Women Should Adjust Nutrition after Menopause

As children, we all heard our parents say, “Eat your fruits and vegetables – they’ll make you healthy and strong.” It was good advice then and could be life-saving today, especially for women. Poor nutrition is implicated as a contributing factor in 5 of the 10 leading causes of death in women – coronary heart disease, cancer, stroke, diabetes, and diseases of the liver and kidneys. It’s also a key factor in osteoporosis (thinning of the bones), putting women especially at risk for fractures of the hip, wrist, back and other bones.

As female “baby boomers” enter midlife in record numbers, more and more of them are becoming aware of the link between what they eat and their health and longevity, says Joan Pleuss, RD, MS, CDE, CD. She is Bionutrition Research Manager at the Medical College of Wisconsin’s General Clinical Research Center.

“Women, especially as they reach menopause, need to reassess their nutrition,” Pleuss says. “As we age, a number of issues emerge that require changes in the nutrients we need.”

For example, metabolism starts to slow down in midlife, she says. Bone mass begins to decrease, and bones become more brittle. Exposure to sunlight triggers vitamin D synthesis in the skin, but older women don’t convert sunlight into essential vitamin D as efficiently as they did when they were younger, nor do they process another essential vitamin – B-12 – as well as they once did.

Good Diet Best, But Some Supplements Can Help
Nevertheless, Pleuss says, women of all ages should strive to get the nutrients they need the old-fashioned way – “by eating a healthy diet with servings from all food groups.”

The federal government’s general Dietary Guidelines for Americans describe a healthful diet this way: “Start with plenty of breads, cereals, rice, pasta, vegetables, and fruits. Add 2 to3 servings from the milk group and 2 to 3 servings from the meat group. Remember to go easy on fats, oils and sweets, the foods in the small tip of the Pyramid,” it says, referring to the government’s Food Guide Pyramid.

Pleuss realizes that few Americans actually fulfill those recommended guidelines, since the typical American diet is too high in fat and sugar, and too low in fiber, fruit and vegetables.

In addition to altering their diets, women often need to increase their physical activity level and add supplementary vitamins and minerals.

“I think a multivitamin is a good idea for all women,” she says. “Older women have increased need for additional calcium, vitamin D and vitamin B-12. Taking a multivitamin together with good food choices ensures women that they are meeting the current dietary recommendations.”

Calcium
After 50, women need more calcium than women 25 to 50 require, Pleuss says. “The recommended amount of calcium for post-menopausal women to maintain bone strength is between 1,200 and 1,500 milligrams a day – the same amount girls and young women need to build bones.”

In dietary form, older women can fulfill their increased demands for calcium by drinking enough milk (an 8-ounce glass contains 300 milligrams of calcium). They can also get 300 milligrams of calcium by eating an 8-ounce cup of yogurt or 1 to 2 ounces of cheese. Some brands of orange juice are fortified with calcium, in the same amount per serving as milk, yogurt or cheese.

Vitamin D
Women 50 to 70 years old should consume 400 international units (IU) of vitamin D daily, Pleuss says. Women over 70 need even more; the recommended amount is 600 IU daily.

Most multivitamins provide 100% of the recommended amount of vitamin D. A glass of milk provides 100 IU of vitamin D, but vitamin D is not available in yogurt or cheese. Pleuss also recommends that women choose low-fat or non-fat milk, yogurt and cheese. Cardiovascular disease and some cancers are thought to be related to diets that are too high in fat. Obesity and overweight may account for 20% of all cancer deaths in US women and 14% in US men, American Cancer Society researchers said in a study published in April in the New England Journal of Medicine.

Vitamin B-12
It is recommended that older women get 2.4 micrograms of vitamin B-12 daily, Pleuss says. “This vitamin is present in all animal products, but in a form the body needs to break down – and that process is less efficient in older women.” Most multivitamins provide at least 2 micrograms of vitamin B-12.

“Women’s” Foods and Vitamins Not Needed
What about those vitamins and other foods – cereals, muffins, even sports drinks – that are targeted toward women?

“They can provide some benefit, especially those that add calcium to the diet,” Pleuss says. “But they’re not necessary, and they tend to be fairly expensive.” Many also contain iron and folate, nutrients that are needed in greater quantities for women in their child-bearing years. Also, some “foods for women” may be surprisingly high in fat, salt (sodium) and sugar. Excess fat and sugar can lead to weight gain and might cause women to eat fewer healthful foods. Overweight increases the risk of diabetes, heart disease and some cancers. Eating less salt decreases the chance of developing high blood pressure.

“Compare food labels,” Pleuss recommends. “Remember it’s whole grains, fruits, vegetables, legumes and dairy products that are found to provide the health benefits.”

Make sure to carefully evaluate vitamin labels, too, she cautions. Many supplements are tailored to meet the needs of adults in the middle age range, and might not be appropriate for older adults. For instance, older women should avoid vitamins with iron unless a physician recommends the extra iron intake. (From about age 50 and on, women need less iron than those under 50, but even some vitamins marketed to older people have more iron than needed for that age group.)

In addition, keep in mind that various units are used to measure different supplements – for instance, vitamin B-12 is measured in micrograms, vitamin C is measured in milligrams and vitamin E is measured in International Units. This can be confusing, so compare labels thoroughly.

Soy Products
Many of today’s “foods for women” contain soy, which is being studied for its ability to help prevent cardiovascular disease by lowering the so-called “bad cholesterol,” or LDLs – low density lipoproteins. Some older adults add niacin to raise their “good” cholesterol (HDL, or high density lipoproteins); however adding supplemental niacin should be avoided unless prescribed by a physician, since extremely high doses are needed to be effective and can have side effects.

Soy also “has a weak estrogenic effect,” Pleuss says. Phytoestrogens – chemicals found in plants such as soy – can mimic the human hormone estrogen. It’s unknown at this point whether the similarities between the estrogen-like substances present in soy has the potential to stimulate estrogen-dependent human breast-cancer cells.

Until more is known, women who have had estrogen-influenced breast cancer should use soy in moderation. As for soy’s ability to reduce hot flashes after menopause, Pleuss says: “A lot of studies are being done. So far, results are showing that soy may have modest effects on reducing hot flashes, but the results are inconclusive.”

Use Herbals Cautiously
As for herbal remedies for women’s health, Pleuss says there are no general recommendations. Some women try black cohosh for relief of hot flashes, but Pleuss says this herb should not be taken for longer than six months. Some women take valerian to thwart insomnia; Pleuss said she tried it and it actually kept her awake.

Some herbs can interfere with or intensify the action of blood thinners and others drugs, she warns, so patients should always ask a health practitioner before taking any herbal products. Patients facing surgery must quit taking certain herbal medications two weeks before the operation.

The bottom line for women’s nutritional requirements? “Eating a variety of foods, supplemented by a multivitamin, is the best way to get the nutrients we need,” Pleuss says.

Barbara Abel
HealthLink Contributing Writer

This article includes information from the Federal Citizen Information Center, the US Department of Agriculture and the US Food and Drug Administration.

For more information on this topic, see the HealthLink articles Nutritional Guidelines for People 70 and Older.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.