For women only - questions and answers on women's health - includes an interview with Harvard Medical School researcher, JoAnn E. Manson - Cover Story

Nutrition Action Healthletter, March, 1995 by Bonnie Liebman

BONING UP ON CALCIUM

Q: Should women worry about calcium?

A: Yes. Because osteoporosis is such a major cause of disability and illness in women, from an early age they should be vigilant about getting enough calcium and vitamin D. That should maximize their peak bone mass in young adulthood and reduce the risk of fractures later in life.

Q: Do the calcium and vitamin D have to come from food?

A: No. Sunlight will help supply the vitamin D. I'm not against calcium supplements if there's any problem like lactose intolerance that interferes with getting calcium from food. A lot of women don't like milk. And some dairy products like cheese often increase the fat and salt in the diet, so supplements may be a good way to go.

Q: Should women take folic acid?

A: If a woman could become pregnant, there's no question tllat she should get enough - 400 International Units a day, either from food or a multivitamin - in order to prevent neural tube [birth] defects. Waiting until a woman has her first prenatal visit is going to miss the boat because these defects develop during the first few weeks of pregnancy. And, irrespective of pregnancy, adequate folic acid may help prevent cancer and heart disease in both women and men.

Ready to Be Randomized?

It's the largest study ever done on women. And you can be part of it.

In September 1993, researchers around the country started recruiting 160,000 healthy postmenopausal women aged 50 to 79 for the Women's Health Initiative. It will test whether:

* a low-fat diet (up to 20 percent of calories from fat) reduces the risk of breast cancer, colorectal cancer, and heart disease, * calcium (1,000 mg a day) and vitamin D (400 IU a day) help prevent osteoporosis and colorectal cancer, and

* the potential benefits of hormone replacement therapy (like lower risk of heart disease and osteoporosis) outweigh its possible risks (higher risk of breast cancer).

Women can participate in one or more parts of the study, so you needn't take honnones if you don't want to. But if you're not willing to end up in the placebo-taking group, it's not for you. If you participate, you'll get several free medical tests like mammograms and Pap smears, and you'll be followed for eight to twelve years. Interested? Call (800) 54-women.

Vive La Difference

Both men and women have a higher risk of heart disease if they smoke, have high blood pressure or high cholesterol, don't exercise, and are overweight. Here's how men and women differ:

* Diabetes. Having diabetes increases a woman's risk of heart disease relatively more than it does a man's. * HDL. It appears to be more dangerous for a woman to have low HDL ("good") cholesterol than high LDL ("bad") cholesterol. There is more evidence that high LDL is dangerous for men. * Triglycerides. High blood triglycerides may be more likely to increase the risk of a heart attack in women than in men. * Chest pains. Women often have chest pains on and off for years before they have a heart attack. When men have chest pains, it's more likely to mean that a heart attack has begun. * Death rates. Women are twice as likely as men to die within two months after having a heart attack and Kvice as likely to die after coronary bypass surgety, perhaps because they are older when they get sick. * Aspirin. The benefits of taking aspirin outweigh the risks in men over age 40 who have never had a heart attack as well as in women and men of any age who have already had one. Researchers don't know if the benefits outweigh the risks in women who have never had a heart attack. * Drugs. Cholesterol-lowering drugs reduce the risk of a heart attack in men, and in women who have already had a heart attack. The jury is still out on women who have never had a heart attack. * Alcohol. Women who drink regularly, even as infrequently as once or twice a week, have to weigh an increased risk of breast cancer against a lower risk of heart disease.