Women’s HealthWomen’s Health

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Review Date 10/09 G-1121Contributed by Shawna Gornick-Ilagan, MS, RD, CWPC

Objectives

• Leading cause of death• How to prevent or manage leading

health conditions• Other health concerns for women• Importance of screenings

Objectives

• Leading cause of death• How to prevent or manage leading

health conditions• Other health concerns for women• Importance of screenings

What Do You Think Are The Leading Causes of

Death for American Women?

Leading Cause of Death: 2004

Source: Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/Women/lcod.htm.

Facts

• Heart disease kills six times as many women as breast cancer

Source: Mayo Clinic. Available at: http://www.mayoclinic.com/health/heart-disease/hb00040.

Can Anyone Tell Me the Difference Between a

Heart Attack and a Stroke?

Stroke vs Heart Attack

• Stroke—blocked blood flow to the brain

• Heart attack—blocked blood flow to the heart

• Risk factors are the same for both

What Causes Heart Disease/Stroke?

• Arteries—blood vessels that carry blood away from the heart to the rest of the body

Normal Artery

Plaque Starts to Build Up

Tear in Artery Wall

Tear in Artery Wall

Plaque Can Grow and Harden and Obstruct the Artery

Tear in Artery Wall

Tear in Artery Wall

Atherosclerosis

Ischemic Stroke

Heart Attack

What Increases Risk?

You Can Not Help• Age

– Men: >45 years– Women: >55 years

• Sex• Race• Family history

You Can Help• Smoking• Alcohol• Poor diet• Overweight/obesity• Diabetes• Physical inactivity• High cholesterol• High blood pressure

What Percentage of Heart Disease Do You Think Is Preventable?

80% of All Heart Disease

Preventable

7 Steps to a Healthier You!

1. Know your numbers– Cholesterol (LDL=lousy, HDL=healthy)– Triglycerides– Blood pressure– Glucose

2. Maintain a healthy weight3. Stay physically active4. Manage stress5. Do not smoke6. Do not drink alcohol excessively7. Eat heart healthy HDL=high-density lipoprotein, LDL=low-density lipoprotein

Cancer Cases in Women: 2007

• 26% breast• 15% lung and bronchus• 11% colon and rectum• 5% uterine corpus• 4% non-Hodgkin's lymphoma• 4% melanoma of skin• 4% thyroid• 3% ovary• 3% kidney• 3% leukemia• 21% all other sites

Cancer Prevention

• Avoid smoking and second-hand smoke

• Practice safe sex and limit your partners (80% of women have HPV)

• Get regular Pap smears• “No thanks” to alcohol

– Women who consume two to five drinks a day are 1.5 times more likely to develop cancer

• Eat a low-fat, sensible diet

HPV=human papillomavirus

Cancer Prevention (cont’d)

• Protect yourself from the sun• Maintain a healthy body weight• Know your family history of cancer• Get moving

Other Common Health Concerns for Women • Osteoporosis

• Depression• Iron• Menopause/weight management

What Percentage of American Women Get Osteoporosis in Their

Lifetime?

Osteoporosis

• One out of every two women age 50 and older will have an osteoporosis-related fracture in their lifetime

• One out of every four men age 50 and older will have an osteoporosis-related fracture in their lifetime

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases. Available at: http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/default.asp#1.

Osteoporosis Progression

Normal bone

Severe osteoporosis

Osteoporosis

Osteopenia

Bone Health and Osteoporosis

Osteoporosis

Normal bone

What’s the Big Deal?

• Affects 44 million Americans• One in two women and one in four men

over age 50 will have an osteoporosis-related fracture in their remaining lifetime

• No early warning signs (silent disease)• Broken bones usually are the first signs

(50%)• 20% of seniors who suffer a hip fracture

die within 1 year• 20% of seniors with a hip fracture end

up in a nursing home within 1 year

How Can We Prevent Osteoporosis?

• If under the age of 25, one can attain a higher peak bone mineral density

• If older than age 25, one can maintain or improve bone mineral density:– Exercise– Nutrition

Exercise for Prevention

• 30 minutes of weight-bearing exercise (walking or jogging) three times a week is all it takes

• Physical activity reduced the risk of bone-breaking falls by 25%

• Aerobic:– Walking– Running– Cycling

• Resistance exercises:– Weight training

Nutrition for Prevention

• Males and females only ingest calcium for storage until age 21-26

• At that age, the epithelial plate closes and no more calcium is ingested for storage, only for blood maintenance

• You have reached the peak at this age—the higher the density peaks, the less chance for bone disease

Nutrition for Prevention (cont’d)

• After the epithelial plate closes, you must consume 1000 milligrams (mg) of calcium/day (even greater amounts if you are older than age 50) to maintain blood levels

• If not maintained, you body will take calcium from the bone

Recommended Calcium Intake

Ages Amount (mg/day)

Birth-6 months 210 mg

6 months-1 year

270 mg

1-3 years 500 mg

4-8 years 800 mg

9-18 years 1300 mg

19-50 years 1000 mg

51+ years 1200 mg

Calcium Sources

What If You Do Not Drink Milk?

• You can get calcium from other foods, including:– Cheese– Cream soups– Custard– Pudding– Ice cream– Canned fish with edible bones

Canned salmon, sardines, and mackerel are good choices

– Milk used in cooking, such as in mashed potatoes

What if You Do Not Drink Milk? (cont’d)

• Other options are fortified foods, such as:– Fortified orange juice– Calcium supplements

Where to Look for Calcium

• Add a “0” to the % to find out how many milligrams of calcium in a food

• The Daily Value for calcium on food labels is 1000 mg

Calcium Absorption

• Less calcium is absorbed as you age• Many factors may decrease the

calcium you are able to absorb from the foods you eat or increase the amount of calcium that comes out of your bones and into your blood

• Both lower your bone density• You only can absorb 300-500 mg in

one sitting

What Decreases Absorption?

• Sodium• 2.3 grams (g) excretes 24-40 mg of

calcium• As dietary protein increases, the

urinary excretion of calcium also increases– The average intake of protein in the US is

two times higher than the RDI– Estimated that each 1-g increase would

require an additional 5.8 mg of calcium/day to offset the calcium loss

RDI=reference daily intake

What Decreases Absorption? (cont’d)

• Caffeine• Smoking• Alcohol

How to Increase Your Calcium Absorption

• Adequate amounts of vitamin D• Sugar (lactose) and vitamin C

increase absorption• How much calcium can you absorb at

one time?– Most people can only absorb 300 mg, but

other can absorb up to 500 mg

How to Increase Your Calcium Absorption

• To get adequate amounts of calcium, consume calcium once in the morning, afternoon, and night

• 300 mg four times/day (8 AM, noon, 4 PM, 8 PM)

• Calcium is better absorbed later at night

Why Is Vitamin D Important?

• Vitamin D helps your body absorb calcium and deposit the calcium in your bones to help keep your bones strong

• The best food sources of vitamin D are fortified milk products and fatty ocean fish

• Recommended amount: 400 IU daily

IU=international units

Tips for Increasing Calcium in the Diet

• Drink calcium-fortified orange juice• Make oatmeal with milk, instead of

water• Put cheese on your sandwiches• Put milk instead of half-and-half or

powdered creamer in your coffee or tea

• Make your own pudding with milk, instead of buying convenience prepackaged pudding

• Add nonfat dry-milk powder to gravies, peanut butter, and other foods

It Is Not Too Late

• Studies in Wisconsin have shown that women in their 80s and 90s can increase bone hardness

• So, it is never too late to increase you bone hardness

Calcium Supplementation

• Calcium citrate:– Best absorbed in an acidic environment– Best absorbed supplemental form of

calcium– Does not require extra stomach acid for

absorption; so, you can take it anytime during the day, even on an empty stomach

• Calcium carbonate (Tums® or Caltrate®)– Most calcium pills in the market are in

this form– Requires extra stomach acid for better

absorption; best taken after meals

Step 4: Manage StressStep 4: Manage Stress

Manage Stress

• If left unmanaged, stress can cause emotional, psychological, physical problems (heart disease, high blood pressure, chest pain, and irregular heart beat)

• Stress also may cause you to overeat, exercise less, and possibly smoke more

• You can think yourself into clinical depression

Stress: Common Warning Signs

Tips to Reduce Stress

• Identify the stressor first• Avoid hassles and minor irritation, if

possible• Try to continue doing the things that

you enjoyed before the change that caused stress occurred in your life

• Learn how to manage your time efficiently

• Do one thing at a time• Learn to take a break• Ask for help when you need it

Depression

• About twice as many women as men experience depression

• As a woman, several factors increase your risk of depression, including:

– Your unique biology– Your life situation– Your culture

Depression: What Can You Do?

• Engage in mild activity or exercise– Go to a movie, ballgame, or another

event or activity that you enjoyed before– Participate in religious, social, or other

activities • Set realistic goals for yourself• Break large tasks into smaller ones

– Set some priorities – Do what you can as you can

Depression: What Can You Do? (cont’d)

• Try to spend some time with other people

– Confide in a trusted friend or relative– Try not to isolate yourself– Let others help you

• Expect your mood to improve gradually, not immediately

– Do not expect to suddenly “snap out of” your depression

– Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts

Depression: What Can You Do? (cont’d)

• Postpone important decisions, such as getting married or divorced, or changing jobs

– Wait until you feel better to make important decisions

– Discuss decisions with others who know you well and have a more objective view of your situation

Depression: What Can You Do? (cont’d)

• Keep confident and know that your positive thinking will replace negative thoughts as your depression responds to treatment

• Psychotherapy and medication: Talk to your doctor

Iron RDA

Menopause and Weight Gain

• Hormones play a critical role in weight gain during and after menopause

• Estrogen—the female sex hormone stored in fat

• During menopause, production decreases and the body looks for estrogen in fat stores

• The body also stores more fat during this time to compensate for declining estrogen production

Weight Management

• Meal plan– Start your day with a good breakfast– Eat from all food groups– Include whole grains, low-fat dairy,

vegetables, lean protein, fruit, and healthy fats in your diet

– Choose healthy snacks– Read nutrition labels– Remember “moderation”

• Exercise– Exercise a minimum 30 minutes most

days

Why Reduce Calories?

• Reduce your calories if you are overweight and want to lose weight

• Calories are the energy in food that contribute to weight loss and weight gain

• 1 pound of fat=3500 calories

Other Benefits of Exercise

• Sedentary women suffer more from:– Chronic back pain– Stiffness– Insomnia– Gastrointestinal (GI) irregularity– Poor circulation– Muscle weakness– Shortness of breath– Depression

Other Benefits of Exercise (cont’d)

• Active women who walk, jog, swim, bike, etc:– Have less chronic back pain,

stiffness, insomnia, GI irregularity, poor circulation, muscles weakness, shortness of breath, and depression

– Achieve higher HDL levels