Menopause International 2012; 18: 123124. DOI: 10.1258/mi.2012.
012041
Editorial
Better life better health lifestyle and
diet for a healthy future
Tony Mander
President Elect, Forum of Food and Health Royal Society of Medicine, London
Gynaecologist, Manor Hospital, Beech Road, Headington, Oxford OX3 7RP, UK
Email: manderanthony@hotmail.com
Life-expectancy increases by five hours per day in the UK,
already most postmenopausal women live beyond
80 years. By this age, one in three women will have
osteoporotic fractures, one in three will have severe
cognitive impairment or Alzheimers and one in two
severe sarcopenia.
The ravages of these conditions can certainly be delayed
or sometimes even avoided with appropriate health and
lifestyle interventions. It is important that individuals
and their health professionals are aware of these changes,
and what they should do or avoid in terms of lifestyle and
diet, yet currently this advice is rarely given.1
Exciting interventions relating to diet, health and
lifestyle that offer possibilities for dramatically improving
the quality of peoples lives now exist.
Exercise
Exercise throughout life, especially in older age will help
avoid osteopenia, osteoporosis and sarcopenia. Exercise
of course has other benefits in general metabolism and
cardiovascular function.2
For many years, exercise and fitness have been
recognized as important for health but recent dramatic
developments in this area,3 such as the high intensity
regimens, shown on the TV Horizon programme by
Michael Mosley, suggest that strenuous exercise for two
minutes has very similar effects to two or three hours of
jogging and even better effect in terms of metabolic
change in reducing postprandial blood fat levels.
The finding that there are genetic types of human who
will or will not respond to the benefits of exercise is also
very important. If an individual is not an exercise
responder it appears there is little point in them
undergoing hours of fruitless activity, unless they really
enjoyed it!
Swimming has particular benefits for postmenopausal
women. A recent study showed after 24 weeks, a 15%
reduction in body fat and 8% reduction in blood pressure.
Swimming benefits ageing joints and for those with
arthritis, water acts as a cushion to protect hips and knees,
aqua activity improves overall body strength.4
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Sarcopenia, the reduction of muscle size by between
0.5% and 2% a year in older people, occurs as a normal
part of ageing resulting in reduction of quality of life and
lack of independence.
Oily fish such as mackerel (omega 3 DHA and EPA) is
implicated in improving muscle strength in women in
their late 60s by 20% with exercise, as compared with
10% in exercise only controls.3
Practice points
Body mass index and abdominal circumference are
underused in health and lifestyle advice; if the measure-
ments are abnormal, their use is crucial to counselling
and forecasting eventual outcomes.2
When advising about hypertensive treatment it is
important to point out that not taking the medication
may cause cognitive impairment as well as the more
obvious risks of heart attack and stroke.
Smoking, importantly is not generally perceived as
being a risk for osteoporosis but is associated with other
risks including cardiovascular disease, lung cancer and
respiratory illness.
Vitamin D is important for reasons other than osteo-
porosis, including potential to reduce risks of malignancy
and improve cognitive impairment; vitamin D levels
should be checked on a regular basis.2
Vitamin B12 and folic acid levels should be estimated as
deficiency is a serious risk for cognitive impairment.
Recent findings from the Optima study in Oxford showed
that B12/folic acid supplements reduced the progression
of Alzheimers by up to 40% and is the most productive
intervention currently available.
Serum homocysteine levels are widely used in Europe as
a predictive test for cognitive impairment, fracture and
cardiovascular disease (a level of 12 mmol/L and above
indicating risk), yet it is very rarely used in the UK.
Dietary issues
It is impossible within the scope of this article to go
through all aspects of nutrition and diet in any detail
123
T Mander Better life better health
but it goes without saying that a balanced diet is impor-
tant; the appropriate five per day portions, vitamins,
avoidance of excessive sugar and carbohydrate load and
salt. Unfortunately the current problems with obesity and
poor lifestyle are self-evident.
But other aspects of diet such as the use of oatmeal
porridge on a daily basis and perhaps more excitingly
potent antioxidants from blueberries, blackberries and
probiotic yoghurts have important immunological
benefits.
Tomatoes (lycopenes) are important for skin,
cardiovascular and prostate health; indeed a full day
international meeting was recently devoted purely to this
topic at the Royal Society of Medicine.
Dark chocolate is an exciting area; cocoa solids are rich
in antioxidants, such as polyphenols, which lower
cholesterol, and flavonoids, which may have anticoagu-
lant effects. The genetic code for cocoa, which was unra-
veled in 2010 is in the public domain. It is likely that
genetic modification of the cocoa plant will be used to
enhance the potent antioxidant effects of chocolate
leading to specific types of chocolate to maximize health
benefits especially in the area of cardiovascular disease.
Most benefits arise from pure dark chocolate with above
70% cocoa content, the stronger the cocoa the better the
health benefit. A small portion every day is to be
recommended.
Certain types of red wine are recommended by
Professor Roger Corder at the William Harvey Institute
in his book The Red Wine Diet.5 Types of traditionally
made red wine have high levels of procyanidins (a type
of flavonoid polyphenol, also present in cocoa and
cranberries), which act on blood vessels rather like anti-
hypertensive drugs and have health and longevity
benefits.
The use of regular 24-hour fasting once a week, dra-
matically improves the individuals glucose metabolic
profile after a number of weeks, apart from facilitating
weight loss.3 So the risk of metabolic syndrome and
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obesity can be reduced by the simple expedient of fasting
one day a week.6
In conclusion, lifelong education should start at
school and we should all have a personal lifestyle plan
at age 50.7 National lifestyle policies should be
pursued, such as free swimming for over 65s; this
policy was instituted in the UK by the last government
then sadly withdrawn by the coalition government in
2010.
Health and lifestyle advice has always been a priority for
the British Menopause Society, and its patient arm,
Womens Health Concern. Detailed proposals were
included in a consultation document to the coalition
government.7 To date there has been little or no govern-
ment response; implementation of the BMS recommen-
dations would surely lead to important ramifications for
many individuals; improving their quality of life into
older age and reducing long-term costs to the National
Health Service by delaying or even avoiding the onset of
chronic illness and disability.
References
1 Mander T. Postreproductive health and lifestyle consultations.
Menopause Int 2010;16:1301. DOI: 10.1258/mi.2010.010030
2 National Institute for Health and Clinical Excellence. Guidelines on
Vitamin D. London: NICE, 2012
3 Gabriel B, Ratkevicius A, Gray P, Frenneaux MP, Gray SR.
High-intensity exercise attenuates postprandial lipaemia and
markers of oxidative stress. Clin Sci (Lond) 2012;123:31321
4 Colado JC, Triplett NT, Tella V, et al. Effects of aquatic resistance
training on health and fitness in postmenopausal women. Eur J
Appl Physiol 2009;106:11322
5 Corder R. The Red Wine Diet. London: Penguin Books, 2007. ISBN:
1583332901, 9781583332900
6 Lee C, Longo VD. Fasting vs dietary restriction in cellular
protection and cancer treatment: from model organisms to
patients. Oncogene 2011;30:330516. doi: 10.1038/onc.2011.91.
Epub 2011 Apr 25
7 British Menopause Society Council. Modernizing the NHS:
observations and recommendations from the British Menopause
Society. Menopause Int 2011;17:413
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