Harvard Guide Healthy

8/8/2019 Harvard Guide Healthy

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The Harvard Guideto Healthy Living

10 steps to alonger healthier life

Harvard Medical School

Trusted advice for a healthier life

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THE HARVARD GUIDE TO HEALTHY LIVING | 10 steps to a longer healthier life www.hea l th .harva rd .edu2


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THE HARVARD GUIDE TO HEALTHY LIVING | 10 steps to a longer healthier life www.hea l th .harva rd .edu

Stay away fromcigarette smoke

f you smoke, quit. There arefew things you can do that willhave such immediate and lastingbenefits as giving up cigarettes.

In 20 minutes, your heart ratewill fall. By tomorrow youll havecleared the excess carbon mon-oxide from your blood. Withinmonths, youll be breathing moreeasily and coughing much less.Over the years, your risk for lungcancer, stroke, and heart diseasewill have dropped by at least half.In 15 years, youll have erasedyour excess risk for heart disease.

Separate yourself from smokers.Inhaling anothers smoke is alsoemerging as a weaker, but stillnoteworthy, risk factor. If youre a

nonsmoker, become a nag. Let thesmokers in your circle of friendsand family know that you wouldlike them to quit, and encouragethem in their efforts. Be patient.Only 4% to 7% of smokers areable to quit on any attemptwithout aids like nicotine replace-ment products or medical help,and only one-quarter to one-thirdwho use any quit-smoking medi-cine stay smoke-free for more

than six months. It usuallytakes many attempts beforea person is successful at quit-ting.

Keep movingLack of physical activityis an independent risk

actor for nearly all of thediseases that are most likelyto kill or disable you. In theong-running Framingham

Heart Study, moderate activ-ity tacked on 1.3 years of lifeor men and 1.5 years of lifeor women versus low activ-ity. Raising the bar to high ac-tivity added 3.7 years for menand 3.5 years for women.

Regular moderate exercise canhelp to protect you against thefollowing problems:

Heart disease and

stroke. egular exercise helpsto strike a healthier balanceof blood lipids (HDL, LDL, andtriglycerides) and helps arter-ies retain resilience despite theeffects of aging. It reduces bloodpressure, which in turn lowersthe risk not just of heart disease,but also of stroke and kidneyfailure. Exercising regularly mayalso promote the growth ofcollateral arteries, small blood

vessels feeding the heart. Even ifyou already have heart disease,exercise lowers your chances ofdying from it.

Cancer. Exercise reducesthe risk of cancers of the co-lon, breast, endometrium, andprostate. By helping you attain ahealthy weight, exercise also less-ens your risk for other cancers inwhich obesity is a factor.

Diabetes. Exercise pares

excess weight, modestly lowersblood sugar levels, and boostssensitivity to insulin so thatyour body needs less of it. If youalready have diabetes, exercisehelps control blood sugar.

Osteoporosis. When com-bined with calcium, vitamin D,and bone-saving medications if

Risk reduction has a lot in common with one-stop shopping: its possible to reduce your riskof the many major degenerative diseases by following the advice below.

Harvard Medical School

SPECIAL REPORT

10 STEPS TO A LONGER HEALTHIER LIFE

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necessary, weight-bearing exerciseike walking, running, and strengthtraining helps ward off bone loss.

Arthritis. xercise helps pro-tect joints by easing swelling, pain,and fatigue and by keeping carti-age healthy. Strong muscles sup-port joints and lighten the loadupon them. Exercise may limit andeven reverse knee problems byelping to control weight.Accidents. Activities like

stretching, yoga, and tai chi extendange of motion and enhance

balance, which helps prevent fallsand other accidents.

Depression and anxiety.Exercise lifts spirits by releasingmood-elevating hormones,elieving stress, and promoting

a sense of well-being. In somestudies, exercising regularly haselped ease mild to moderate

depression as effectively asmedications; combining exercisewith medications, therapy, andsocial engagement is even better.

Eat like an AegeanAlthough countless observa-tional studies have pointed

to the health benefits of specificoods or nutrients, rarely haveentire eating regimens undergoneclose scientific examination. Anotable exception is the Medi-terranean diet, a term coined todescribe the traditional eatingpattern of people living in theegion bordering the Mediterra-

nean Sea. The Mediterranean dietconsists mostly of plant foods(fruits, vegetables, grains, beans,nuts, and seeds); animal proteinconsumed chiefly in the forms offish and poultry; olive oil as theprincipal fat; and wine taken withmeals (see Figure 1).Although the diet was a productof the foods easily cultivated orgathered in that region centuries

ago, modern research confirmsits unintentional wisdom. Multiple

compounds in plant foods appearto act as antioxidants, slowing theaging process and hindering thedevelopment of cancer and heartdisease. By slowing digestion, thefiber in whole grains, legumes,and fruit can help keep bloodsugar under control; fiber alsocreates a feeling of fullness, which

may help satisfy appetite. Themonounsaturated fats in oliveoil, nuts, and fish can have anti-inflammatory effects, which mayhelp stave off heart disease andmany other conditions. Perhapsmost important to its success isthat Mediterranean-style eatingexcludes many foods known tocause health problems: saturatedfat from animal sources, trans fat,and refined carbohydrates.Studies have found that the diethelps to lower the risk of the fol-lowing conditions:

Obesity. A two-year random-ized trial comparing low-fat, low-carbohydrate, and Mediterraneandiets in middle-aged, mildly obesemen and women found that those

who followed the low-carb andMediterranean diets lost an aver-age of 10 pounds, compared withan average of 6 pounds amongthose on the low-fat diet. TheMediterranean diet also loweredLDL (bad) cholesterol most andcontrolled blood sugar mosteffectively.

Heart disease. In the Nurs-es Health Study, which involvednearly 75,000 women, those

whose diets most closely approxi-mated the Mediterranean patternwere 28% less likely to die ofheart disease or stroke during an18-year period than women whoate a typical American diet.

Diabetes. In a 13,380-personSpanish study, participants whostrongly adhered to a traditionalMediterranean diet were 83%less likely to develop diabetesthan those following the diet least

closely.Alzheimers disease. A

study of cognitive function in2,258 older Americans over afour-year period found a 40% re-duced risk for Alzheimers diseaseamong those who most closelyfollowed the Mediterranean diet.

All-cause mortality. The

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HOW MUCH EXERCISE IS ENOUGH?

In the fall of 2008, the U.S. Department of Health and Human Services is-sued a detailed exercise prescription for the nation. Every adult was urgedto get at least 150 minutes of moderate aerobic activitythe equivalentof walking at a rate of 3 to 5 miles per houror at least 75 minutes ofhigher-intensity activitya rate of 5 mph or morea week. The sessionsshould be at least 10 minutes long and may combine both moderate andvigorous activities. In addition, adults were advised to engage in at leasttwo sessions of strengthening exercises a week.

Go beyond the basics if you can, say the guidelines. Once youre rou-tinely logging the recommended levels of aerobic activity, start to add aew minutes a day. (Ramping up slowly reduces the likelihood of injury.)The HHS committee found that you can get even greater health benefits

and more effective weight control when you reach twice the recom-mended weekly amountthat is, 300 minutes of moderate activity, 150minutes of vigorous activity, or a combination of the two. And more thanthat may be even better still.

The HHS exercise guidelines emphasize that people with chronic medi-cal conditions and disabilities should get just as much exercise as otheradults, if they can, and advise them to speak with their health care provid-ers about appropriate kinds and levels of exercise. The American Collegeof Sports Medicine Web site also has detailed advice for people with cer-tain chronic health conditions at www.exerciseismedicine.org/public.htm.


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NIHAARP Diet and HealthStudy, involving nearly 400,000women and men ages 50 through71, found that people who mostclosely followed this diet wereabout 20% less likely to have diedof heart disease, cancer, or anycause over a five-year follow-upperiod.

Other conditions. Researchhas also found Mediterranean-style eating to be associated withimprovements in rheumatoidarthritis, reduced risk for COPD,and reduced risk for recurrenceof colon cancer.

Mind your BMIxcess body weight increases

your risk for more than 50different health problems. These

conditions include some of theeading causes of deathheartdisease, stroke, and diabetesaswell as less serious ailments suchas arthritic knees and gallstones.A Harvard study that combineddata from more than 50,000 menand more than 120,000 womenound that obesity increased theisk of diabetes 20 times and

substantially boosted the riskof developing high blood pres-sure, heart disease, stroke, andgallstones. Among people whowere overweight or obese, therewas a direct relationship betweenbody mass index (BMI) and risk:the higher the BMI, the higher theikelihood of disease (see Table1).Studies are also linking obesity tocancer deaths. An American Can-cer Society investigation followedmore than 900,000 people for 16

years. Thefindings suggested thatamong people ages 50 and older,

overweight and obesity accountsor 14% of all cancer deaths inmen and 20% of all cancer deathsin women. Higher BMIs wereassociated with a higher risk ofdying from cancer of the esopha-gus, colon and rectum, liver,

gallbladder, pancreas, or kidney. Inmen, excess weight also increasedthe risk of dying from stomach orprostate cancer. In women, deathsrom cancer of the breast, uterus,cervix, or ovary were elevated inwomen with higher BMIs.at distribution also plays a role

in health risk (see Figure 2).While fat accumulated in thelower body settles directly underthe skin, fat in the abdominal areais largely visceral, serving as pad-ding between the organs. Visceralat produces substances that spurinflammation and decrease thebodys response to insulin, whichsets the stage for diabetes. Thatswhy a big bellya waist mea-surement of 35 inches or more

in women or 40 inches or morein menconfers a higher risk ofheart disease and diabetes.

he best way to lose excessweight, wherever it is located, isto consume fewer calories than

you use. One way to start is tofollow the exercise and dietaryguidelines outlined above. Infact, information from the Na-tional Weight Control Registry,a database of more than 6,000people who have lost at least 30pounds and kept them off for atleast a year, reinforces that notion.

he registrants report exercis-ing approximately one hour a day(primarily through brisk walking);eating an average of 1,400 caloriesa day, with about 25% providedby fat; making breakfast a regularhabit; and maintaining a consistenteating pattern across weekdaysand weekends. They also keepclose tabs on their weight, hitting

the scales frequently.

Lift a glass, but onlyone (or two for men)We toast to good health for

good reason. Moderate drink-ingdefined as one drink per

Figure 1Mediterranean diet pyramid

Winen moderation

Meats and sweetsLess often

Poultry and eggsModerate portions,

every two days or weekly

heese and yogurtModerate portions,

daily to weekly

Fish and seafoodOften, at least two

times per week

les,Fruits, vegeta

ly whole),grains (most

ans, nuts,olive oil, be

nd seeds,legumes a

d spicesherbs any mealBase everfoodson thes

physicallyB

ive; enjoyac

als with

ersot

Drink

water

Illustration by George Middleton and Exchange Trust2009 Oldways Preservationwww.oldwayspt.org

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day for women and two formenhas been linked to a lowerisk for heart disease and deathrom all causes. Alcohol of anyind increases HDL cholesterol,

improves the bodys response toinsulin, and reduces inflammation.Wine in particular contains smallamounts of plant substances called

avonoids that have demonstratedanti-inflammatory and anticanceractivity in laboratory experiments.

But the dangers of heavy drink-ing far outweigh these potentialbenefits. For men, heavy drinkingmeans more than four drinks onany day or more than 14 drinksper week. For women, its definedas more than three drinks on anyday or more than seven drinksper week. Heavy drinkers face a

higher risk of liver disease, heartdisease, sleep disorders, depres-sion, stroke, bleeding from the

stomach, and several types ofcancer. Some studies hint that forwomen, even moderate drinkingmay raise the risk of breast canceespecially for women with a famihistory of the disease or who areon hormone therapy.

Dont Run Up

a Sleep DebtMedical evidence suggests

that for optimum health and function, the average adult should getseven to nine hours of sleep dailyBut more than 60% of womenregularly fall short of that goal.And as your sleep debt mounts,the health consequences increaseputting you at growing risk forweight gain, diabetes, heart dis-ease, stroke, and memory loss.

In some cases, sleep debt resultsfrom insomnia or other underly-ing conditions that may requiremedical attention. But most sleepdebt comes from burning thecandle at both endsconsistentlfailing to get to bed on time andto stay there until youve sleptenough.Fortunately, sleep doesnt chargeinterest on the unpaid balance,or even demand a one-for-one

repayment. It may take somework, but you can repay even achronic, longstanding sleep debt(see Sound advice for sleepingsoundly, page 8).

Be your ownbest advocateTo help ensure youre

taking the best possible care ofyour own health, perseverancewill serve you well, along with

these tips:Form a partnership. At

midlife and beyond, good healthis increasingly dependent on goocollaborations with your clinicianSince you are likely to be makingmore medical visits, find a primarcare clinician with whom you feecomfortable. Work with your

Table 1Weighing in

The body mass index (BMI) is an index of weight by height. The definitions of normal,overweight, and obese were established after researchers examined the BMIs ofmillions of people and correlated them with rates of illness and death. These studiesidentified the normal BMI range as that associated with the lowest rates of illnessand death. Obesity has been further subdivided into three classes (I, II, and III).

HEIGHT BODY WEIGHT IN POUNDS

410 91115 119138 143162 167186 191+

411 94119 124143 148168 173193 198+

50 97123 128148 153174 179199 204+

51 100127 132153 158180 185206 211+

52 104131 136158 164186 191213 218+

53 107135 141163 169191 197220 225+

54 110140 145169 174197 204227 232+

55 114144 150174 180204 210234 240+

56 118148 155179 186210 216241 247+

57 121153 159185 191217 223249 255+

58 125158 164190 197223 230256 262+

59 128162 169196 203230 236263 270+

510 132167 174202 209236 243271 278+

511 136172 179208 215243 250279 286+

60 140177 184213 221250 258287 294+

61 144182 189219 227257 265295 302+

62 148186 194225 233264 272303 311+

63 152192 200232 240272 279311 319+

64 156197 205238 246279 287320 328+

BMI 1924 2529 3034 3539 40+

NORMALOVER-

WEIGHT

CLASS I

OBESITY

CLASS II

OBESITY

CLASS III

OBESITY

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clinician to devise a schedule for

screening tests and clinical exams(see Table 2). If you are prescribedmedications, take them as direct-ed; dont stray from the designat-ed dose without talking to yourdoctor. Find out what you shouldexpect from every new medica-tion and procedure, and let yourclinician know what you expect itto accomplish in return.

Lower your expecta-tions. Few medical treatments,from knee replacements toface lifts, will restore you toyour 20-year-old self. Accept afew minor aches and pains as aconsequence of overexertion. Ifyou have a chronic condition likefibromyalgia or irritable bowelsyndrome, be prepared to try anumber of therapies before find-ing the one, or the combination,that works best for you.

Pay attention to yourbody. Keep an eye on new spotsand bumps, and any changes inyour regular patterns, be they inappetite, sleep, energy, bowel hab-its, or mood. Its easy to write offmany changes as consequencesof aging when they could signalunderlying disease.

Keep connected

Dont go bowling alone. Nu-merous studies have charted

the positive influence of socialnetworks on health later in life.The Baltimore Longitudinal Studyon Aging and the Georgia Cen-tenarian Study have both foundthat older adults who remainedsocially active lived longer andhealthier lives than their solitarycounterparts. The type of pursuitdidnt matter. Activities ranged

from bridge clubs to group travelto part-time jobs.

Although the benefits of socialnetworks are largely unchal-lenged, investigators from theFramingham Study have substanti-ated the importance of holdingfirm to your principles even whenthey may be counter to those of

your group of friends. Their dataindicate that adopting health hab-its of your group can have nega-tive as well as positive effects onyour health. Data collected overmore than 30 years indicatedthat a person had a 36% chanceof giving up cigarettes when afriend stopped smoking, but a57% chance of becoming obese ifa friends BMI mushroomed.

Say NO to stressYou know what stress is.Whether the source is a

death in the family, the pain of ar-thritis, or an unfulfilled obligation,stress affects the body the samewaytriggering a cascade ofhormones that produce a familiarphysical response poundingheart, rapid breathing, and clammypalms. Intermittent episodes ofstress are not harmful; in fact, we

he excess pounds that tend toTreep on at midlife often settlecround the belly and hips. Fat thataccumulates in the lower body isaund between the skin and thef

bdominal wallso-called subcuta-aeous fat. Fat in the abdominal areanlargely visceral fat. Located aroundise abdominal organs as well ast

ehind the abdominal cavity, visceralbt appears to increase the risk offsulin resistance, which can set theiage for type 2 diabetes.s

Figure 2 Types of body fat

Visc ral fat

Subcutaneous fat

Whats a standard drink?

Spirits

1.5 oz

Brandy

1.5 oz

Cordial

23 oz

Fortifiedwine

3 4 oz

Tablewine

5 oz

Beer

12 oz

1 ounces (a jigger) of 80-proof liquor (bourbon, gin, rum, scotch, tequila,

vodka, or whiskey)

23 ounces of fruit, coffee, chocolate, or other flavored liqueurs (cordials)

3 ounces of fortified wine (sherry, port, marsala, or Madeira)

45 ounces of table wine

12 ounces of regular or light beer

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experience many of these symp-toms during excitement and plea-sure. However, chronic stress isa major contributor to a host ofserious physical and psychologicalconditions.

Whatever it is that sets yourstress cycle in motion, having apersonal escape plan can helpyou manage stressful situationsand even nip stress in the bud.To create a plan, make a list ofthe specific mental, emotional,and physical sensations that youfeel when stressed. For example,do you get a stomachache, grindyour teeth, raid the fridge, andhave trouble thinking clearly?

Whenever you notice your stresssymptoms, take a momentortwo, or threeto relax. Hereare some suggestions from Dr.Herbert Benson, president of theBenson-Henry Institute for MindBody Medicine at MassachusettsGeneral Hospital:

When youve got oneminute. Place your hand justbeneath your navel so you canfeel the gentle rise and fall of yourbelly as you breathe. Breathe inslowly. Pause for a count of three.Breathe out. Pause for a countof three. Continue to breathedeeply for one minute, pausingfor a count of three after each

inhalation and exhalation.If you have two minutes.

Count down slowly from 10 tozero. With each number, takeone complete breath, inhaling andexhaling. For example, breathein deeply saying 10 to yourself.Breathe out slowly. On yournext breath, say nine, and soon. If you feel lightheaded, countdown more slowly to space yourbreaths further apart. When youreach zero, you should feel morerelaxed. If not, go through theexercise again.

When youve got threeminutes. While sitting down,take a break from whateveryoure doing and check your bodyfor tension. Relax your facial

muscles and allow your jaw to falopen slightly. Let your shouldersdrop. Let your arms fall to yoursides. Allow your hands to loosenso that there are spaces betweenyour fingers. Uncross your legsor ankles. Feel your thighs sinkinto your chair, letting your legsfall comfortably apart. Feel yourshins and calves become heavierand your feet grow roots into thefloor. Now breathe in slowly and

breathe out slowly.Dr. Benson offers two other

tools for stress reductiontheworry box and the gratitude journal. The first is a repository forconcerns that are beyond yourpower to influencethe safetyof your children or grandchildrenthe direction of the stock marketthe heating of the planet. Writeeach worry on a slip of paper, putit in the box, and forget about it

for at least a week. The second isa ritualreflecting on the posi-tive experiences and encountersof the day. If you jot them downin a journal, even in the darkestof nights, youll eventually have anencyclopedia of appreciation foryour circumstances.

SOUND ADVICE FOR SLEEPING SOUNDLY

Create a sleep sanctuary. Reserve it for sleep, intimacy, and otherrestful activities, like pleasure reading and meditation. Keep it on thecool side. Banish the television, computer, cell phone or digitalorganizer, and other diversions from that space.

Nap only if necessary. Night owls and shift workers are at the greatestrisk for sleep debt. Napping an hour or two at the peak of sleepinessin the afternoon can help to supplement hours missed at night. Butnaps can also interfere with your ability to sleep at night and throwyour sleep schedule into disarray.

Avoid caffeine after noon, and go light on alcohol. Caffeine can stay in

your body for up to 12 hours. Alcohol can act as a sedative, but it alsodisturbs sleep.

Get regular exercise, but not within three hours of bedtime. Exerciseacts as a short-term stimulant.

Address a long-term debt. If youve shorted yourself on sleep fordecades, you wont be required to put in a Rip Van Winklelike effortto repay the hours of missed slumber. Nonetheless, it could take a fewweeks to recoup your losses. Plan a vacation with a light schedule andfew obligationsnot a whirlwind tour of the museums of Europe ora daughters wedding. Then, turn off the alarm clock and just sleepeverynight until you awake naturally. At the beginning, you may besleeping 12 hours or more a night; by the end, youll be getting aboutthe amount you regularly need to awake refreshed.

Avoid backsliding into a new debt cycle. Once youve determined howmuch sleep you really need, factor it into your daily schedule. Try togo to bed and get up at the same time every dayat the very least, onweekdays. If need be, use weekends to make up for lost sleep.

If youre able to get enough sleep but dont feel refreshed in themorning, discuss the problem with your clinician. Many commonmedical conditions, from depression to sleep apnea (brief cessationsin breathing during sleep), could be responsible.


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Table 2 Screening tests and immunization schedule

TESTS/IMMUNIZATIONS AGES 5064 AGES 65 AND OLDER

General exam; weight and height Discuss with clinician

Thyroid (TSH) test Every 5 years

HIV test Get this test at least once to find out your HIV status; ask your clinician if repeattesting is necessary

Blood pressure measurement At least every 2 years

Cholesterol test Discuss with clinician; many groups recommend screening every 5 years.

Blood glucose or A1c test Every 3 years

Sexually transmitted infection (STI) tests Both partners should be tested for STIs and HIV before initiating intercourse

Mental health screening Discuss with clinician

Colorectal health: Use one of the following three methods:

1) Fecal occult blood test Yearly Discuss with clinician

2) Flexible sigmoidoscopy Every 5 years Discuss with clinician

3) Colonoscopy Every 10 years Discuss with clinician

Complete eye exam Every 24 years or as advised by clinician Every 12 years

Hearing test Every 3 years Every 3 years

Mole exam Yearly clinical exam or physical; self-exam monthly

Dental exam Routinely; discuss with dentist

Influenza vaccine Yearly

Pneumococcal vaccine One time only

Tetanus-diphtheria booster Every 10 years

Herpes zoster vaccine for shingles Once only at 60 or later; discuss with clinician

For women:For women:Bone density screen Discuss with clinician At least one; talk to clinician about repeating

Mammogram Every 2 years; discuss with clinician

Clinical breast exam Discuss with clinician

Pap smear Every 13 years Discuss with clinician

Pelvic exam Every 13 years

Chlamydia test Get if you have new or multiple partners

For men:For men:Digital rectal exam Discuss with your doctor or nurse

Prostate-specific antigen (PSA) test Discuss with your doctor or nurse

Testicular exam Discuss with your doctor or nurse

Source: U.S. Department of Health and Human Services.


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Use supplementsselectivelyIt was once believed

that it was possible to compen-sate for dietary deficiencies bypopping a multivitamin every day.But research suggests that mul-tivitamins may not be all theyrecracked up to be. Moreover, many

multivitamins contain some mi-cronutrients in amounts greaterthan those recommended in thegovernments Dietary Guidelinesfor Americans. This effect may beamplified if you take more thanone pill to get the minimum re-quirement of a specific micronu-trientfor instance, taking extrapills to get enough vitamin D maymean youre getting too much

vitamin A. In some cases, highlevels may be harmful.Meanwhile, the benefits of mul-tivitamins remain uncertain.The Womens Health Initiativeconcluded that postmenopausalwomen who took multivitaminsdid not have a lower death ratethan others and were just aslikely to develop cardiovasculardisease or cancers of the lung,colon and rectum, breast, and

endometrium. These results areconsistent with findings fromother studies. And in 2006, theNIH said there wasnt enoughevidence for a recommendationabout taking multivitamins.Theres also been little or noevidence of protection againstcardiovascular disease or can-cers from a number of individualvitamin supplements, including vi-tamin E, vitamin C, beta carotene,

and the B vitamin trioB6, B12,and folic acid. Recent researchsuggests that potential harm hasbeen added to the mix.

In 2008, a Cochrane Collabora-tion review found that low-riskpeople in trials for a host ofdiseases who were given supple-ments of vitamin A, vitamin E, andbeta carotene had a slightly higherdeath rate. And theres some

evidence that excess folic acid(the synthetic version of folate, avitamin found abundantly in veg-etables, fruits, and grains) may becontributing to an uptick in colonpolyps. Both observations war-rant further study.Experts agree that the best wayto get the nutrients we need isthrough food. It is likely that whatcounts is the synergistic interac-

tions of these nutrientswhichmight also help explain why trialsof single nutrients often dontpan out.However, it may be too soon todraw the line on all supplements.Adequate calcium and vitamin Dare essential in preserving bonedensity. Although you can get therecommended 1,200 mg of cal-cium from your diet, studies sug-gest that most people (especially

women) do not. It is possible toget the government-endorsedvitamin D intakes (400 IU for ages51 to 70; 600 IU over age 71)through diet or sun exposure. Butmany health experts now recom-mend 1,000 IU, which is moredifficult without taking supple-mentsespecially during wintermonths if you live in the northernUnited States, if you always wearsun block, or if you are unable

to spend time outdoors. Consultyour doctor about the appropri-

ate supplementation for you.

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