? When there was no dessert until you ate your green beans?

It seems that mom might have been on to something.

That's because fruits and vegetables have been shown to be among the best means to reduce the risk of cancer and other diseases. According to the Produce for a Better Health Foundation, "deeply hued fruits and vegetables provide the wide range of vitamins, minerals, fiber, and phytochemicals your body needs to maintain good health and energy levels, protect against the effects of aging, and reduce the risk of cancer and heart disease.

Of course, there aren't any fail-safe methods to ward off cancer, but most experts agree that cutting down risk factors, like not smoking and choosing to eat better foods, are our best bets to fight the disease. Here's a simple guide on why you need to eat your fruits and vegetables and how to shop for food by color.

The Secret is in Phytochemicals

Eating healthy means piling fruits and veggies on your plate because they contain phytochemicals that can help prevent cancer. Phytochemicals fight destructive cancer-causing cells, said Karen Collins, a registered dietitian and nutrition advisor to the American Institute for Cancer Research (AIRC) in Washington, D.C, in a recent Oakland Tribune interview.

Phytochemicals are natural compounds found in plant-based foods like dark green vegetables, citrus, berries, nuts and other fruits and vegetables. Collins explained that there is not a single secret ingredient, fruit or vegetable that can do it alone though. So, don't go hog wild on just blueberries, since each phytochemcial has its own job. "You need a broad variety of phytochemcials," she said.

"One month you hear spinach or apples [or blueberries] are good. You can't eat all blueberries and give up green vegetables," she said. "There are so many different foods that have wonderful health benefits. It's the variety that's the message. It's variety and making this whole broad category of fruits and vegetables the centerpiece of your diet…no one food can do it." To get the full range of phytochemicals needed in your diet, the AIRC recommends reversing the portions on the dinner plate, and the lunch and breakfast plate too, that Americans have become accustomed to. Animal meat should occupy one-third or less of the plate, while fruits and vegetables should command the lion's share of the plate.

They do double duty too. Not only can a plant- and fruit-based diet help ward off the possibility of cancer, it's also ideal for fighting other chronic illnesses like heart disease and diabetes. A diet rich in whole foods, like fruits, vegetables and whole grains will infuse the body with healthy substances to reduce the risks of disease.

Such a diet is also a healthy way to control weight, Collins said. "There are so many different foods that have wonderful health benefits."

Shop By the Rainbow

That's why it's helpful to think about shopping by color. Look for purple and blue food like blackberries, purple grapes and eggplant for health-promoting phytochemicals. Such foods are also being studied for their anti-aging benefits, said the Produce for a Better Health Foundation. In the green category, go for avocados, green apples and asparagus, for instance. Think red and opt for cherries, strawberries and beets. Don't forget orange and yellow foods like apricots, peaches, and yellow peppers. Finally, make sure to get white foods too, like bananas, cauliflower and even mushrooms.

Above all, eat healthy, exercise and drink plenty of fluids, said Tinrin Chew, a registered dietician specializing in cancer nutrition in Berkeley, Calif.

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6 Reasons Why You Should Eat Sea Foods

Although the link between seafood consumption and improved health has been known for decades, a number of recent studies are shedding new light on the many health benefits of the omega-3 fatty acids found in fish. Considered essential nutrients because the body does not make them, omega-3 fatty acids are fundamental molecules in the structure and activity of cell membranes, especially in the brain and retina of the eye.

The following summarizes some important research findings that show the omega-3 fatty acids in fish play a major health role at every stage of life, from healthy infant development through the prevention and management of certain diseases and chronic conditions that may appear later on.

1. Benefits for the Developing Infant

New Findings from Harvard Medical School

When it comes to the developing fetus, extensive research shows that one of the essential omega-3 fatty acids in fish - DHA (docosahexaenoic acid) - is a critical component for building brain tissue, for nerve growth, and for the retina. In fact, research finds that when babies are developing during the last third of pregnancy, the brain and nervous system rapidly accumulate DHA. Before birth, babies get the DHA they need from their mother. After birth they obtain it mainly from breast milk.

However, a new study by researchers at Harvard Medical School now finds that the importance of DHA to the developing brain is significant during the second trimester of pregnancy. According to a research article - Maternal Fish Consumption, Hair Mercury, and Infant Cognition in a U.S. Cohort - published in the October 2005 issue of Environmental Health Perspectives, the study of 135 mothers and their infants reported that the greater a woman's fish intake during the second trimester, the better her 6-month-old performed on a standard test of mental development. Overall, babies' scores on the test climbed by 4 points for each weekly serving of fish their mothers had during the second trimester, after findings were adjusted for maternal hair mercury and other confounding factors. Examining the impact of mercury, the study found that elevated maternal mercury levels were associated with deficits in infant cognition, but in spite of that, greater fish consumption was associated with better cognition. These results suggest that higher consumption of fish low in mercury is beneficial for infant cognition.

New Data from the National Institute of Environmental Health Sciences (NIEHS)

In July 2004, researchers with the National Institute of Environmental Health Sciences (NIEHS) published a research article in the Journal of Epidemiology based on assessing the fish intake of more than 7,400 mothers in the United Kingdom and found that those who ate fish regularly during pregnancy had children with better language and communication skills by the age of 18 months. Using standard tests of language, comprehension, motor and social skills to assess childhood development at 15 and 18 months, the study found a subtle but consistent link between eating fish during pregnancy and a child's early cognitive development, even after adjusting for factors such as the age and education of the mother, whether she breastfed, and the quality of the home environment. Moreover, the study revealed that the amount of fish associated with these cognitive benefits was one to three servings a week, which is consistent with the advice of the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) that pregnant women should eat up to 12 ounces a week of fish low in mercury.

2. Benefits for Young Children

Findings from Child Asthma Prevention Study

Recent study findings from the Childhood Asthma Prevention Study in Australia also reported that the consumption of omega-3 fatty acids was linked to a reduction in asthma symptoms in children. Published in the October 2004 issue of the Journal of Allergy & Clinical Immunology and conducted by researchers at the University of Sydney, the study examined 616 children at high risk for developing asthma and found that those children whose diets were high in omega-3 fatty acids were much less likely to develop a cough, one of the major triggers for asthma attacks. Moreover, the study concluded that increasing the proportion of omega-3 fatty acids in the diet significantly reduced airway inflammation in children as young as age 3. Other research has found omega-3 fatty acids to be beneficial in other lung diseases such as cystic fibrosis.

3. Omega-3 Fatty Acids and Women's Health

Lower Prevalence of Postpartum Depression

Because the omega-3 fatty acids in fish enhance the ability of brain-receptors to comprehend mood-related signals from the brain, some researchers have observed that the likelihood of having depressive symptoms is significantly higher among infrequent fish consumers than among habitual fish eaters. This includes postpartum depression, where a 1998 study published in the Lancet, found that women in 23 countries whose breast milk was rich in omega-3 fatty acids because they had consumed fatty fish were less likely to suffer from this condition. Researchers noted that there was an inverse relationship between the consumption of fatty fish and the occurrence of postpartum depression. That means that women eating fatty fish were less likely to develop post partum depression.

Lower Risk of Breast Cancer

At a time when more than 40,000 American women die each year from breast cancer, the "Singapore Chinese Health Study" published in the May 2004 issue of the British Journal of Cancer found that postmenopausal women who ate more fish had a 26 percent lower risk of developing the disease. Conducted by researchers at the Keck School of Medicine at the University of Southern California and the National University of Singapore, the study examined the eating habits of 35,298 women aged 45 to 74 years over a five-year period and found that those who consumed an average of one and a half to 3 ounces of fish and shellfish daily were 30 percent less likely to develop breast cancer than women who ate less than one ounce of fish a day. Based on these observations, the study authors suggested that eating approximately 40 grams of seafood a day - about 10 ounces of fish a week - could reduce breast cancer risk by 25 percent. As a comparison, the average American consumes less than 5 ounces of seafood per week according to National Marine Fisheries data.

4. Reducing the Risk of Heart Disease and Stroke

Protection Against Heart Disease

The cardiovascular benefits of omega-3 fatty acids have been documented in many prospective studies and randomized clinical trials. For example, the findings of a small clinical trial published in the Annals of Internal Medicine found that patients who were given fish oil concentrate for two years had lower triglyceride levels and minimal artery blockage when compared to those receiving a placebo. Moreover, in a 1998 issue of Diabetes Care, a meta-analysis of studies on diabetes and fish oils found a 30 percent reduction in patient triglyceride levels, particularly among subjects with Type I diabetes who are at greatly increased risk of heart disease than people without the disease.

Along with these smaller studies, there have been a number of large trials reporting that omega-3 fatty acids in fish provide a protective mechanism of reducing the risk of irregular heartbeats. One major study called the GISSI-Prevenzione secondary prevention trial is particularly noteworthy. Reported in 2002 in the journal Circulation, this study of 11,323 subjects who survived their first heart attack demonstrated that even a small amount (about one gram a day) of the omega-3 fatty acids found in fish was effective in cutting the chance of cardiac death by 45 percent-nearly half.

Preventing Stroke

Although less is known about the relationship between the omega-3 fatty acids in fish and the prevention of stroke, findings from the Nurses Health Study, which were published in the January 23, 2001 issue of the Journal of the American Medical Association, found that women who ate fish more than once per month had a lower risk of stroke when compared with those who ate fish less than once a month. Moreover, women who ate fish two or more times per week had a significantly reduced risk of thrombotic infarction, the type of stroke most common in the U.S. Fish consumption is also linked to lower risk of stroke in men according to a major epidemiological study.

New Conclusions in 2005 Dietary Guidelines for Americans

Based in part on this body of evidence, the 2005 Dietary Guidelines for Americans recommend that Americans aged two and over get two eight-ounce servings a week of foods rich in the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). In making this recommendation, the 13-member 2005 Dietary Guidelines Advisory Committee whose scientific review formed the basis for updating the government's nutrition advice, concluded that higher levels of EPA and DHA are associated with the reduced risk of both sudden death and death from coronary heart disease in adults. Specifically, the Dietary Guidelines Advisory Committee estimates that there could be a 30 percent reduction in coronary deaths if people increased their intake of omega-3 fatty acids.

5. Improved Eye Function

Age-related macular degeneration (AMD) is a leading cause of loss of vision in older persons in developed countries. Although the exact causes of AMD are still unknown, many researchers believe that certain nutrients, such as the omega-3 fatty acids in fish, help lower the risk for AMD or slow down its progression. Towards this end, the August 2001 issue of Archives of Ophthalmology reported findings that consumption of omega-3 fatty acids had a protective effect against advanced macular degeneration. The Age-Related Eye Disease Study (AREDS) confirmed this finding in 2003. In this case-control study of 4,513 participants aged 60 to 80 years at enrollment, total fish consumption of more than two servings per week was associated with a decreased risk for AMD compared with no fish in the diet.

6. Improved Brain Function

Halting Mental Decline Later in Life

Growing scientific evidence now suggests that the omega-3 fatty acids found in seafood improve brain function in middle aged people and may actually lower the risk of mental impairment as people age. The latest research comes from researchers with Utrecht and Maastricht Universities in the Netherlands and was published in the journal Neurology in 2004. Tracking more than 1,600 Dutch men and women aged 45 to 70 over a six-year period, the researchers found that those who ate fish regularly scored higher on a battery of tests for memory, psychomotor speed, cognitive flexibility, and overall cognition. Moreover, the study concluded that the specific factors contributing to better brain function were fatty fish and the consumption of two essential omega-3 fatty acids found in canned tuna, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).

Slowing the Progression of Alzheimer's Disease

Reported in the September 2, 2005 issue of the journal Neuron, neuroscientists at UCLA showed for the first time, in animals with Alzheimer's disease, that a diet high in DHA helps protect the brain against the memory loss and cell damage caused by the condition, which now affects an estimated 4.5 million Americans. In the study, the researchers bred mice with genetic mutations that cause the brain lesions linked to advanced Alzheimer's disease. When the mice aged and showed brain lesions but displayed no major loss of brain-cell activity, the scientists then fed one group a diet high in omega-3 fatty acids and the other a diet depleted of these fatty acids. After five months, the researchers compared each set of mice to a control group without the disease and found extensive synaptic damage in the brain cells of the Alzheimer's mice that ate the DHA-depleted diet, but not in those consuming DHA.

Controlling Epilepsy

At a time when an estimated 2.5 million Americans have been diagnosed with epilepsy, new research from the Emory University School of Medicine finds that people with a common type of seizure (refractory complex partial seizures) often have significantly lower amounts of the omega-3 fatty acid DHA (docosahexaenoic acid) in their blood. Because this form of epilepsy is often resistant to drug treatment, the researchers suggest that an important way to control these seizures may be as simple as consuming more foods rich in DHA. These preliminary findings suggest another area of brain function that might be linked to omega-3 fatty acids that warrants additional investigation.

Therapeutic Effect on Depression

A growing body of research finds a connection between the intake of omega-3 fatty acids and a lower prevalence of depression. This is because the brain and central nervous system contain high levels of DHA and EPA to keep the pattern of thoughts, reactions, and reflexes running smoothly and efficiently. Although the precise mechanisms by which these omega-3 fatty acids regulate mood are unknown, a number of studies on omega-3 fatty acids and mood have reported positive outcomes. In a 2002 study published in the American Journal of Psychiatry, researchers showed that 2 grams of EPA could improve the symptoms of treatment-resistant depression. The researchers found that the EPA (versus placebo), when added to an ineffective antidepressant for one month, significantly improved depressive symptoms. A larger study published in Archives of General Psychiatry in 2002 confirmed these findings using a daily dose of 1 gram of EPA, and noted significant improvements in depressive symptoms, sleep, anxiety, lassitude, libido, and thoughts of suicide.

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Meeting Your Body's Daily Minerals And Vitamins Needs

Of course, you eat a balanced diet. That's why you're sure you get all the nutrients you need.

Just yesterday, for example, you had--oh, well, you skipped breakfast because you were in a hurry, then grabbed a fast-food lunch. For dinner--who has the energy to make dinner?--you zapped a frozen entrée and rewarded yourself with a cappuccino-mix coffee and mini chocolate chip cookies.

Like many of us, you probably have days when you eat more healthfully--having a salad with your meals and fresh fruit for snacks or dessert. But how regularly does your daily menu include the 1-1/2 cups of fruit, 2 to 2-1/2 cups of vegetables, 3 cups of fat-free or lowfat milk, 3 ounces of whole-grain foods and 5 ounces of meat or beans that the U. S. Department of Agriculture now recommends for most women?¹ (In April 2005, these new guidelines replaced the old food pyramid requirements. To see the new food pyramid and new dietary recommendations, visit www.mypyramid.gov .)

Our eating habits, aging, even how much sunlight we get, all affect how well we meet our bodies' daily nutrient needs. As a result, many women are deficient in one or more important micronutrients, such as vitamins A, B6, B12, C, D, E, folate (folic acid) and calcium. Having lower levels of these means greater risk for cardiovascular and other chronic diseases, certain cancers, bone fractures, and more.²

Getting the right balance

In middle age and beyond, it's important to give your body the vitamins and minerals that support good health.³ The best way to do that is by eating a balanced diet, with a variety of foods, minimal alcohol, and plenty of fruits, vegetables and fiber, says Marian Neuhouser, Ph.D., R.D., a nutritional epidemiologist and cancer prevention expert at the Fred Hutchinson Cancer Research Center in Seattle.

Yet that ideal is rarely achieved. "Almost all Americans are deficient in fruit and vegetable intake," Dr. Neuhouser says.

Indeed, research⁴ shows that most of us don't get all the vitamins we need through diet alone. Taking a daily multivitamin helps close that gap. "Even if you don't remember to take it every day, if you take it most days of the week, it's still a good investment in your health," says nutritionist Jo-Anne M. Rizzotto, M.Ed., R.D., L.D.N., C.D.E., Joslin Diabetes Center, Boston.

Change happens

As we age, our bodies may have difficulty absorbing and using certain nutrients that occur naturally in foods. However, very little is known about which individuals may be at nutritional risk from these changes. Because vitamin B12 absorption and utilization may be particularly problematic for some older individuals, the IOM has recommended that everyone over age 50 get their daily requirement by consuming foods specially fortified with vitamin B12, such as some cereals, or by taking a multivitamin supplement that includes B-12, notes Dr. Neuhouser.⁵

Similarly, levels of vitamin D--which the skin produces from ultraviolet light--often drop with age. This could be due to limited sun exposure, the skin's declining ability to make the vitamin, as well as low intake of foods containing vitamin D. "Increasing sun exposure and ensuring adequate vitamin D, whether by food or supplements, will optimize vitamin D status," Dr. Neuhouser says.

Calcium also shows an age-related decline in postmenopausal women, in addition to the drop that occurs at menopause.⁶

What you're not getting--or getting too much of--could hurt you

There's reason to be concerned about your vitamin and mineral intake. Here's a brief run-down on some key micronutrients:

• Vitamin A--helps immune function⁷, but a high intake (3,000 or more mcg. daily) may lead to hip fractures.⁸
  
• Vitamin B6-- may help manage depression and anxiety;⁹ in combination with folate, may reduce heart disease risk.¹⁰
  
• Vitamin B12--deficiency of B12 and folate may lead to development of Alzheimer's disease;¹¹ reduced B12 may cause anemias, neuropsychiatric disorders,¹² and lower bone mineral density;¹³ combined with folate, reduces coronary heart disease.¹⁴
  
• Vitamin C--potent antioxidant needed for body function, helps counteract some effects of smoking, but its role in lowering the risk of chronic disease is still unknown,¹⁵ as is whether it can help prevent the common cold.
  
• Vitamin D--deficiency may lead to osteoporosis, rheumatoid arthritis, multiple sclerosis, cancers and more;¹⁶ protects against fractures¹⁷ and falls;¹⁸ boosts absorption of calcium for protection against osteoporosis.¹⁹
  
• Vitamin E--inhibits cancer cell growth, may reduce risks of other chronic diseases;²⁰ controls cholesterol;²¹ despite high hopes, does not slow progression to Alzheimer's disease.²²
  
• Folate--low levels may increase risk for vascular disease, cancer and cognitive decline, while too much may mask B12 deficiency (so take multivitamin supplement that contains both);²³ may reduce breast cancer risk in women who are moderate drinkers²⁴
  
• Calcium--vital for preventing osteoporosis,²⁵ low intake may also contribute to risk of stroke in middle-aged women.²⁶

What's in your multivitamin?

The shelves of discount stores and drug chains are crammed with a dizzying number of multivitamin offerings. Your vitamin needs as a woman at midlife or later are different than for adolescents or men.

Rizzotto advises choosing multivitamins especially formulated for women over 50. Such supplements usually meet women's needs during all stages of menopause. Be sure to compare the vitamin amounts shown on the supplement label with these Dietary Reference Intake (DRI) recommendations from the IOM*:

	Women, 19-50	Women, 51-70	Women, 70 >
Vitamin A	700 mcg.	700 mcg.	700 mcg.
Vitamin B6	1.3 mg.	1.5 mg.	1.5 mg.
Vitamin B12	2.4 mcg.	2.4 mcg.**	2.4 mcg.**
Vitamin C	75 mg.	75 mg.	75 mg.
Vitamin D***	5 mcg. (200 IU)	10 mcg. (400 IU)	15 mcg. (600 IU)
Vitamin E	15 mg.	15 mg.	15 mg.
Folate (folic acid)	400 mcg.	400 mcg.	400 mcg.
Calcium	1,000 mg.	1,200 mg.	1,200 mg.
Iron	18 mg.	8 mg.	8 mg.

*The above amounts represent 100 percent of the daily value of each nutrient. Use this amount to compare with the daily value information on a supplement label.
**Due to age-related modest decreases in the ability to use the B12 from natural sources, fortified foods or supplements can help to meet the recommendation.
***In the absence of adequate exposure to sunlight.

To see the complete list of Dietary Reference Intake (DRI) levels for women, visit the IOM site at http://www.iom.edu/project.asp?id=4574 .

Tips on vitamin supplements

• Read the label carefully. All vitamin formulations are not the same.
  
• Make sure you understand what the "serving size" is. Some vitamin labels show a nutrient list for a "serving size" of two tablets or capsules. It's easy to mistakenly think that list shows the vitamin amounts in one tablet.
  
• Check the expiration date. Make sure you'll use the contents before you reach that date.
  
• Store supplements in a cool, dry place--not the bathroom.
  
• As with all medication, keep supplements away from children, in a locked or secure location.
  
• Supplements lose strength quickly in hot, humid climates. Air conditioning helps protect them.
  
• Your body can only absorb about 500 mg. of calcium at a time, Rizzotto says, so take it in separate doses, at different times, to get your full daily requirement. Avoid taking with iron-containing foods or supplements. She advises taking one dose at bedtime, when you're not eating anything that would interfere with absorption.
  
• More than 100% of a vitamin's daily DRI is not necessarily better. Avoid the dangers that megadoses may cause by consulting the recommended tolerable upper intake levels contained in the IOM Dietary Reference Intakes Table ( http://www.iom.edu).

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