A M E R I C A N C O L L E G E O F S P O R T S M E D I C I N E

ACSM FIT SOCIETY® PAGE

Letter from the Editorby Dixie Thompson, Ph.D., FACSM

Welcome to the Fall 2009 edition of theACSM Fit Society® Page! We recentlyconducted a survey of all subscribers, andwe’ve utilized your feedback and ideas tobring you the focus of this issue: menopause.

Menopause affects millions of women, andin this edition you’ll learn how exercise andgood nutrition may ease symptoms andmake that stage of life much moremanageable. Happy reading!

Dixie L. Thompson, Ph.D., FACSM

Editor, ACSM Fit Society® Page

E-mail: dixielee@utk.edu

To subscribe to the ACSM Fit Society® Page,please send an e-mail to publicinfo@acsm.org.

THEME: MENOPAUSE

ExerciseRecommendationsfor Menopause-Aged Women

by Chris Eschbach, Ph.D.

The symptoms of menopause are numerous,and they can affect the quality of life of womenmoving through this stage. The good news isthat exercise can often help reducemenopause-related symptoms.

Menopause is the term commonly used torefer to the period of time both before andafter a woman’s last menstrual period.Technically, menopause is a woman’s lastmenstrual period, while the time periodimmediately prior to menopause is referred toas “peri-menopause” and the time followingmenopause is referred to as “post-menopause.”

This process of changing hormone levels canlast for more than 10 years and women mayexperience widely varying hormone levels,specifically estrogen, progesterone, folliclestimulating hormone,and luteinizing hormone.These hormones alone, and in combination,are responsible for a wide range of processes

within the body. The changes that occurduring this stage of life may result indisruptions to normal daily living. Thesedisruptions may include hot flashes, sleepdisruption, weight gain, loss of libido, short-term memory impairment or a lack of focus,increased anxiety, fatigue, depression anddrastic mood swings, joint/muscle aches andpains, irregular periods, heavy bleeding, dryeyes, vaginal changes, hair loss, osteoporosis,and cardiovascular disease – most of whichcan be lessened with an effective exerciseprogram. It is important to note that not allwomen experience the same changes or withsimilar intensity, which is one reason whymenopause can be quite frustrating for manywomen.

Research has demonstrated the positive effectsof exercise and physical activity on reducingmenopausal symptoms. Interestingly, thepositive changes do not seem to be brought onby “correction” of hormonal concentration butrather from the acute effects of exercise andthe long-term positive adaptations that resultfrom exercise training. The positive outcomesresulting from regular exercise and/or physicalactivity programs include increasedcardiovascular fitness, improvements in bodycomposition, decreased anxiety anddepression, and enhanced feelings of well-being. Additionally, exercise and/or physicalactivity has, in some cases, been shown todecrease feelings of fatigue and chronic musclepain, improve quality and duration of sleep,and increase or minimize loss of bone density.

The exercise recommendations for women ineither peri- or post-menopause are very similarto those recommended for all women. Startingan exercise program can be a difficult task,especially during a time when hormonalfluctuations result in a variety of physiologicaland psychological changes. The key is toremember that the main goal is to boost yourhealth and minimize any symptoms broughtabout by natural body changes. It is importantto choose activities that you enjoy.

Any cardiovascular activity (brisk walking,cycling, water aerobics, mowing the lawn)that causes you to elevate your heart rate and

I N S I D E T H I S I S S U E :1 | Letter from the Editor1 | Exercise Recommendations for Menopause-Aged Women2 | Q&A with ACSM3 | Exercise, Menopause and Osteoporosis

4 | Stages of Menopause4 | Controversy in Hormone Therapy5 | The Athlete’s Kitchen

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Fall 2009

ACSM Fit Society® Page Editorial Board:Dixie L. Thompson, Ph.D., FACSM, Editor

University of TennesseeThomas Altena, Ed.D.

Southwest Missouri State UniversityKatherine A. Beals, Ph.D., R.D., FACSM

University of UtahDawn Coe, Ph.D.

University of TennesseeKate A. Heelan, Ph.D.

University of Nebraska-KearneyCherilyn Hultquist, Ph.D.

Kennesaw State UniversityGerald Jerome, Ph.D.

Towson UniversityAnthony Luke, M.D., M.P.H.

University of California, San FranciscoLynn Millar, Ph.D., FACSM

Andrews UniversityJan M. Schroeder, Ph.D.

California State University, Long Beach

ACSM is the world’s largest association devoted tosports medicine and exercise science. ACSM advances andintegrates scientific research to provide educational andpractical applications of exercise science and sportsmedicine.

Permission to reprint material from this publication isgranted by ACSM contingent upon manuscripts beingreprinted in total without alteration and on proper creditgiven to ACSM by citing ACSM Fit Society® Page, issue andpage number; e.g., “Reprinted with permission of theAmerican College of Sports Medicine, ACSM Fit Society®

Page, Fall 2009, p. 3.”

break a sweat while still able to carry on aconversation is adequate for meeting theACSM-recommended 30 minutes a day, fivedays a week (or 150 minutes per week). Evenshort bouts of exercise lasting at least 10minutes can be accumulated toward the 30-minutes-per-day goal. In addition tocardiovascular exercise, twice-a-week bouts ofstrength training with at least eight exercises ofeight to 12 repetitions working the wholebody can result in positive outcomes.

For both cardiovascular and strength trainingexercises, remember to increase the amount ofexercise gradually, starting with realisticamounts and moving toward achieving theminimum recommendations. Exceeding theminimum recommendations further reducesthe risk of inactivity-related chronic diseaseand may be helpful in minimizing symptomsof menopause.

Special consideration should be given forthose women who are especially affected byhot flashes. Research has shown that arelaxation-based method with pacedrespiration significantly reduces objectivelymeasured hot flash occurrence. With this inmind, programs that encourage focusedrelaxation and breathing, such as yoga, maybe beneficial for reducing hot flashes. Whilethe benefits of cardiovascular activity arenumerous, researchers have not consistentlyfound positive effects specific to hot flashes,although it may work for some women.

It is important to consult your physician on aregular schedule as peri-menopauseapproaches and work with him or her tobalance the changing needs of your body. Besure to use exercise to help managecomplications brought about by this lifechange.

Q&Aby Anthony Luke, M.D., FACSM

Q: I’m worried about gaining weight once menopause occurs. I heard weight gain happens,and I’m starting to experience hot flashes. What can I do?

A: Unfortunately, it’s estimated that about 90 percent of women gradually gain about 10 to 15pounds after menopause. Weight changes may be greater and faster when women undergomenopause early. There are several reasons why weight gain can occur with menopause. Changinghormone levels associated with menopause are a big reason, but are not necessarily the only cause ofweight gain. It’s natural that as you age, your metabolism slows down and you burn fewer calories.Aging also leads to the body having more fat than muscle – and fat burns fewer calories. Manypeople also eat more and exercise less over time. Doing the same exercise routine and eating thesame diet may not be able to keep the pounds off, requiring further lifestyle changes. Of course,eating a healthy, balanced diet is always recommended. Avoid refined sugars, caffeine, nicotine andalcohol. Maintaining or increasing aerobic activities can be useful especially getting to moderate orvigorous activity levels that can burn calories and fat at a higher rate. Reducing stress can be helpfulalso to avoid excessive stress hormone levels that trigger the body to store more fat. It’s important toremember that this is a normal part of life and accepting the transition and living a healthy lifestyleare the best ways to prepare for life’s changes.

Q: Is exercise important for reducing breast cancer risk after menopause?

A: Several studies demonstrate that exercise is indeed protective against breast cancer. This effectmay be even greater for women who are post-menopausal. For example, a case-control study fromGermany published in 2008 showed that the effects of physical activity on lowering breast cancerrisk were independent from adult weight gain, body mass index and energy intake. The researcherssuggested that physical activity may reduce post-menopausal breast cancer risk at least in part viahormonal pathways and not solely by changing body composition. They encourage inactive post-menopausal women to become physically active, even later in life. An earlier study done in theUnited States showed a moderate effect for physical activity with the greatest protection seen inwomen who were consistently active throughout their lifetime. A review published in the BritishJournal of Sports Medicine in 2008 reported that three-quarters of the studies showed a breastcancer risk reduction associated with increased physical activity with an average risk decrease of 25-30 percent. Most studies showed a relationship between the amount of exercise (dose) and theprevention of breast cancer (response). They also found greater risk decreases in specific subgroupsof the population, including specifically post-menopausal women, those who participate in lifelongor later-life activity, and/or those who are regularly involved in recreational activity and vigorousactivity.

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Exercise Recommendations (continued from page 1)

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THEME: MENOPAUSE

Exercise,MenopauseandOsteoporosis

by Kerri Winters-Stone, Ph.D., FACSM

Osteoporosis, a weakening of the bonescausing them to fracture easier, is a diseasethat most women are familiar with because it’slong been considered a woman’s disease. Eventhough we now know that men are alsovulnerable to osteoporosis, the disease afflictsmore women than men largely becausewomen have naturally smaller and lighterskeletons and because women suffermenopause-related bone loss in addition toage-related losses.

Near or at the onset of menopause, typicallyaround age 50, women’s bodies lose the abilityto produce normal levels of estrogen, thusestrogen’s protective effect on the skeleton islost. During the early menopausal years, lossof estrogen can cause bone to be lost two tofive times more quickly than loss caused byage alone. While estrogen and/or hormone-replacement therapy (combination of estrogenand progesterone) has been shown toeffectively stop menopause-related bone loss,recent health concerns over the use ofhormone replacement therapy have made itless popular. (Read a related article on page 5)

While estrogen levels are one factor thatdetermines the health of the skeleton, manymore factors play a role in maintaining bonehealth. Two of the most important factors arephysical activity and nutrition. These factorsare no less important after menopause.Physical activity plays a very important role in

keeping our bones strong. Many studies haveshown that physically active women havehigher bone mass than inactive women andthat physically active persons experience fewerfractures even if they have osteoporosis.Studies have also shown that when peopleengage in a certain types and amounts ofphysical activity (see below), their bone massmay increase, or at least be protected againstsevere decreases.

Another important role of physical activity isto prevent falls. While bone health is certainlya strong indicator of a person’s fracture risk,falling may be an equally important risk factorfor fracture.

Evidence-based guidelines specific to reducingfracture and falling risks have been developedby a group of experts convened to write theAmerican College of Sports Medicine’s PositionStand on Physical Activity and Bone Health1.These current exercise recommendations fromthis publication are as follows.

For preserving bone healthin adulthood:

• Mode: Weight-bearing endurance activities(tennis; stair climbing; jogging, at leastintermittently during walking), activities thatinvolve jumping (volleyball, basketball), andresistance exercise (weight lifting)

• Intensity: Moderate to high• Frequency: Weight-bearing endurance

activities 3-5 times per week; resistanceexercise 2-3 times per week

• Duration: 30-60 minutes/day of acombination of weight-bearing enduranceactivities, activities that involve jumping,and resistance exercise that targets all majormuscle groups

For Elderly Women and Men:

Exercise programs for elderly women and menshould include not only weight-bearingendurance and resistance activities aimed atpreserving bone mass, but also activitiesdesigned to maintain balance and preventfalls.

The most effective fall prevention exerciseprograms in older adults are those that includeboth moderate to vigorous resistance exercisetargeting the lower body and balanceexercises. Alternative forms of exercise thatfocus on dynamic strength and balance, suchas Tai Chi, are also effective at reducing falls inolder adults.

For individuals with diagnosed osteoporosis,the ACSM Resource Manual2 suggests thefollowing guidelines for physical activity andresistance training aimed to prevent falls:

• One to three sets with five to eightrepetitions of four to six weight-bearing,lower-body strength exercises using bodyweight as resistance

• Activities performed two to three days/week• Additional resistance may be applied

gradually and conservatively (up to 10 lbs.)with weighted vest

• Therapy bands & rubber tubing may beused to facilitate range-of-motion exercises

• Avoid impact exercise, spinal flexion againstresistance, spinal extension, highcompressive forces on the spine, quick trunkrotation

When it comes to bone health, a sensible dietis the perfect complement to a physicallyactive lifestyle. The two most importantnutrients for the skeleton are calcium andvitamin D. If dietary intake of calcium ischronically inadequate, bone will be lost fromthe skeleton and it can weaken. Vitamin Dkeeps bone strong because it facilitatescalcium absorption. More recently, researchhas shown this nutrient is also important formaintaining strong muscles and can helpprevent falls. The Food and Nutrition Board ofthe Institute of Medicine of the NationalAcademies (http://dietary-supplements.info.nih.gov/) recommends the followingintake levels for post-menopausal women:

• Calcium: 1200 milligrams/day• Vitamin D: 10 micrograms/day (400

International Units/day) from ages 51 to 70(Increase to 15 micrograms/day [600International Units/day] after age 70)

Menopause marks an important time forwomen to evaluate their risk of osteoporosis.For women who are concerned about theirrisk of fracture, physical activity and goodnutrition are important strategies to adopt.Following dietary guidelines and practicing aspecific exercise program based on ACSMrecommendations are bone-smart habits thatwill help women stay fracture free. We knowthat bone benefits from exercise are lost whensomeone stops training, so exercise done totarget the bones must be a lifelongcommitment. An ACSM-certified fitnessprofessional has the background and trainingto help develop a comprehensive program thatis enjoyable, safe and effective.

References:

1. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, YinglingVR. American College of Sports Medicine Position Stand:physical activity and bone health. Med Sci Sports Exerc.Nov 2004;36(11):1985-1996.

2. Shaw JM, Witzke KA, Winters KM. Exercise for SkeletalHealth and Osteoporosis Prevention, ACSM ResourceManual, 4th Edition, Williams & Wilkins Publishers, 2001.

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THEME: MENOPAUSE

Stages ofMenopause

by Jan Schroeder, Ph.D.

By the year 2025, the World HealthOrganization estimates that 1.1 billion womenwill be age 50 or over, all of whom are or willsoon be experiencing menopause. In fact,menopause affects so many women that theInternational Menopause Society, incollaboration with the World HealthOrganization, has designated Oct. 18 as WorldMenopause Day.

Menopause literally means “the permanent‘pause’ of menses,” which signifies the end of awoman’s ability to have children. Typically,menopause is a natural and gradual process inwhich the ovaries reduce their production ofthe female sex hormones – estrogen andprogesterone. These hormones allow a womanto become pregnant, cause menstruation, andaffect many other functions in the body, suchas the circulatory system, urogenital system(urinary and vaginal) and the bones. Whenthe production of these hormones drops,menopausal symptoms may occur. Whilesome women experience no menopausalsymptoms, approximately 75 percent willexperience some type of symptoms varying indegree of severity.

Most women experience natural menopausebetween the ages of 40 and 58, with theaverage age of onset around 51 years of age. Itis interesting to note that while the average lifeexpectancy of women has increased, theaverage age of menopause onset has remainedthe same for centuries.

Stages of menopauseThe misuse of terminology in the field ofmenopause can cause confusion and spreadmisinformation. The stages of menopause arenot distinct, but rather overlap. Menopause isonly one of several stages in the reproductivelife of a woman. The World HealthOrganization defines the stages of menopauseas:

• Pre-menopause – The entire reproductiveperiod up to the final menstrual cycle. It isbest defined as a time of “normal”reproductive function in a woman.

• Peri-menopause – Includes the timeimmediately prior to menopause and thefirst year after menopause. This is the timewhen a woman’s body slowly makes less ofthe hormones estrogen and progesterone,resulting in menopause symptoms (see Table1). The onset of peri-menopause is typicallybetween 45 and 60 years old and can span atwo- to six-year period. There is no way totell in advance how long this stage will take.

• Menopause – The permanent cessation ofmenstruation and fertility resulting from theloss of ovarian follicular activity. This stagecan only be confirmed a year or more afterthe final menstrual cycle. Most women willexperience natural menopause; however, ina few cases, premature or inducedmenopause is experienced (see sidebar).Menopause can be confirmed by 12consecutive months without a menstrualperiod.

• Post-menopause – The period of time afterthe final menstrual period. Post-menopausecan bring up new health issues due to thereduced production of the female hormonesestrogen and progesterone. Two possiblehealth concerns in post-menopausal womenare osteoporosis and heart disease.

While some women view menopause as anuisance, it can actually be a very enjoyabletime of life for many women. Understandingthe stages of menopause, as well as how

exercise, nutrition, and treatment aid insymptom relief and may reduce menopausalhealth concerns, may assist you through thisnatural process.

Menopause Terms

• Natural menopause is a gradual process inwhich the ovaries reduce their production of thefemale sex hormones.

• Induced menopause occurs when both ovariesare surgically removed (with or without ahysterectomy) or when the ovaries are damagedby medical treatment such as radiation,chemotherapy or medications. Inducedmenopause causes an immediate discontinuationof ovarian hormones, which may lead to moresevere menopausal symptoms. Hot flashes maybe more severe, more frequent and last longerand the female has a greater risk of heartdisease, osteoporosis and depression.

• Premature menopause is when a femaleenters menopause before the age of 40, whethernatural or induced. Unfortunately, these womenspend a greater portion of their lives without theprotective benefits of their own estrogen, whichputs them at an even greater risk formenopause-related health problems.

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Vasomotor Changes Emotional Changes Urogenital Changeschanges in your period loss of confidence vaginal dryness or itchingabnormal bleeding or “spotting” irritability urinary tract infectionshot flashes and night sweats nervousness or anxiety frequent desire to pass urineweight fluctuation reduced libido discomfort during

(reduced interest in sex) sexual intercoursedizziness insomnia leaking of urine when

(difficulties sleeping) coughing or laughing (stressincontinence)

skin - dryness/sensations fatigue, tiredness(crawling or itching) or exhaustionmuscle/joint pain problems with memory

and staying focusedhair loss or thinning headachespalpitations (rapid heart beat)

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THEME: MENOPAUSE

Controversyin HormoneTherapy

by Barbara Bushman, Ph.D., FACSM

Research and media attention on hormonetherapy (HT) within the past decade hasresulted in many questions. The reportednumber of prescriptions for HT declinedfollowing the release of certain clinicalresearch study results.1 The decision to utilizeHT is one that must include consideration ofthe risks and benefits for the individualwoman.

Although a blanket recommendation might bedesired, it would not be appropriate. Rather,this article will provide the typical indicationsfor HT use as well as the background relatedto HT use with regard to heart disease. For thepurposes of this article, HT refers to bothestrogen therapy as well as combinedestrogen-progestogen therapy (as would beprescribed for women with an intact uterus inorder to avoid increased risk of endometrialcancer from unopposed estrogen therapy). HTis not recommended for women with a historyof hormone-sensitive cancers, liver disease,blood-clotting disorders, or confirmedcardiovascular disease.2

The primary indication for use of HT is fortreatment of menopause-related vasomotorsymptoms (i.e., hot flashes, night sweats). HTis very effective for women experiencingtroublesome vasomotor symptoms. Treatmentof vaginal symptoms (e.g., vaginal dryness) isanother indication for HT prescriptions withregulatory agency approval in place for manysystemic products as well as local vaginalestrogen therapy products.

Bone health may also benefit from extendedHT use, although regulatory agency approvalis not in place for all products (for a list ofgovernment-approved post-menopausalosteoporosis drugs seehttp://www.menopause.org/edumaterials/otcharts.pdf). HT is currently not recommended asa primary method for protection of hearthealth for women of any age. This is an area ofresearch focus and at the center of mediaattention.

Reductions in coronary heart disease for HTusers compared with non-users have beennoted in observational studies (i.e. thosestudies that simply “observe” or track womenwho are already using HT over a given periodof time). This benefit was not noted withrecent randomized controlled trials (RCT).RCT are typically considered to be a morerigorous type of research since women arerandomly assigned to either HT or a placebo(non-active pill), thus removing potential biasof self-selection.

The issue of “safety” regarding HT use came tothe attention of the media and thus theAmerican consumer when a number of theRCT associated with the Women’s HealthInitiative (WHI) were prematurely stoppeddue to risks exceeding benefits based onspecific criteria. Why did the RCT result insuch different results compared with theobservational studies? Selection of the subjectsas well as timing of HT likely played a role.Subjects in the RCT were older and hadstarted on HT at a later point followingmenopause (10+ years compared to less thantwo to six years).3 For women in the WHIwho initiated HT closer to menopause, therisk of coronary heart disease was reducedcompared to those who initiated HT later.Some researchers now suggest that earlyinitiation of HT (within six years ofmenopause or by age 60) continued for sixyears or more following menopause isassociated with heart disease risk reduction.4

There are a number of clinical trials currentlyunderway that should help clarify theinfluence of the timing of HT initiation andage of the woman.

Until more details become available, theindividual woman should consult with herphysician to determine if HT is the bestdecision when considering personal healthhistory. In general, HT use is recommended atthe lowest dose for the shortest duration toreach treatment goals. Hormone therapy is stillconsidered a viable short-term option formanagement of moderate to severe vasomotorsymptoms for recently menopausal women ingood health.5 However, at this time, HT is notconsidered appropriate for the single purposeof preventing cardiovascular disease.5

Although not the focus of this article, exerciseis one intervention without side effects that isbeneficial for bone, cardiovascular health, and,for some women, menopausal symptoms.ACSM is committed to encouraging andproviding guidance for women with regard toexercise (please see ACSM’s Action Plan forMenopause published by Human Kinetics,2005, at www.humankinetics.com).

References

1. Hersh AL, Stefanick ML, Stafford RS. National use ofpostmenopausal hormone therapy: annual trends andresponse to recent evidence. JAMA. 2004;291:47-53.

2. North American Menopause Society. Treatment ofmenopause-associated vasomotor symptoms: positionstatement of The North American Menopause Society.Menopause. 2004;11:11-33.

3. Hodis HN, Mack WJ. Randomized controlled trials and theeffects of postmenopausal hormone therapy oncardiovascular disease: facts, hypotheses, and clinicalperspective. In: Lobo RA, editor. Treatment of thepostmenopausal women: basic and clinical aspects, 3rdedition. Oxford UK: Elsevier;2007, p. 529-564.

4. Hodis HN, Mack WJ. Postmenopausal hormone therapyand cardiovascular disease in perspective. ClinicalObstetrics and Gynecology. 2008;51:564-580.

5. Gass MLS, Bassuk SS, Manson JE. Reassessing benefits andrisks of hormone therapy. American Journal of LifestyleMedicine. 2009;3:29-43.

THE ATHLETE’S KITCHEN:

CalciumConcerns:Boning Up OnNutrition

by Nancy Clark, M.S., R.D., FACSM

“I’m 44. Should I start taking calcium pills?”

“A bone density test indicated I have thebones of a 70 year old — and I’m only 34. Iguess I should have had more milk and lesssoda as a kid?”

“Will drinking more milk help my stressfracture heal faster?”

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Questions and confusion abound about therole of calcium in athletes’ diets. If you are likemost active people, you may think that “milkis for kids” and quench your thirst at lunchand dinner with (diet) soda or water. As aresult, you can easily end up consuming acalcium-deficient diet (that is, unless youconsume yogurt and cheese instead of milk).

Weight-conscious women, in particular, areknown to have calcium-deficient diets out of(an unjustified) fear that milk’s calories willadd to undesired weight gain. Many men alsohave calcium-poor diets. If they are not milkdrinkers, men’s main sources of calcium arefrom the cheese on cheeseburgers and pizza.Not very health-enhancing...

Given the average American lives for 77.7years, maintaining bone health throughout thelifespan should be a priority for all athletes,starting as youngsters and continuing asmaster’s athletes. A calcium-rich diet, weight-bearing exercise (such as running, as opposedto biking and swimming) and strength-training to have strong muscles tugging onbones are all important factors for optimizingthe bone density of both growing children andactive adults.

Bones are alive and require a life-long calciumintake. If your family has a history ofosteoporosis, your risk for “shrinking” (losingheight) as you get older is high and youshould pay special attention to maintainingyour bone density. Female athletes with ahistory of amenorrhea also have a high risk forweak bones and should get their bone densitytested so they know where they stand and ifthey need to take extra steps to try to enhancebone density. Continue reading to learn moreinformation about calcium and bone health tohelp you enjoy lifelong health – no bonesabout it.

Q: Can I take a calcium supplementinstead of drink milk?

A: While any calcium is better than none,taking a calcium pill does not compensate fora calcium-poor diet. A supplement offerscalcium, but it does not offer the high-qualityprotein found in milk or soy milk, nor thenumerous other health-enhancing nutrients.Little babies thrive on milk, not calcium pills.Do you really think a pill can replace a wholefood?

Q: I like to save calories by taking acalcium pill instead of drinking milk. Isthat ok?

A: Not really. Although a calcium pill offers alow-calorie alternative to consuming therecommended three (eight-ounce) servings of

milk or yogurt each day, research indicatesmilk drinkers tend to be leaner than milkavoiders. I encourage my clients to embracemilk as a “liquid food” that is satiating andcurbs one’s appetite. That is, milk can be morefilling than the same number of calories fromsoda or juice.

Most of my active female clients reduce weighton 1,800 calories; men on 2,100+ calories.That breaks down to 500 to 600 calories permeal (breakfast, lunch, dinner) and 300calories for a snack. Enjoying low-fat (or soy)milk on cereal, a mid-morning latte and ayogurt for a snack seems like a powerful wayto spend 300 of those calories and approachthe recommended intake of 1,000 milligramsof calcium per for adults 19-50 years old;1,200 mg for adults older than 50 years; and1,300 mg for kids 9-18 years old. If you are aparent, be a role model and drink milk atdinner to encourage a calcium-rich intake foryour kids. Building strong bones during theages of 10 to 18 is a wise investment for thefuture.

Q: I’m lactose intolerant. Can I getenough calcium from non-dairy foods likesoy milk, spinach, broccoli and almonds?

A: You certainly can get calcium from non-dairy sources. Soy milk is calcium-fortifiedand offers around 300 mg of calcium in eightounces — similar to cows’ milk. Otherconvenient non-dairy calcium sources includefortified orange juice (350 mg per eightounces) and fortified breakfast cereal, such asTotal Cereal (1,000 mg per 3/4 cup).

If you are do not consume dairy products orfortified soy products, you will have to workhard to consume adequate calcium. Forexample, to get the recommended intake fromplant sources, you’d need to eat 10 cups ofspinach salad, 3.5 cups of broccoli, and fourounces of almonds (about 88 almonds at 675calories) per day. That’s a lot of eating…

What you do NOT get from those plantsources of calcium is Vitamin D. Vitamin Denhances the absorption of calcium and isneeded to not only protect bone health butalso to reduce the risk of high blood pressure,diabetes, and heart disease, and to enhanceimmune function and reduce inflammation.Vitamin D is added to milk and some brandsof yogurt, but is hard to find naturally infoods other than oily fish. Hence, non-milkdrinkers have a high risk for both calcium andvitamin D deficiencies.

Q: I live in Boston and spend lots of timeoutdoors in the sun. Should I takeadditional Vitamin D even though I drinkmilk?

A: Yes, especially between Thanksgiving andEaster. Vitamin D deficiency is surprisinglycommon in people who live in northernlatitudes (north of Atlanta, Ga.), where thesun’s ultraviolet rays do not effectively convertthe body’s inactive form of D (just under theskin) into an active form. And evenSoutherners need to be mindful. A study ofsouthern distance runners indicates 40percent of them were D-deficient. Indoorathletes (dancers, swimmers, hockey players,figure skaters, basketball players, gym rats,etc.) should ask their doctors about gettingtheir blood tested to determine their level ofvitamin D, and if it is low, take steps to correctthe problem.

Q: Does the fat in milk contribute toheart disease?

A: Controversial. A study that tracked thehealth and dairy intake of 4,374 children for56 years (between 1948 and 2006) reportsthere was no increased risk of heart disease orstroke among the 34 percent who died duringthat time — even though as kids the subjectsin the study drank whole milk. In fact, thechildren who consumed the most milk andcheese lived longer.

This study conflicts with the prevalentmessage to reduce the risk of heart disease bylimiting the intake of milk’s saturated fat. Untilmore research clarifies this confusion, Irecommend you enjoy low-fat dairy/calcium-rich foods to help reduce excessive fat andcalorie intake while maintaining a strongcalcium intake.

Q: Will drinking extra milk help a brokenbone heal faster?

A: Doubtful. Bones need time to heal —about six to eight weeks. But perhaps you canreduce the risk of breaking a bone by buildingit stronger in the first place.

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The Athlete’s Kitchen (continued from page 5)

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