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If you're in your thirties or forties and you don't take at least a multivitamin, start taking one today! A large body of research shows that taking vitamin and mineral supplements over a long period of time significantly supports better health.

Calcium and vitamin D are two of the most important supplemental nutrients, helping to build stronger bones now that can withstand the bone-loss effects of aging.

Calcium can also help keep your weight down. One study of younger women found that for every extra 300 milligrams of calcium a day they consumed, they weighed about two pounds less (Experimental Biology 2003 meeting, San Diego).

In the same way, taking vitamin D supplements not only helps strengthen your bones, it can also lower your risk of multiple sclerosis (Neurology 1/13/04). In this study, which looked at the health records of more than 180,000 women for up to 20 years, taking D supplements dropped the chances of multiple sclerosis (although eating vitamin D-rich foods did not have the same benefit). And if you're thinking about having children at this age, a multivitamin is crucial for lowering your baby's risk of birth defects and other health problems. A study at the University of North Carolina at Chapel Hill found that women who take multivitamins during pregnancy lower their children's risk of nervous system cancer by up to 40% (Epidemiology 9/02).

" Our finding, combined with previous work on reducing several birth defects with vitamin supplementation and other childhood cancers, supports the recommendation that mothers' vitamin use before and during pregnancy may benefit their babies' health," says Andrew F. Olshan, MD, professor of epidemiology at the UNC School of Public Health. "We believe physicians and other health care providers should continue to educate women about these benefits and recommend appropriate dietary habits and daily dietary supplements."

In particular, Dr. Olshan feels that folic acid (one of the B vitamins), and vitamins C and A, are particularly important for lowering the risk of childhood cancers and birth defects.

Ages 45 to 55

When you reach this in-between age-the time when most women have moved past childbearing age but haven't usually fully moved into the post-menopausal stage-you enjoy a propitious opportunity to take stock of your health and plan for an even healthier future. One thing that may need adjustment is your sleep habits, as sleeplessness is a common problem for women in this age group. Even if you haven't been exercising or watching your diet until now, it's not too late to start. Making lifestyle changes at this age can still improve your chances for aging successfully.

For instance, it is at these ages that women should have their heart health checked. Research published in the journal Stroke (5/01) shows that having your cholesterol and blood pressure checked at this time more accurately shows your future chances of heart disease than having it checked at a later date after menopause, in your late fifties.

" The premenopausal risk factors may be a stronger predictor of carotid atherosclerosis [artery blockages] because they represent cumulative risk factor exposure during the premenopausal years, whereas the risk factors...during the early postmenopausal years have a shorter time for influence," says Karen A. Matthews, PhD, a professor at the University of Pittsburgh Medical Center. In other words, Dr. Matthews' research shows that if you have high blood pressure and high cholesterol before menopause, you are at serious risk for a stroke or heart attack soon after menopause: These are important reasons that you need to start improving your health habits immediately.

Increase in Heart Disease

Before menopause, a woman's hormones and other physiological characteristics usually hold down her chance of heart disease. After menopause, when hormones and other bodily changes occur, the risk of heart attacks and stroke in women rises significantly. (Heart disease is the leading killer of women.) At least part of this increased risk is linked to the postmenopausal decrease in estrogen production.

Dr. Matthews studied about 370 women in their late forties, measuring their weight, their BMI (body mass index, an indication of body fat compared to height), blood pressure, cholesterol and blood sugar. Ten years later, after the women had entered menopause, she and her fellow scientists used ultrasound to measure blockages in these women's neck arteries (a sign of heart disease).

The researchers found that indications of potential heart problems (such as high blood pressure, high cholesterol and being overweight) when women were in their forties did indeed forecast future difficulties.

" Women who had elevated cholesterol, higher blood pressures and increased body weight before menopause had increased blood vessel thickening and atherosclerotic plaque formation in the neck arteries after menopause. Such changes in the carotid arteries are associated with an increased heart attack and stroke risk," says Dr. Matthews.

Heart Health Factors

The four main lifestyle factors you should adjust at this age to support better heart function are diet, stress, exercise and weight. According to Dr. James Williams, "[M]ore than any other cause, dietary factors are the most critical factor in cardiovascular disease." He recommends eliminating "dietary saturated fatty acids as found in flame-broiled and fried meats." He also urges women to eat more fish and poultry, consume organic fruits and vegetables and cut back on refined sugar.

Stress becomes an ever more important heart disease factor at this age as estrogen begins to drop.

" Our study [in the lab] indicates that stress affects estrogen levels and can lead to the development of heart disease-even before menopause," says Jay Kaplan, PhD, of the Wake Forest University Baptist Medical Center (The Green Journal 3/02).

Dr. Kaplan's research shows that stress in women ages 45 to 55 may reduce estrogen earlier in life and make women more susceptible to the arterial blockages that lead to heart disease. "We know from [lab] studies that stress can lower estrogen levels to the point that health is affected," he says.

Stress can also hurt bone health: In a study of 66 women with normal-length menstrual periods, estrogen levels were low enough in half of the women to cause bone loss, making the women susceptible to osteoporosis.

Exercise and Weight

Although exercise used to be considered to be mainly a young woman's activity, the thrust of recent research suggests that physical activity actually becomes more important to health as you get older.

A 17-year study of about 10,000 Americans found that exercising and keeping your weight down is probably the most important thing you can do to lower your risk of heart disease as you enter your forties and fifties (Am J Prev Med 11/03).

Of the people who took part in this study, more than 1,500 people died of heart disease. Those who performed the most exercise were thinner and had a 50% chance less of dying of heart disease than overweight nonexercisers.

" The fact is that those who both exercised more and ate more nevertheless had low cardiovascular mortality," says Jing Fang, MD, a researcher at the Albert Einstein College of Medicine in the Bronx, New York.

An added benefit of exercise: If you burn up calories exercising, you can eat more and not have to worry as much about being overweight.

Supplements and Diet

If you're a woman at midlife, a multivitamin and mineral is still good nutritional insurance. Eating plenty of fruits and vegetables are also important for getting enough phytochemicals, the health substances in plants that convey a wealth of health benefits.

As you enter this age group, your immune system gradually slows down. To help support immune function, eating produce rich in antioxidant nutrients, and supplementing with antioxidants like vitamins C and E as well as carotenoids, can be especially important. For example, a study of people with ulcers found that people with less vitamin C in their stomachs are more likely to be infected with Helicobacter pylori, the bacteria that can cause peptic ulcers and is linked to stomach cancer (J Amer Coll Nutr 8/1/03).

This research, which looked at the health of about 7,000 people, found that vitamin C probably helps the immune system fend off this bacterial infection.

" Current public health recommendations for Americans are to eat five or more servings of fresh fruits and vegetables a day to help prevent heart disease, cancer and other chronic diseases," says Joel A. Simon, MD, MPH, professor of medicine at the University of California at San Francisco.

Calcium and Bones

At midlife, calcium continues to be a vital mineral for supporting bone health.

According to Gameil T. Fouad, PhD, "It has been routinely shown that a woman's calcium status and level of physical activity (specifically, the degree to which she participates in weight-bearing exercise) are positively associated with bone mineral density. It is less well appreciated that this is a process which takes place over the course of a lifetime."

Dr. Fouad adds that calcium works in concert with other vitamins and minerals to keep bones healthy: "Research in the United Kingdom involving nearly 1,000 premenopausal women over age 40 illustrates those women with the highest bone density tended to have the highest intake of calcium. Surprisingly, this study also demonstrated that calcium does not act alone: those women with the best bone health also had the highest intakes of zinc, magnesium and potassium."

Dr. Fouad stresses that supplements should go together with a lifestyle that includes enough sleep and exercise to help the body stay in top shape.

" As a general guideline," he says, "a woman concerned with her mineral intake should take concrete steps to make sure she is getting adequate rest, is eating a well-balanced diet focused on fresh fruits, vegetables and lean protein as well as getting adequate exercise....A multi-mineral containing bio-available forms of zinc, magnesium, copper and selenium is probably a safe addition to anyone's routine. Taking these proactive steps dramatically reduces the chances that deficiencies will arise."

Ages 55 and Beyond

Entering the post-menopausal phase of life can present challenging opportunities for a new perspective on life and health. While some signs of aging are inevitable, experts who have looked at how the human body changes with age are now convinced that healthy lifestyle habits can improve how well you can think, move and enjoy life well past age 55.

As Dr. Williams notes, "In your fifties, the force of aging is undeniably present: Your body shape changes and organ function declines, both men and women have a tendency to gain weight....Heart disease becomes more common, energy and endurance are considerably reduced and your memory begins to slip."

But Dr. Williams also points out that you don't have to age as rapidly as other people do. He believes you should employ a "natural longevity program...[that starts] to reverse the course of aging as early as possible."

One key to staying vital as you age is your outlook on life, an aspect of life that's greatly enhanced by strong social ties.

Avoiding the Aging Slowdown The latest research shows that one of the most crucial ways to slow the effects of aging is to exercise and keep your weight down. It won't necessarily be easy, though. The change in hormonal balance at this age makes the body more prone to extra pounds (Society for Neuroscience Meeting, 11/12/03).

" In women, it has been demonstrated that major weight increases often occur during menopause, the time in a woman's life in which cyclic ovarian function ends and the ovarian hormones estrogen and progesterone decline," says Judy Cameron, PhD, a scientist in the divisions of reproductive sciences and neuroscience at the Oregon Health & Science University.

In Dr. Cameron's lab trials, she has found that the decrease in estrogen after menopause "resulted in a 67% jump in food intake and a 5% jump in weight in a matter of weeks."

In other words, the hormonal changes you undergo as enter your late fifties causes your appetite to grow as well as your waistline: Developments that increase your chances of heart disease, cancer, diabetes, stroke and joint problems.

Vigilance against this weight gain is necessary to save your health: Start walking and exercising. Research on exercise in people aged 58 to 78 found that getting off the couch for a walk or other physical activity not only helps control weight but also helps sharpen your thinking and helps you become more decisive (Proceedings of the National Academy of Sciences, 2/16-20/04, online edition). This recent study, done at the University of Illinois at Urbana-Champaign, found that performing aerobic exercise improved mental functioning by 11% (on a computer test).

" We continue to find a number of cognitive benefits in the aerobic group," says Arthur F. Kramer, PhD, a professor of psychology at the Beckman Institute for Advanced Science and Technology at Illinois. "The brain circuits that underlie our ability to think-in this case to attend selectively to information in the environment-can change in a way that is conducive to better performance on tasks as a result of fitness." In simple terms, that means that walking at least 45 minutes a day boosts brain power as well as protecting your heart.

An Herb for Menopause

The physical changes that accompan> y menopause can be uncomfortable. But traditional herbal help is available: Black cohosh (Cimicifuga racemosa), an herb used for eons by aging women, has been shown in recent studies to be both safe and effective (Menopause 6/15/03).

" This [research] should reassure health professionals that they can safely recommend black cohosh to their menopausal patients who cannot or choose not to take HRT [hormone replacement therapy]," says researcher Tieraona Low Dog, MD, Clinical Assistant Professor at the University of New Mexico Department of Family and Community Medicine.

While HRT has been used to help women cope with menopause, a flurry of studies in the past few years have shown that HRT increases the risk of heart disease and cancer. Instead, black cohosh, which alleviates such menopausal discomforts as hot flashes, has been shown to be much safer.

Keeping Track of Crucial Vitamins

While continuing to take multivitamins and minerals at this age is important, some experts believe that as we grow older, vitamin D supplementation, as well as taking antioxidant nutrients, is particularly vital. Arthritis is a common affliction of aging, and rheumatoid arthritis (RA) is one particularly destructive form of this joint problem. But taking vitamin D can significantly lower your risk of this condition.

When scientists analyzed the diets of 30,000 middle-aged women in Iowa over 11 years, they found that women who consumed vitamin D supplements were 34% less likely to suffer RA (Arth Rheu 1/03).

Other vitamins are equally important to an older woman's well-being. For example, vitamins C and natural E have been found to lower the risk of stroke in those over the age of 55 (Neurology 11/11/03). In this study, smokers who consumed the most vitamin C and natural vitamin E were 70% were much less likely to suffer strokes than smokers whose diets were missing out on these vitamins.

Rich sources of vitamin C in food include oranges and other citrus fruits, strawberries, red and green peppers, broccoli and brussels sprouts. Sources of vitamin E include vegetable oils such as sunflower seed, cottonseed, safflower, palm and wheat germ oils, margarine and nuts.

Saving Your Sight

After age 55, your eyes are particularly vulnerable. Eight million Americans of this age are at risk for age-related macular degeneration (AMD), a condition that destroys structures in the back of the eye necessary for vision (Arch Ophthal 11/03). But you can drop your risk of AMD by taking supplements of antioxidant vitamins and zinc, according to researchers at Johns Hopkins' Wilmer Eye Institute.

Their research shows that a dietary supplement of vitamins C, natural vitamin E and beta carotene, along with zinc, lowers the chances of progressing to advanced AMD in certain at-risk people by about 25%. Daily supplements also reduced the risk of vision loss by about 19%.

The carotenoids lutein and zeaxanthin also help protect aging eyes. When scientists compared healthy eyes with eyes suffering from AMD, they found that AMD eyes contained lower levels of these vital nutrients (Ophthalmology 2003; 109:1780). Furthermore, they found that levels of these chemicals generally decline as you grow older.

Healthy at All Ages

When it comes to designing a healthy lifestyle, general rules like these can be followed, but you should individualize your plan to fit your needs. No matter which type of exercises you pick out or what healthy foods you choose, look for a strategy and a plan you can stick to. If you think a selection of foods are good for you but you absolutely hate their taste, chances are you won't be able to stick to a diet that includes them.

The same goes for exercise: Pick out activities that you enjoy and that you can perform consistently. That increases your chance of sticking to an exercise program.

Staying healthy is enjoyable and it helps you get more out of life every day, no matter what stage of life you're in.

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