Female & fit for life

Nutrition Action Healthletter, May, 2004 by JoAnn Manson

True or false:

1. Coronary heart disease kills ten times more middle-aged women than breast cancer.

2. Fatigue, nausea, or dizziness can be warning signs of a heart attack.

3. A woman aged 45 or older should have her blood sugar tested every five years.

May 9 is not just Mother's Day. It's also the beginning of National Women's Health Week. Yet most women still don't know all they should about protecting their health. Here's a rundown of the latest research on foods, vitamins, exercise, and more.

How'd you do on our mini-quiz?

1. False. Women shouldn't underestimate their risk of heart disease. But coronary heart disease kills ten times more women than breast cancer only if you look at women aged 75 or older (see "Heart Disease vs. Breast Cancer," p. 5).

2. True. In a 1997 survey, 90 percent of women didn't know these less common signs of a heart attack.

3. False. Experts recommend that women get their blood sugar tested at least every three years (see "What to Check & When," p. 7). Diabetes rates are climbing, but many women don't routinely get blood sugar tests.

To get the latest on women's health, we talked to one of the leading researchers in the field.

Q: What have we learned from the last decade's worth of research on women?

A: We've made a lot of progress in women's health. Life expectancy for women is close to 80 years now. We've seen many treatment advances.

But in the last decade, obesity and sedentary lifestyles have become even greater public health problems. Two-thirds of adult Americans are now overweight or obese. And probably 75 percent of Americans get less than the recommended amount of exercise.

It's been estimated that more than 400,000 deaths per year in the U.S. are attributable to obesity and sedentary lifestyle. And the epidemic of obesity in childhood portends a tremendous burden of disease in the future.

Q: So we're losing ground?

A: Yes, in some areas. People have become complacent about heart disease and stroke because of the dramatic declines in the death rates for both over the last 30 years. But that may change.

We've clearly made progress detecting and treating high cholesterol and high blood pressure and treating cardiovascular disease. But with three risk factors--body weight, physical activity, and diabetes--going in the wrong direction, that progress is being threatened.

Q: So heart disease isn't the only worry?

A: No. We're concerned because diabetes is so closely linked to overweight and a sedentary lifestyle. Diabetes has been called the epidemic of the 21st century. The prevalence has more than doubled over the last 30 years.

And it's not just diabetes, but the burden of illness from diabetes--the eye disease, kidney disease, and nerve damage--and the fact that diabetes greatly increases the risk of heart disease and stroke.

Q: Are women at greater risk than men?

A: Yes. Diabetes is a particular problem for women because cardiovascular events--like heart attack or stroke--are five to seven times more likely in women with diabetes than in women without the disease, but only two to three times more likely in men with diabetes.

About 75 to 80 percent of deaths among people with diabetes are due to cardiovascular disease. Diabetes could become a public health crisis over the next couple of decades.

Q: Do women think that they won't get heart disease?

A: While that's a common misconception, they're not immune. The risk of heart disease in women lags behind that of men by about 10 to 15 years. But heart disease is still the leading cause of death in women.

In fact, heart disease and stroke kill more women each year than men, mostly because women tend to die at older ages, when cardiovascular disease is most prevalent.

Heart Attack & Stroke

Q: What can lower the risk of a heart attack or stroke?

A: Our Nurses' Health Study suggests that more than 80 percent of heart attacks, strokes, and diabetes cases in women could be prevented by simple behavioral changes--not smoking, 30 minutes a day of moderate-intensity exercise, maintaining a healthy weight, and eating a healthy diet. That's a pretty striking statistic.

Q: What kind of healthy diet?

A: We gave the nurses higher diet scores if they consumed more fish, fruits, vegetables, whole grains, and fiber. They also got higher scores if they ate less trans fat and more poly-unsaturated fats, which you get from foods like fish, vegetable oils, salad dressings, and nuts, rather than saturated fats, which come from foods like red meat, butter, cheese, and ice cream.

And the nurses got points if they had a low glycemic load. That means they ate fewer refined carbohydrates that are rapidly digested and absorbed--foods like low-fiber cereals, white bread, white rice, cakes, and cookies. Even white potatoes tend to be rapidly digested and absorbed.

Q: Should people avoid those foods entirely?

A: No. You can eat them in small quantities. But the evidence is mounting that a diet with a high glycemic load increases the risk of heart disease, stroke, high blood pressure, and diabetes. That's probably because it causes a rapid rise in blood sugar, which raises blood insulin levels. It's a particular problem in people who are overweight or who are already insulin resistant.