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Healthy at Every Age

You can make a significant, positive difference in your well-being. Find out what to do in each decade of your life to fend off cancer, heart disease, osteoporosis, and more with advice from top integrative doctors.

20s and 30s 
You're young and busy, and illnesses such as heart disease, cancer, and osteoporosis don't cross your mind. But experts agree: This is the time to put disease-fighting strategies in place. Start with an anti-inflammatory, Mediterranean diet that includes plenty of fruits and vegetables, whole grains and legumes, and healthy omega-3 (wild salmon, walnuts, flax) and monounsaturated (olive oil) fats. 

Limit or eliminate processed foods and sugar, and don't eat red meat more than twice a week (when you do, choose lean cuts). Rack up 30 to 40 minutes of exercise most days of the week and develop a regular stress-relieving practice, such as meditation or yoga. Also, learn the details of your family's medical history to get a clearer picture of your health risks.

Build Bone, Pronto 
What's Important Now 
At this age, most of us take our skeletons for granted -- but that's a big mistake. "You can improve bone density until around 30," says Sharon Plank, M.D., "but that's your last chance." From that point, we tend to lose more bone than our bodies can build. Conscious efforts now can lower your risk of fractures as you age. 

What You Should Be Doing 
Exercise is essential, says Birgit Rakel, M.D. Resistance training and weight-bearing exercise (running and jumping, not biking or swimming) stimulate bone growth, so include them several times a week. Calcium and vitamin D are also critical for sturdy bones. Aim for 1,000 milligrams of calcium daily from a combination of foods such as low-fat dairy and leafy greens and supplements (calcium citrate is easiest to absorb). To get enough D, take a supplement that contains 1,000 IU of vitamin D3, and spend 15 minutes outside (no sunscreen) daily during summer months.

Consider This 
Scientists recently gave twenty-somethings a daily dose of 1,000 IU of vitamin D during the winter months; by winter's end, 100 percent of the women still had insufficient levels of vitamin D.

Sexual Health
What's Important Now 
An estimated one in four women between 14 and 59 are infected with human papillomavirus (HPV), a mostly symptomless sexually transmitted disease. HPV causes cervical dysplasia, which is characterized by precancerous cell changes that can progress to cervical cancer. "But if you catch it early, you can prevent it from moving forward," says Marcia Prenguber, a naturopathic physician who specializes in cancer care. 

What You Should Be Doing 
While they help, condoms provide only partial protection; HPV can spread through contact with skin near the genitals. Get an annual Pap smear, and talk to your doctor about an HPV-specific test. "HPV is relatively common in younger women, and many times it goes away," says Tieraona Low Dog, M.D. So some doctors run the test in twenty-something women only if a pap smear shows abnormal cells. However, after a woman turns 30, most doctors run the test routinely. "Women over 30 have likely had HPV longer and are at greater risk for developing cervical cancer," explains Low Dog. Since studies suggest that cigarette smoke interacts with HPV to increase cervical cancer risk, limit your exposure to secondhand smoke, and if you smoke, quit.

A diet packed with colorful produce, which offers beneficial nutrients such as carotenoids and folic acid, may help reverse mild cervical dysplasia, Prenguber says. She also recommends a multivitamin or B-complex that provides 400 to 800 mcg of folic acid, especially if you take oral contraceptives. Some studies have shown a relationship between the pill and diminished folate levels, which may leave you more vulnerable to cervical dysplasia. 

Consider This 
At some point in their lives, at least 50 percent of sexually active women become infected with HPV.

Thwart the "Big Two" 
What's Important Now 
Heart disease and cancer rank as the top two killers of women. The habits you form now will help cut your risk for both diseases in the future. 

What You Should Be Doing 
Cancer specialist Keith Block, M.D., and cardiologist Mimi Guarneri, M.D., agree: Adopt an anti-inflammatory diet, because abnormal inflammation can spark both diseases. Broccoli, leafy greens, and cabbage are especially important cancer foes, Block says; they convert procancer estrogens in your body to more protective forms of these hormones. What you drink matters, too. It's a good time to rethink your cocktail consumption if you drink alcohol regularly. Researchers recently found that even one drink a day can slightly increase a woman's risk for certain cancers. Although red wine has a heart-protective reputation, Guarneri warns against drinking more than four to five ounces (a small glass) daily. Not only does it fuel inflammation, but it's also "too much sugar, so it's fattening," she says. Any excess weight puts you at greater risk for both of the big two. 

Consider This 
An assessment of 12 studies showed that sticking to a Mediterranean diet can decrease the risk of dying from cardiovascular disease by nine percent and from cancer by six percent.

Beat IBS 
What's Important Now 
If you regularly experience symptoms such as crampy abdominal pain, bloating, constipation, and diarrhea, you've got company. Irritable bowel syndrome (IBS) is shockingly common; nearly a quarter of women in the United States suffer from this digestive disorder. The average age of onset: 29. 

What You Should Be Doing 
Confirm the diagnosis with a physician, says Rakel. Other diseases -- ulcerative colitis and celiac disease, for example -- have similar symptoms but require different treatments. Try an elimination diet to identify irritants, suggests Rakel, who cites dairy and gluten as two common culprits. 

Keep a food diary for clues to what bothers you, then remove suspect foods one at a time for a week to see if your symptoms improve. She recommends taking a daily probiotic to repopulate your bowels with beneficial bacteria (buy a supplement with at least a billion of a variety of organisms), and she also suggests stirring a tablespoon or two of ground flaxseeds into your cereal or smoothie each day. These tiny seeds contain soluble fiber, which, in time, eases both constipation and diarrhea. Enteric-coated peppermint oil may help as well; take one or two capsules containing 0.2 milliliters of peppermint oil three times a day between meals.

Additionally, chill out with mind-body practices; scientists continue to discover strong links between stress and digestion. Plank recommends this calming breath anytime you feel tense: Breathe in through your nose for four counts, and then exhale for six. Repeat six times. Consider this IBS is the second most common reason Americans miss work, after the common cold.

Key Tests 
Make these tests a must, and discuss them with your doctor, who may recommend additional screenings depending on your individual risk factors. 

Dental cleaning and exam: Every six months 
Eye exam: Annually 
Pelvic exam and Pap smear: Annually for pelvic; every one to three years for Pap; more after an abnormal Pap  
HPV test: Every three years beginning at 30 
STD test: After sexually active; frequency according to risk 
Clinical breast exam: Every three years 
Self breast exam: Monthly 
Cholesterol test*: Every five years starting at 20 
Blood pressure: Annually 
Self skin exam to check for changing moles or freckles: Monthly 
Clinical skin exam: Annually (as part of a regular checkup) 
Thyroid test: Every five years beginning at 35 
Vitamin D: Every one to three years 
*Total cholesterol, LDLs and HDLs, and triglycerides

40s and 50s 
As you age, you need to work harder to keep your body healthy, says Keith Block, M.D. A woman generates more inflammatory chemicals as she grows older, he says, setting the stage for heart disease and cancer. Over time, we also accumulate more oxidative damage to our DNA, further raising our risk of cancer. Increase your odds of staying illness-free by sticking with an anti-inflammatory, Mediterranean diet, including fruits and vegetables, whole grains and legumes, and healthy omega-3 (wild salmon, walnuts, flax) and monounsaturated (olive oil) fats. Processed foods and sugar should be limited or eliminated, and red meat should show up no more than twice a week on your plate (be sure it's lean). Aim for 30 to 40 minutes of exercise most days of the week, and develop a regular stress-relieving practice, such as meditation or yoga.

Meet Menopause Head-On 
What's Important Now 
Estrogen levels drop through your forties until you reach menopause (marked by the absence of a period for a year), often in your early fifties. For some women, this dwindling hormone supply triggers symptoms such as hot flashes and sleep problems. 

What You Should Be Doing 
Try the simplest solutions first. One daily serving of whole soy foods, such as tempeh and edamame, may help cool hot flashes, says Birgit Rakel, M.D. (Women with breast cancer or who've had breast cancer should not eat soy so often.) For some women, a standardized form of the herb black cohosh helps calm hot flashes. A typical dose would be 20 milligrams twice a day, says Melinda Ring, M.D., but she recommends working with your doctor due to potential side effects. For sleep problems, Rakel suggests melatonin (start with 0.5 milligrams before bed; if this doesn't help after a week, raise your dose to 1 milligram, increasing to a maximum of 6 milligrams over time) or valerian (start with 400 milligrams before bed; if this doesn't help after a week, raise to 800 milligrams). Cautionary advice: Don't combine these remedies or take them for more than six weeks at a time. If none of these options help, some women consider a short course of hormone replacement therapy. You should make this highly personal decision with your doctor, based on individual risk factors, family history, and your own health history. 

Consider This 
About 6,000 U.S. women reach menopause every day. The average age of onset: 51.

Love Your Heart 
What's Important Now 
Beginning at menopause, more women die of cardiovascular disease than any other cause. Your heart attack risk rises -- and that's not all. A 2007 study found that women 45 to 54 were twice as likely to suffer a stroke as men were. Make protecting your heart and blood vessels one of your main priorities. 

What You Should Be Doing 
Continue to get regular cardiovascular screenings. The high-sensitivity test for C-reactive protein (CRP), a marker for abnormal inflammation, is especially important. "For women, the marker for inflammation appears to be the most sensitive predictor of a future heart attack," says Mimi Guarneri, M.D. Because inflammation often lies at the root of heart disease, follow an anti-inflammatory diet. A healthy diet and regular exercise also helps prevent type 2 diabetes, which greatly raises a woman's risk of heart disease. Heart attack symptoms in women differ from those in men, so learn the signs. "If all of a sudden you have unexplained fatigue, shortness of breath, nausea or vomiting, tightness between your shoulder blades, or discomfort in your left arm, neck, or chest that comes with exertion, go to the emergency room," Guarneri says -- the sooner, the better. "We have a little expression in cardiology: Time is tissue. The more time you waste, the more potential damage to your heart muscle." 

Consider This 
Eating a couple squares of dark chocolate each week can reduce your levels of C-reactive protein, decreasing your risk for cardiovascular disease. 

Look Out for Cancer 
What's Important Now 
Your risk of many types of cancers -- including breast, colon, and ovarian cancer -- rises as you age. Go on the defensive now. 

What You Should Be Doing 
Be conscientious about cancer screenings. Catching the disease early may save your life, Block says. But keep in mind that while mammograms and other screenings spot existing cancer, they can't stop a cancer from developing. Block recommends other tests that "give you ways of seeing what's going on before cancer becomes a full-blown, diagnosable disease," he says. These include high-sensitivity C-reactive protein (to check for inflammation) and a glucose test (to check for insulin resistance), because inflammation and excess insulin can set the stage for cancer. If patients have a CRP level of 2.7 milligrams/l or higher, for example, Block helps them design an aggressive regimen to quell inflammation. Regular exercise, along with an optimal diet, may be the most important insurance against breast cancer deaths, Block adds. A recent study of women over 50 shows that those who exercised the most reduced breast cancer risk by up to a third. This protection may come from the fact that aerobic exercise can convert estrogens from a cancer-stimulating form to a version that may help prevent cancer. In a study of women being treated for cancer, those who walked three to five hours per week (26 to 43 minutes daily) cut their risk of death in half. 

Consider This 
Behaviors such as smoking, physical inactivity, and bad eating habits account for as many as 50 to 75 percent of U.S. cancer deaths, estimate scientists.

Review Bone Status 
What's Important Now 
In the first five years after menopause, the drop in estrogen can trigger dramatic declines in bone mass. Making a big effort now can help you slow those declines. 

What You Should Be Doing 
Rakel advises that patients undergo a DEXA scan to check bone density at menopause, once their period has ceased for a year. This first DEXA provides a baseline so you can track any future declines, Rakel says. Some women may need a scan in their forties, including those with digestive disorders like celiac disease (which limits nutrient absorption) and those on medications that compromise bone, like corticosteroids. Diet and exercise play key roles in maintaining bone density. All of our experts recommend that women have their vitamin D levels tested regularly; deficiencies of this bone-building vitamin are common, especially in northern latitudes, where sunlight is weak. Take 1,000 IU of D3 daily, and spend 15 minutes outside every day in summer months before applying sunscreen; this allows your body to synthesize vitamin D in your skin. Consume 1,000 milligrams of calcium daily from a combination of foods (such as low-fat dairy and leafy greens) and supplements (calcium citrate is easiest to absorb). After menopause, increase your intake to 1,200 milligrams. And be diligent about making weight-bearing activities (such as jumping rope and jogging) and weight lifting part of your exercise routine. 

Consider This 
Women can lose 20 percent or more of their bone density during the five to seven years following menopause.

Mind Your Midlife Weight 
What's Important Now 
"Most women gain 10 pounds with menopause," says Guarneri. Excess weight is a powerful risk factor for heart disease, cancer, and type 2 diabetes. 

What You Should Be Doing 
Muscle burns calories, so rev a slowing metabolism by working out with weights three times a week. And keep in mind that as your metabolism slows after menopause, your calorie needs decrease slightly. "We may continue to eat out of habit, however, not listening to our hunger levels," says Sharon Plank, M.D. To counteract mindless eating, she recommends a food diary. For several weeks, write down everything you eat. Record other details, too, such as hunger levels and mood states when eating, energy levels after eating, and calorie counts. "Once you're aware, you eat less," Plank says. "It's also nice to review diaries over time to focus on how foods make you feel and whether they give you energy or take it away." Guarneri recommends cutting calories by decreasing or eliminating soft drinks, beer, and wine. 

Consider This 
A large study that followed women 42 to 52 for three years found that those who maintained a high level of physical activity -- or began to exercise more -- didn't gain midlife weight.

Key Tests 
Make these tests a must, and discuss them with your doctor, who may recommend additional screenings depending on your individual risk factors. 

Dental cleaning and exam: Every six months 
Eye exam: Annually 
Self breast exam: Monthly 
Mammogram and clinical breast exam: Annually starting at 40 
Pap smear and pelvic exam: Every one to three years; more after an abnormal Pap 
Full cholesterol panel*: Every five years 
Blood pressure: Annually 
Thyroid test: Every five years 
Glucose tolerance: Every three years starting at 45 test (to screen for diabetes) 
Fecal occult blood test (to check for blood in stool): Annually starting at 50 
Flexible sigmoidoscopy: Every five years starting at 50 
Colonoscopy: Every 10 years starting at 50 
Bone density (DEXA): Every two years beginning at menopause 
Self skin exam to check for changing moles or freckles: Monthly 
Clinical skin exam: Annually (as part of a regular checkup) 
Vitamin D: Every one to three years 
*Total cholesterol, LDLs and HDLs, triglycerides, and high sensitivity C-reactive protein

60s and Beyond 
It's best to have healthy habits in place by now, but if you don't, "it's not too late to start," says Keith Block, M.D. Population studies of older people, for instance, show they can reduce their cancer risk by one third with lifestyle and nutrition changes. The same advice from previous decades still holds true: Adopt an anti-inflammatory, Mediterranean diet of fruits and vegetables, whole grains and legumes, and healthy omega-3 (wild salmon, walnuts, flax) and monounsaturated (olive oil) fats. Limit or eliminate processed foods and sugar, and don't eat red meat more than twice a week. (When you do, be sure to choose lean cuts.) Get 30 to 40 minutes of exercise most days, and adopt a regular stress-relieving practice, such as meditation.

Keep an Eye on Cancer 
What's important now 
You're more likely to get a cancer diagnosis now than at any other time of your life. The median ages of breast cancer, lung cancer, and colon cancer diagnoses are 61, 71, and 71 years old. 

What You Should Be Doing 
Keep up with screenings. Catching the disease early can make treatment easier, says Block. But because the immune system grows less effective with age, in part due to declining attention to nutrition, Block urges even more diligence about other anticancer habits, like eating an anti-inflammatory diet, and suggests cutting back on fat. 

Postmenopausal women who limited their fat intake to 20 percent or less of total daily calories experienced a 24 percent drop in breast cancer recurrence rates. "That's profound," says Block. "There aren't many drugs on the planet that could provide that significant a decline in risk of recurrence." Cut way back on red meat, chicken, full-fat dairy, and processed snack foods, and eat more omega-3 fats (wild salmon, trout, walnuts) and omega- 9s (olives, avocados). These changes reduce your overall fat intake while providing more of the healthy fats that help prevent and fight cancer. In addition, emphasize plant-based proteins and whole grains, and up your intake of vegetables. 

Block also recommends a daily dose of ground flaxseeds (two tablespoons), which provide omega-3s along with lignans, plant chemicals that have anti-estrogenic properties and protect against breast, cervical, and ovarian cancers. A small study of postmenopausal nuns found that eating flax reduced their levels of two types of estrogen that may increase the risk of developing breast cancer. Grind the seeds in a food processor or coffee grinder and stir into your cereal or yogurt. (The ground seeds spoil quickly, so grind small amounts and store them in the refrigerator or freezer.) Consider this A study of more than 14,000 women who were living in New York City found that those with the highest meat consumption had nearly twice the likelihood of developing breast cancer.

Bone Up on Osteoporosis 
What's Important Now 
Your risk of osteoporosis keeps rising with age. Small-framed women with a family history of osteoporosis face particular risk, but all postmenopausal women should be attentive. The stakes are high: One in five patients who break a hip require long-term care, and about a quarter of older people with a hip fracture die within a year of the break. 

What You Should Be Doing 
Continue to exercise. In addition to weight-bearing cardio (like walking) and strength training, add a balance component to your workout to help ensure against stumbles, says Sharon Plank, M.D. Consider a tai chi class, for example; studies show that this system of traditional Chinese movement can help lessen falls. If DEXA scans confirm that you have osteoporosis, work with a personal trainer or yoga teacher who understands the disease and can design a workout that protects your skeleton, Plank adds. Another important probone habit: Consume up to 1,200 milligrams of calcium daily, getting a combination from supplements (calcium citrate is easiest to absorb) and food (such as low-fat dairy and leafy greens), says Birgit Rakel, M.D. Vitamin D also appears to be crucial for bone health; take 1,000 IU of D3 daily, and ask your doctor to test your levels. 

Consider This 
A study of women over age 65 showed a nine-week Iyengar yoga class improved their balance, stability, and gait.

Stay on Heart Health 
What's Important Now 
Cardiovascular disease remains the number-one killer of women in this phase of life. The average age of first heart attacks: 70. 

What You Should Be Doing 
The basic strategies for protecting your heart and blood vessels remain the same: Eat an anti-inflammatory diet, exercise most days of the week, and drink no more than one alcoholic drink a day. Consider your emotional state; researchers continue to link depression and stress with heart disease risk. To counteract their effects, develop positive coping skills, such as exercise and meditation, and reach out to friends or a therapist. "Research shows that even if you're depressed, if you have support, you have better health outcomes," says Mimi Guarneri, M.D. And be sure to monitor your own health if you're caring for an ill spouse or parent. "It's a wonderful thing to be a caregiver, but the research shows that if you don't take care of yourself, it's very much associated with getting sick," she says. A 2008 study found that people who were the primary caregivers to loved ones who'd suffered a cardiac event had increased heart disease risk factors themselves. Be diligent about eating well, getting enough sleep, and taking time for yourself, including breaks for mind-body practices like yoga. 

Consider This 
In one study, people with elevated C-reactive protein lowered their levels by 34 percent by taking daily doses of vitamin C; the reduction compared favorably to those achieved in studies of statins.

Stimulate Your Brain 
What's Important Now 
So-called "senior moments" are often a normal symptom of getting older, says Evangeline Lausier, M.D. But take note if you become especially forgetful: One new case of Alzheimer's develops every 70 seconds in this country, reports the Alzheimer's Association. 

What You Should Be Doing 
"First get tested to make sure you're not dealing with some medical illness that's causing dementia," Lausier says. Memory trouble can stem from treatable disorders, including thyroid problems or vitamin B12 deficiency. Because age-related memory declines are linked to inflammation, Lausier recommends eating an anti-inflammatory diet, including several servings of cold-water fish (such as salmon or trout) each week. And get active: A number of studies show that regular activity improves brain function. Finally, stimulate your brain to keep it working well. Plank recommends playing cards, chess, or computer games or learning a new language. 

Consider This 
A study found older people with mild memory problems who exercised 150 minutes per week earned higher scores on thinking and memory tests.

Boost Digestion 
What's Important Now 
Aging can be tough on your digestive health. Your stomach produces less hydrochloric acid, making digestion less efficient and triggering bloating and indigestion in some people, says Lausier. Long-term digestive troubles can lead to more serious problems. Constipation also plagues older women, especially those who don't exercise. Putting on extra pounds, as many women do after menopause, also boosts your risk of gastroesophageal reflux disease (GERD). 

What You Should Be Doing 
The loss of stomach acid allows bad gut bacteria to thrive, so Lausier recommends eating eight ounces of a probiotic-rich yogurt daily to boost good bacteria and ease symptoms such as bloating. Plant-based digestive enzymes can also perk up sluggish digestion; chew one or two tablets before meals. Both Lausier and Rakel recommend flaxseeds to ease constipation. Grind them in a food processor (or buy them already ground) and stir a teaspoon or two into cereal or smoothies. Follow with a glass or two of water for best results, and refrigerate or freeze any seeds you don't use (they spoil quickly). For acid reflux, Rakel recommends taking two deglycyrrhizinated licorice (DGL) tablets before meals to neutralize acid. Consider this Findings from the Nurses' Health Study show that GERD symptoms increase progressively as a woman gains weight. Conversely, symptoms decrease in women who shed pounds.

Key Tests
Make these tests a must, and discuss them with your doctor, who may recommend additional screenings depending on your individual risk factors. 

Dental cleaning and exam: Every six months 
Eye exam: Annually 
Self breast exam: Monthly 
Mammogram and clinical breast exam: Annually 
Pap smear and pelvic exam: Every one to three years; more after an abnormal Pap 
Full cholesterol panel*: Every five years 
Blood pressure: Annually 
Thyroid tests: Every five years 
Glucose tolerance test (to screen for diabetes): Every three years 
Fecal occult blood test (to check for blood in stool): Annually 
Flexible sigmoidoscopy: Every five years 
Colonoscopy: Every 10 years 
Bone density (DEXA): Every two years 
Self skin exam to check for changing moles or freckles: Monthly 
Clinical skin exam: Annually (as part of a regular checkup) 
Vitamin D: Every one to three years 
*Total cholesterol, LDLs and HDLs, triglycerides, and high sensitivity C-reactive protein

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