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The Harvard Guide to Healthy Living 10 steps to a longer healthier life

Harvard Medical School Trusted advice for a healthier life 

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THE HARVARD GUIDE TO HEALTHY LIVING

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Harvard Medical School

SPECIA L REPOR SPECIAL REPORT T 10 STEPS TO A LONGER HEAL HEALTHIER THIER LIFE it’s possible to reduce your risk  Risk reduction has a lot in common with one-stop shopping: it’s of the many major degenerative diseases by following the advice below below..

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Stay away from cigarette smoke f you smoke, sm oke, quit. There are a re few things you can do that will have such immediate and lasting benefits as giving up cigarettes. In 20 minutes, your heart rate will fall. By tomorrow you’ll have cleared the excess carbon monoxide from your blood. Within months, you’ll be breathing more easily and coughing much less. Over the years, your risk for lung cancer, stroke, and heart disease will have dropped by at least half. In 15 years, you’ll have erased your excess risk for heart disease.

Separate yourself from smokers. Inhaling another’s smoke is also emerging as a weaker, but still noteworthy, risk factor. If you’re a nonsmoker,, become a nag. nonsmoker na g. Let the smokers in your circle of friends and family know that you would like them to quit, and encourage them in their efforts. Be patient. Only 4% to 7% of smokers are able to quit on any attempt without aids like nicotine replacement products or medical help, and only one-quarter to one-third who use any quit-smoking medicine stay smoke-free for more than six months. It usually takes many attempts before a person is successful at quitting.

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Keep moving Lack of physical activity is an independent risk  actor for nearly all of the diseases that are most likely to kill or disable you. In the ong-running Framingham Heart Study, moderate activity tacked on 1.3 years of life or men and 1.5 years of life or women versus low activity. Raising the bar to high activity added 3.7 years for men and 3.5 years for women.

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Regular moderate exercise can help to protect you against the following problems: Heart disease and stroke. egular exercise helps to strike a healthier balance of blood lipids (HDL, LDL, and triglycerides) and helps arteries retain resilience despite the effects of aging. It reduces blood pressure, which in turn lowers the risk not just of heart disease, but also of stroke and kidney failure. Exercising regularly may also promote the growth of  collateral arteries, small blood vessels feeding the heart. Even if  you already have heart disease, exercise lowers your chances of  dying from it. Cancer. Exercise reduces the risk of cancers of the colon, breast, endometrium, and prostate. By helping you attain a healthy weight, exercise also lessens your risk for other cancers in which obesity is a factor. Diabetes. Exercise pares excess weight, modestly lowers blood sugar levels, and boosts sensitivity to insulin so that your body needs less of it. If you already have diabetes, exercise helps control blood sugar. Osteoporosis. When combined with calcium, vitamin D, and bone-saving medications if 

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necessary, weight-bearing exercise ike walking, running, and strength training helps ward off bone loss. Arthritis. xercise helps protect joints by easing swelling, pain, and fatigue and by keeping cartiage healthy. Strong muscles support joints and lighten the load upon them. Exercise may limit and even reverse knee problems by elping to control weight. Accidents. Activities like stretching, yoga, and tai chi extend ange of motion and enhance balance, which helps prevent falls and other accidents. Depression and anxiety a nxiety.. Exercise lifts spirits by releasing mood-elevating hormones, elieving stress, and promoting a sense of well-being. In some studies, exercising regularly has elped ease mild to moderate depression as effectively as medications; combining exercise with medicatio medications, ns, therapy, and social engagement is even better.

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Eat like an Aegean Although countless observational studies have pointed

to the health benefits of specific oods or nutrients, rarely have entire eating regimens undergone close scientific examination. A notable exception is the Mediterranean diet, a term coined to describe the traditional eating pattern of people living in the egion bordering the Mediterranean Sea. The Mediterranean diet consists mostly of plant foods (fruits, vegetables, grains, beans, nuts, and seeds); animal protein consumed chiefly in the forms of  fish and poultry; olive oil as the principal fat; and wine taken with meals (see Figure 1). Although the diet was a product of the foods easily cultivated or gathered in that region centuries ago, modern research confirms its unintentional wisdom. Multiple compounds in plant foods appear to act as antioxidants, slowing the aging process and hindering the development develop ment of cancer and heart disease. By slowing digestion, the fiber in whole grains, legumes, and fruit can help keep blood sugar under control; fiber also creates a feeling of fullness, which

HOW MUCH EXERCISE IS ENOUGH? In the fall of 2008, the U.S. Department of Health and Human Services issued a detailed exercise prescription for the nation. Every adult was urged to get at least 150 minutes of moderate aerobic activity—the equivalent of walking at a rate of 3 to 5 miles per hour—or at least 75 minutes of  higher-intensity activity—a rate of 5 mph or more—a week. The sessions should be at least 10 minutes long and may combine both moderate and vigorous activities. In addition, adults were advised to engage in at least two sessions of strengthening exercises a week. Go beyond the basics if you can, say the guidelines. Once you’re routinely logging the recommended levels of aerobic activity, start to add a ew minutes a day. (Ramping up slowly reduces the likelihood of injury.) The HHS committee found that you can get even greater health bene fits and more effective weight control when you reach twice the recommended weekly amount—that is, 300 minutes of moderate activity, 150 minutes of vigorous activity, or a combination of the two. And more than that may be even better still. The HHS exercise guidelines emphasize that people with chronic medical conditions and disabilities should get just as much exercise as other adults, if they can, and advise them to speak with their health care providers about appropriate kinds and levels of exercise. The American College of Sports Medicine Web site also has detailed advice for people with certain chronic health conditions at www.exerciseismedicine.org/public.htm.

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THE HARVARD GUIDE TO HEALTHY LIVING

may help satisfy appetite. The monounsaturated fats in olive oil, nuts, and fish can have antiinflammatory effects, which may help stave off heart disease and many other conditions. Perhaps most important to its success is that Mediterranean-style eating excludes many foods known to cause health problems: saturated fat from animal sources, trans fat, and refined carbohydr carbohydrates. ates. Studies have found that the diet helps to lower the risk of the t he following conditions: Obesity. A two-year randomized trial comparing low-fat, lowcarbohydrate, and Mediterranean diets in middle-aged, mildly obese men and women found that those who followed the low-carb and Mediterranean diets lost an average of 10 pounds, compared with an average of 6 pounds among those on the low-fat diet. The Mediterranean diet also lowered LDL (bad) cholesterol most and controlled blood sugar most effectively. Heart disease. In the Nurses’ Health Study, which involved nearly 75,000 women, those whose diets most closely approximated the Mediterranean pattern were 28% less likely to die of  heart disease or stroke during an 18-year period than women who ate a typical American American diet. Diabetes. In a 13,380-person Spanish study, participants who strongly adhered to a traditional Mediterranean diet were 83% less likely to develop diabetes than those following the diet least closely. Alzheimer’s disease. A study of cognitive function in 2,258 older Americans over a four-year period found a 40% reduced risk for Alzheimer’s disease among those who most closely followed the Mediterranean diet. All-cause mortality mortality.. The

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NIH–AARP Diet and Health Study, involving nearly 400,000 women and men ages 50 through 71, found that people who most closely followed this diet were about 20% less likely to have died of heart disease, cancer, or any cause over a five-year follow-up period. Other conditions. Research has also found Mediterraneanstyle eating to be associated with improvements in rheumatoid arthritis, reduced risk for COPD, and reduced risk for recurrence of colon cancer.

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Mind your BMI xcess body weight increases your risk for more than 50 different health problems. These conditions include some of the eading causes of death—heart disease, stroke, and diabetes—as well as less serious ailments such as arthritic knees and gallstones. A Harvard study that combined data from more than 50,000 men and more than 120,000 women ound that obesity increased the isk of diabetes 20 times and substantially boosted the risk  of developing high blood pressure, heart disease, stroke, and gallstones. Among people who were overweight or obese, there was a direct relationship between between body mass index (BMI) and risk: the higher the BMI, the higher the ikelihood of o f disease dise ase (see (s ee Table 1). Studies are also linking obesity to cancer deaths. An American Cancer Society investigation followed followed more than 900,000 people for 16 years. The findings suggested that among people ages 50 and older, overweight overw eight and obesity accounts or 14% of all cancer deaths in men and 20% of all cancer deaths in women. Higher BMIs were associated with a higher risk of  dying from cancer of the esophagus, colon and a nd rectum, rectu m, liver, liver,

gallbladder, pancreas, or kidney. In men, excess weight also increased the risk of dying from stomach or prostate cancer. In women, deaths rom cancer of the breast, uterus, cervix, or ovary were elevated in women with higher BMIs. at distribution also plays a role in health risk (see Figure 2). While fat accumulated in the lower body settles directly under the skin, fat in the abdominal area is largely visceral, serving as padding between the organs. Visceral at produces substances that spur inflammation and decrease the body’s response to insulin, which sets the stage for diabetes. That’s why a big belly—a waist measurement of 35 inches or more in women or 40 inches or more in men—confers a higher risk of  heart disease and diabetes. he best way to lose excess weight, wherever it is located, is to consume fewer calories than

you use. One way to start is to follow the exercise and dietary guidelines outlined above. In fact, information from the National Weight Weight Control Registr Re gistryy, a database of more than 6,000 people who have lost at least 30 pounds and kept them off for at least a year, reinforces that notion. he registrants report exer exerciscising approximately one hour a day (primarily through brisk walking); eating an average of 1,400 calories a day, with about 25% provided by fat; making breakfast a regular habit; and maintaining a consistent eating pattern across weekdays and weekends. They also keep close tabs on their weight, hitting the scales frequently.

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Lift a glass, but only  one (or two for men) We toast to good health for good reason. Moderate drinking—de fined as one drink per

Figure 1 Mediterranean diet pyramid

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Meats and sweets Less often Wine n moderation

Poultry and eggs  Moderate portions, every two days or weekly  heese and yogurt  Moderate portions, daily to weekly 

Drink  water

Fish and seafood Often, at least two times per week

Fruits, vegeta les, grains (mostly whole), olive oil, beans, nuts, legumes and seeds, herbs and spices Base ever   y meal  on thes foods

B physically  ac ive; enjoy  als with ot ers Illustration by George Middleton

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day for women and two for men—has been linked to a lower isk for heart disease and death rom all causes. Alcohol of any ind increases HDL cholesterol, improves the body’s response to insulin, and reduces in flammation. Wine in particular contains small amounts of plant substances called avonoids that have demonstrated anti-inflammatory and anticancer activity in laboratory experiments.

But the dangers of heavy drinking far outweigh these potential benefits. For men, heavy drinking means more than four drinks on any day or more than 14 drinks per week. For women, it’s de fined as more than three drinks on any day or more than seven drinks per week. Heavy drinkers face a higher risk of liver disease, heart disease, sleep disorders, depression, stroke, bleeding from the

Table 1 Weighing in The body mass index i ndex (BMI) is an index of weight by height. The definitions of normal, overweight, and obese were established after researchers examined the BMIs of  millions of people and correlated them with wi th rates of illness il lness and death. These studies identified the normal BMI range as that associated with the lowest rates of illness and death. Obesity has been further subdivided into three classes (I, II, and III). HEIGHT

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BODY WEIGHT IN POUNDS

4’ 10 ”

9 1–1 1 5

1 19 –1 38

1 4 3–1 62

16 7– 1 8 6

1 91 +

4’ 11 ”

9 4–1 1 9

12 4– 143

1 4 8–1 68

1 73 –1 93

1 98 +

5’ 0”

9 7 –1 23

128 –1 48

15 3– 17 4

1 79 –19 9

204 +

5’ 1”

1 00 –12 7

13 2– 153

1 5 8–1 80

185–206

211+

5’ 2”

10 4 – 13 1

1 36 –1 58

1 6 4–1 86

19 1– 2 1 3

2 18 +

5’ 3”

1 07 –13 5

14 1– 163

169 –19 1

19 7– 2 2 0

2 25 +

5’ 4”

1 10 – 14 0

14 5 –1 69

1 7 4–1 97

20 4– 2 2 7

2 32 +

5’ 5”

11 4 – 144

15 0 –1 74

1 8 0–2 04

2 10 –2 3 4

2 40 +

5’ 6”

11 8 – 148

15 5– 179

1 8 6–2 10

2 16 –2 41

2 47 +

5’ 7”

1 21 –15 3

15 9– 185

1 9 1–2 17

22 3– 2 4 9

2 55 +

5’ 8”

12 5 – 158

16 4– 190

1 9 7–2 23

23 0– 2 5 6

2 62 +

5’ 9”

12 8 – 162

16 9 –1 96

2 0 3–2 30

23 6– 2 6 3

2 70 +

5’ 10 ”

132 –1 6 7

17 4 –2 0 2

20 9– 23 6

2 43 –2 71

2 78 +

5’ 11 ”

13 6 – 1 72

179 –2 0 8

21 5– 24 3

2 50 –2 79

2 86 +

6’ 0”

1 40 –17 7

18 4– 213

2 2 1–2 50

2 58 –2 87

2 94 +

6’ 1”

1 44 –18 2

18 9 –2 19

2 2 7–2 57

26 5– 2 9 5

3 02 +

6’ 2”

1 48 – 18 6

19 4– 225

2 3 3–2 64

27 2– 3 0 3

3 11 +

6’ 3”

1 52 –19 2

20 0– 232

2 4 0–2 72

2 79 – 311

3 19 +

6’ 4”

15 6 – 197

20 5– 238

2 4 6–2 79

2 87 – 320

3 28 +

BMI

19 – 24

25 – 29

30 – 34

35 – 39

40+

NORMAL

OVERWEIGHT

CLASS I OBESITY

CLASS II OBESITY

CLASS III OBESITY

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stomach, and several types of  cancer. Some studies hint that for women, even moderate drinking may raise the risk of breast cancer, especially for women with a family history of the disease or who are on hormone therapy.

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Don’t Run Up a Sleep Debt Medical evidence suggests that for optimum health and function, the average adult should get seven to nine hours of sleep daily. But more than 60% of women regularly fall short of that goal. And as your sleep debt mounts, the health consequences increase, putting you at growing risk for weight gain, diabetes, heart disease, stroke, and memory loss. In some cases, sleep debt results from insomnia or other underlying conditions that may require medical attention. But most sleep debt comes from burning the candle at both ends—consistently failing to get to bed on time and to stay there until you’ve slept enough. Fortunately, sleep doesn’t charge interest on the unpaid balance, or even demand a one-for-one repayment. It may take some work, but you can repay even a chronic, longstanding sleep debt (see “Sound “Sound advice for sleeping soundly,” page pa ge 8).

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Be your own best advocate To help ensure you’re taking the best possible care of  your own health, perseverance will serve you well, along with these tips: Form a partnership pa rtnership.. At midlife and beyond, good health is increasingly dependent on good collaborations with your clinicians. Since you are likely to be making more medical visits, find a primary care clinician with whom you feel comfortable. Work with your

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Figure 2 Types of body fat

Visc ral fat

The excess pounds that tend to creep on at midlife often settle around the belly and hips. Fat that accumulates in the lower body is f  und between the skin and the abdominal wall—so-called subcutaneous fat. Fat in the abdominal area is largely visceral fat. Located around t e abdominal organs as well as behind the abdominal cavity, visceral f  t appears to increase the risk of  i sulin resistance, which can set the s age for type 2 diabetes.

Subcutaneous Subcu taneous fat

clinician to devise a schedule for screening tests and clinical exams (see Table 2). 2 ). If you are prescribed medications, take them as directed; don’t stray from the designated dose without talking to your doctor. Find out what you should expect from every new medication and procedure, and let your clinician know what you expect it to accomplish in return. Lower your expectations. Few medical treatments, from knee replacements to face lifts, will restore you to your 20-year-old self. Accept a few minor aches and pains as a consequence of overexertion. If  you have a chronic condition like fibromyalgia or irritable bowel syndrome, be prepared to try a number of therapies t herapies before finding the one, or the combination, that works best for you. Pay attention to your body. Keep an eye on new spots and bumps, and any changes in your regular patterns, be they in appetite, sleep, energy, bowel habits, or mood. It’s easy to write off  many changes as consequences of aging when they could signal underlying disease.

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Keep connected Don’t go bowling alone. Numerous studies have charted the positive influence of social networks on health later in life. The Baltimore Longitudinal Study on Aging and the Georgia Centenarian Study have both found that older adults who remained socially active lived longer and healthier lives than their solitary counterparts. The type of pursuit didn’t matter. matter. Activities Acti vities ranged

from bridge clubs to group travel to part-time jobs. Although the benefits of social networks are largely unchallenged, investigators from the Framingham Study have substantiated the importance of holding firm to your principles even when they may be counter to those of  your group of friends. Their data indicate that adopting health habits of your group can have negative as well as positive effects on your health. Data collected over more than 30 years indicated that a person had a 36% chance of giving up cigarettes when a friend stopped smoking, but a 57% chance of becoming obese if  a friend’s BMI mushroomed.

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Say NO to stress You know what stress is. Whether the source is a death in the family, the pain of arthritis, or an unful filled obligation, stress affects the body the same way—triggering way—tri ggering a cascade of  hormones that produce a familiar physical response— pounding heart, rapid breathing, and clammy palms. Intermittent episodes of  stress are not harmful; in fact, we

What’s a standard drink? • 1½ ounces (a jigger) of 80-proof liquor (bourbon, gin, rum, scotch, tequila, vodka, or whiskey) • 2–3 ounces of fruit, coffee, chocolate, or other flavored liqueurs (cordials) • 3 ounces of fortified wine (sherry, port, marsala, or Madeira) • 4–5 ounces of table wine • 12 ounces of regular or light beer

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Spirits 1.5 oz

Brandy 1.5 oz

Cordial 2–3 oz

Fortified wine 3– 4 oz

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Table wine 5 oz

Beer 12 oz

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experience many of these symptoms during excitement and pleasure. However, chronic stress is a major contributor to a host of  serious physical and psychological conditions. Whatever it is that sets your stress cycle in motion, having a personal escape plan can help you manage stressful situations and even nip stress in the bud. To create a plan, make a list of  the specific mental, emotional, and physical sensations that you feel when stressed. For example, do you get a stomachache, grind your teeth, raid the fridge, and have trouble thinking clearly?

Whenever you notice your stress symptoms, take a moment—or two, or three—to relax. Here are some suggestions from Dr. Herbert Benson, president of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital: When you’ve got one minute. Place your hand just beneath your navel so you can feel the gentle rise and fall of your belly as you breathe. Breathe in slowly. Pause for a count of three. Breathe out. Pause for a count of three. Continue to breathe deeply for one minute, pausing for a count of three after each

SOUND ADVICE FOR SLEEPING SOUNDLY • Create a sleep sanctuary. Reserve it for sleep, intimacy, and other restful activities, like pleasure reading and meditation. Keep it on the cool side. Banish the television, computer, cell phone or digital organizer, and other diversions from that space. • Nap only if necessary. Night owls and shift workers are at the greatest risk for sleep debt. Napping an hour or two at the peak of sleepiness in the afternoon can help to supplement hours missed at night. But naps can also interfere with your ability to sleep at night and throw your 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 also disturbs sleep. • Get regular exercise, but not within three hours of bedtime. Exercise acts as a short-term stimulant. • Address a long-term debt. If you’ve shorted yourself on sleep for decades, you won’t be required to put in a Rip Van Winkle–like effort to repay the hours of missed slumber. Nonetheless, it could take a few weeks to recoup your losses. Plan a vacation with a light schedule and few obligations—not a whirlwind tour of the museums of Europe or a daughter’s wedding. Then, turn off the alarm clock and just sleep everynight until you awake naturally. At the beginning, you may be sleeping 12 hours or more a night; by the end, you’ll be getting about the amount you regularly need to awake refreshed. • Avoid backsliding into a new debt cycle. Once you’ve determined how much sleep you really need, factor it into your daily schedule. Try to go to bed and get up at the same time every day—at the very least, on weekdays. If need be, use weekends to make up for lost sleep. • If you’re able to get enough sleep but don’t feel refreshed in the morning, discuss the problem with your clinician. Many common medical conditions, from depression to sleep apnea (brief cessations in breathing during sleep), could be responsible.

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inhalation and exhalation. If you have two minutes. Count down slowly from 10 to zero. With each number, take one complete breath, inhaling and exhaling. For example, breathe in deeply saying “10” to yourself. Breathe out slowly. On your next breath, brea th, say say “nine,” “nine,” and an d so on. If you feel lightheaded, count down more slowly to space your breaths further apart. When you reach zero, you should feel more relaxed. If not, go through the exercise again. When you’ve got three minutes. While sitting down, take a break from whatever you’re doing and check your body for tension. Relax your facial muscles and allow your jaw to fall open slightly. Let your shoulders drop. Let your arms fall to your sides. Allow your hands to loosen so that there are spaces between your fingers. Uncross your legs or ankles. Feel your thighs sink  into your chair, letting your legs fall comfortably apart. Feel your shins and calves become heavier and your feet grow roots into the floor. Now breathe in slowly and breathe out slowly. Dr. Benson offers two other tools for stress reduction—the worry box and the gratitude journal. The first is a repository for concerns that are beyond your power to influence—the safety of your children or grandchildren, the direction of the stock market, the heating of the planet. Write each worry on a slip of paper, put it in the box, and forget about it for at least a week. The second is a ritual—reflecting on the positive experiences and encounters of the day. If you jot them down in a journal, even in the darkest of nights, you’ll eventually have an encyclopedia of appreciation for your circumstances.

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Table

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Screening tests and immunization schedule

TESTS/IMMUNIZATIONS TESTS/IMMUNI ZATIONS

AGES 50–64

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 repeat testing 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 2–4 years or as advised by clinician

Every 1–2 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: 

Bone density screen

Discuss with clinician

Mammogram

Every 2 years; discuss with clinician

Clinical breast exam

Discuss with clinician

Pap smear

Every 1–3 years

Pelvic exam

Every 1–3 years

Chlamydia test

Get if you have new or multiple partners

At least one; talk to clinician about repeating

Discuss with clinician

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 supplements selectively  It was once believed that it was possible to compensate for dietary deficiencies by popping a multivitamin every day. But research suggests that multivitamins may not be all they’re cracked up to be. Moreover, many multivitamins contain some micronutrients cronutrie nts in amounts greater than those recommended in the government’s Dietary Guidelines for Americans. This effect ef fect may be amplified if you take more than one pill to get the minimum requirementt of a specific micronuquiremen trient—for instance, taking extra pills to get enough vitamin D may mean you’re getting too much vitamin A. In some cases, high levels may be harmful. Meanwhile, the bene fits of multivitamins remain uncertain. The Women’s Health Initiat Initiative ive concluded that postmenopausal women who took multivitamins did not have a lower death rate than others and were just as likely to develop cardiovascular disease or cancers of the lung, colon and rectum, breast, and endometrium. endometriu m. These results resu lts are a re consistent with findings from other studies. And in 2006, the NIH said there wasn’t enough evidence for a recommend recommendation ation about taking multivitamins. There’s also been little or no evidence of protection against cardiovascular disease or cancers from a number of individual vitamin supplements, including vitamin E, vitamin C, beta carotene, and the B vitamin trio—B6, B12, and folic acid. Recent research suggests that potential harm has been added to the mix.

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In 2008, a Cochrane Collaboration review found that low-risk  people in trials for a host of  diseases who were given supplements of vitamin A, vitamin E, and beta carotene had a slightly higher death rate. And there’s some evidence that excess folic acid (the synthetic version of folate, a vitamin found abundantly in vegetables, fruits, and grains) may be contributing to an uptick in colon polyps. Both observations warrant further study. Experts agree that the best way to get the nutrients we need is through food. It is likely that what counts is the synergistic interactions of these nutrients—w nutrients—which hich might also help explain why trials of single nutrients often don’ don’tt pan out. However, it may be too soon to draw the line on all supplements. Adequate calcium and vitamin D are essential in preserving bone density. Although you can get the recommended recommend ed 1,200 mg of calcium from your diet, studies suggest that most people (especially women) do not. It is possible to get the governm government-endorsed ent-endorsed vitamin D intakes (400 IU for ages 51 to 70; 600 IU over age 71) through diet or sun exposure. But many health experts now recommend 1,000 IU, which is more dif ficult without taking supplements—especially ments—especi ally during winter months if you live in the northern nor thern United States, if you always wear sun block, or if you are unable to spend time outdoors. Consult your doctor about the approp appropririate supplementation for you.

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