Online edition of Sunday Observer

From bonny baby to child, teenager and woman; through menarche, child-bearing, breast-feeding and menopause - a woman goes through many phases in one lifetime. Each phase is unique requiring different nutrient needs.

This article highlights four nutrients that require extra attention in women's diets.

Folate or folic acid, is a B Vitamin that is especially important for women throughout life. Beyond supporting growth and development, preventing birth defects and anaemia, recent research is highlighting the importance of folate in lowering risk of heart disease and certain cancers too.

Folate's role in the formation of DNA (The genetic material in the nucleus) makes it essential for periods of rapid growth and development viz, during childhood, adolescence, and pregnancy.

Folate deficiency in pregnancy has been seen to cause neural tube defects, low birth weight babies and premature deliveries. Since neural tube defects occur early in pregnancy, even before most women know they are pregnant, and more than 50% of pregnancies are unplanned, it is advisable for all women of child bearing age to consider taking a folate supplement right up to the first trimester of pregnancy. Folate is also essential for building fetal tissues and organs.

Red blood cells development is dependent on folate intake; a deficiency leads to a kind of anaemia in which red blood cells cannot carry much oxygen.

Most women are at high risk of heart disease and the risk increases after menopause.

High blood homocysteine levels have been linked to increased risk of heart disease.

Folate, along with Vitamins B6 and B12, is essential to a process that clears homocysteine from the blood and may help lower the risk of heart disease.

Low folate levels have also been implicated in the development of cervical, colon and lung cancer. Researchers hypothesise that folate's anti-cancer role may be due to its ability to prevent a cancer-causing gene from being switched on.

Calcium intake must especially be emphasized during the teen years. There are three reasons for this; firstly, almost half of the adult skeleton is formed during adolescence, secondly calcium absorption is very efficient during this phase of life and thirdly it helps achieve peak bone mass potential.

The maximal bone density achieved is called peak bone mass and the more bone a girl builds at this stage in life, the better off she will be as bone is lost later in life (during menopause and aging) and osteoporosis becomes a threat.

During pregnancy and breast-feeding, additional calcium is needed for the development of the baby's bones; in case of a deficiency, the baby draws on the mother's bone calcium stores and weakens her bones. Another advantage of adequate calcium in pregnancy, is reduced risk of high blood pressure and toxaemia. During menopause, falling estrogen levels initiate bone loss. The earlier a woman goes through menopause, the greater is this loss.

A calcium-rich diet or supplements along with weight bearing exercise and hormone replacement therapy (HRT) slows bone loss to some extent during the pre-menopausal, menopausal and post menopausal stages. For those with osteoporosis researchers have found that calcium intake helps enhance the efficacy of osteoporosis medication.

Phytoestrogens are weak plant estrogens that are similar in structure and have the ability to mimic the action of the female hormone estrogen.

Researchers believe that a phytoestrogen-rich diet can help curb symptoms of menopause, prevent bone disease, promote cardiovascular wellness and lower risk of certain cancers.Phytoestrogen-rich diets have also been linked to an increase in bone mineral content in postmenopausal women.Coronary Heart Disease (CHD) is the major cause of morbidity and mortality in women. The incidence of CHD in premenopausal women is low, but it increases dramatically after menopause.

Studies on the soy isoflavones - phytoestrogens in soy and its impact on CHD have determined that phytoestrogens have the ability to slow the development of atherosclerotic diseases; lower lipid levels and inhibit lowdensity lipoprotein oxidation. Researchers also believe that phytoestrogens lower risk of breast, endometrial and ovarian cancers by maintaining estrogen levels in the body.

Iron is an essential mineral found. Women are especially prone to iron-deficiency, because of menstrual blood loss. Pregnancy brings additional dietary iron demands because of increased blood volume requirements for both mother and developing foetus and the blood loss associated with childbirth. Signs of possible iron deficiency are irritability, difficulties in concentration, tiredness, plus increased susceptibility to infections. Physical body signs to look out for include paling of skin colour, eye membranes and nailbeds, and slow wound healing. Chronic deficiency can result in depletion of body iron stores resulting in anaemia with loss of appetite, extreme fatigue and an inability to regulate body temepratue efficiently.

Those who suspect they may be lacking in iron should see their doctor for a simple blood test. For those who cannot consume enough iron from dietary source because of poor appetite or increased needs, an iron supplements may be advised.

Folate requirements

Green leafy vegetables; dried beans, peas and lentils, orange juice, oranges and cantaloupes; fortified milk, ready-to-eat fortified with folate, cereals and oats are good sources of folate. Many other vegetables and fruits plus tea provide small amounts of folate.

Dairy and Soya milk and milk products such as cheese and yogurt are excellent sources of well-absorbed calcium. Beancurd; green leaf vegetables, broccoli; and whole fish (sardines, salmon, ikan bilis) provide some calcium too. For people who cannot consume enough calcium-rich foods, calcium supplements are essential.

Phytoestrogens recommended

The threshold intake of dietary phytoestrogens necessary to achieve a biological effect in humans appears to be 30 to 50 mg/day

Phytoestrogens comprise isoflavones (particularly, genistein and daidezein) found in soybeans, garbanzo beans, sprouting beans and other legumes; lignans found in seed oils, especially flaxseed. Soy foods are the most popular source of phytoestrogens, the variety viz, tofu, tempeh, soy granules, soy sprouts, soy milk and soy flour and the versatility of these foods makes them easy to include in the diet.

Iron requirements Teenage girls and adult women 30mg/day
pregnant women - as above + 100 mg/day
supplement
Lactating women 15 mg/day
Post-menopausal women 11.3 mg/day

* Figures based on average 10% bio-availability of iron in diet

Lean red meat, chicken, pork and fish are all good sources of Iron-fortified breakfast cereals, eggs, legumes, dark green vegetables also provide some iron, but this is less well absorbed by the body than meat and fish sources. The iron in plant-based foods is better absorbed if eaten with meat and fish iron containing foods. Vitamin C found in citrus fruits and juices also improve uptake of iron by the body. Calcium is also believed to play a role in regulating brain chemicals that affect mood and water retention adequate calcium intake is therefore recommended for women who suffer from premenstrual syndrome.

The World Health Organization (WHO) has recently launched a research programme to investigate the unresolved issues regarding travellers thrombosis.The research programme aims to determine the frequency and causes of travellers' thrombosis, to identify who is at greatest risk and what may be done to prevent it. It includes studies in three principal areas.

* Epidemiological studies will assess the frequency of occurrence of thrombosis amongst travellers and identify which groups are most at rick. The impact of pre-existing risk factors, such as a previous history of thrombosis, use of oral contraceptives or HRT, recent illness, operation or injury and genetic susceptibility will be examined. Factors such as class of travel and in-flight behaviour (e.g. alcohol consumption, leg-exercises and use of compression stockings) will also be considered.

* Pathophysiological studies will investigate the causal mechanisms and in particular, whether factors other than immobility, such as low cabin pressure and oxygen levels, might be responsible for venous thrombosis after air travel, which has been the most prominent focus of public attention. Clinical studies will focus on the effectiveness of possible preventive strategies. On completion of the programme, it should be possible to give clear guidance to the travelling public regarding both the magnitude of any risk and the most appropriate preventive measures.

There is an association between your diet and your behaviour. After taking food, some type of chemical substances are released in the system. These substances are called neurotransmitters of which there are two types viz. excitatory neurotransmitters and inhibitory neurotransmitters. The examples of excitatory neurotransmitters are adrenaline and non-adrenaline which are known as catacholamines. examples of inhibitory type of neurotransmitters are serotin and encephalon.

It has been observed that these neurotransmitters change human behaviour to such an extent that sometimes these cause sleep. In schizophrenia (a psychotic disorder characterized by loss of contact with environment by disintegration of personality expressed as disorder of feeling, thought and conduct). There is an excess of these transmitters but in depression these neurotransmitters particularly dopamine are diminished in the Central Nervous System (C.N.S.). Today there is sufficient scientific evidence to support that food influences the human behaviour because of the neurotransmitters. Alcohol and meat have certain substances that excite the C.N.S. After taking alcohol it has been seen that there is a state of excitement and after taking meat we have high levels of excitatory neurotransmitters whereby human behaviour becomes more aggressive. Food which are rich in neuro-inhibitory transmitters are carbohydrate rich food, vegetables, fruits and sweets. These inbibitory neurotransmitters help you to have a sound sleep.

This may be one reason why some Sri Lankans have a short nap after consuming a high carbohydrate meal for lunch. It is common knowledge that many people who consume a diet high in meat such as chicken, beef, pork, mutton and crayfish for dinner do not get good sound sleep and do not feel fresh when they get up next morning as the blood catacholamines increase following a high fat meat diet. In a study done at the Institute of Technology in U.S.A. there is scientific evidence to support this belief.

Food also has an impact on our memory. Most of the medical scientists believe that memory cannot be improved by medicines or by any type of food. However there is evidence that contradicts this belief. Tea has been found to be coated with certain chemical substances such as choline that make you feel better and you can grasp better and these chemical substances are responsible for improvement of your memory functions. After taking tea it has been found that people can remember better.

In aggressive behaviour in hyperkinetic children, or treatment of pain, depression, criminal behaviour and memory disturbances, the role of diet, particularly, vegetarian diet could be expanded. A study done at Central gail of Gwalior, India, showed that changing the diet of criminals to a vegetarian diet changed their criminal behaviour.

When the previous non-vegetarian diet was resubstituted the behaviour reverted to the original. Thus the vegetarian diet has an influence on human behaviour and it produces a sense of tranquillity. It has been seen that vegetarians can think in one direction for longer periods, and that they can maintain a sense of balance and this helps them in achieving their targets.

Modern lifestyles and the rat-race for survival has caused much stress and tension in our lives. At no period in history has there been a greater need for relaxation, since tension saps vitality and stress leads to a number of stress-related illnesses including diabetes.

First stand with feet comfortably apart. Now bend the elbow until the forearms are parallel to the floor. Then bring the hands to the front of the body barely removed from each other, the wrists flexed until the palms face inward. Keeping the forearms parallel to the floor, rotate them until the palms of the hand face the body.

Now shake the writs - lightly at first, then with increased vigour. Work for an up-and-down movement of the wrists.

Keep head erect, raise shoulders exaggeratedly trying to touch the ears with them.

Keep the knee slightly bent while executing this upward movement of the shoulders. Next allow the head and shoulders to droop downwards until the arms are at full length and the forearms are between the bent knees. This is the relaxed position in which a monkey stands when he is at rest.

An important step in loosening the muscular system is to take the tension out of the neck.

Now swing head slowly backward until it is to the rear of the right shoulder. Keeping head well back, bring it over to rear of left shoulder. Swing head slowly to left shoulder. Then return to normal vertical position. Reverse exercise.

Lower the torso, by slightly drooping the shoulders and bending the knees, but do not bend at the waist. Hang the hands between the knees at knee-level wrists bent until the backs of the hand are parallel to the floor. Without changing the position of the hands or arms, work slowly downward until the backs of the hands - from the 2nd joints to the tip of the fingers - lie flat on the floor. This downward profession is done in 4 up-and-down movements, each gradually carrying the hands lowers.

Thus the muscles leading to the hips, knees and ankles are loosened by degrees avoiding strain.

A common mistake in early detection of alcohol dependence is that medical personnel think of physical damage first, whereas social problems such as marital breakdown or loss of job are earlier indicators. These are often followed by psychological difficulties such as depression, anxiety or change in personality. Physical disorders generally occur later.

Alcohol induced gastritis, ulcer pain, vomiting of blood and cirrhosis are the common medical problems. Alcohol related problems may occur singly but the more and longer an individual drinks the more problems he risks.

* The dependent drinker drinks to relieve or avoid withdrawal symptoms and drinking increasingly takes, priority over other activities.

* The development of tolerance is shown by the dependent persons being able to sustain an alcohol intake which would incapacitate the average man. For example blood alcohol concentration of 300 mg% does not indicate a person's manly ability to hold his drink, but rather his pathological tolerance.

* The dependent drinker becomes liable to withdrawal symptoms after 8 -12 hours of abstinence. Each morning he may experience tremor, which varies from shaking of the hands to the whole body, nausea or vomiting, sweating, itching, muscle cramps and mood disorders.

* These withdrawal symptoms are temporarily 'cured' by drinking more alcohol. The drinker finds he can no longer control his drinking or be sure of stopping once he has started and drinking after abstinence is likely to lead to reinstatement of the entire episode.

Because of the relatively poor results of treating the established and heavily dependent drinker, emphasis has recently turned towards prevention and early detection.

Alcohol related problems are caused by many causes and research has implicated a variety of predisposing factors such as heredity, personality and occupation.

Overall per capita consumption is related to the price and availability of alcohol.

Wherever alcohol is relatively cheap and widely available (as in Sri Lanka) the per capita consumption is high and alcohol related problems are common. Since governments control the price and availability of alcohol, the prevalence of alcoholism is not only a medical but also a political question. Psychologists and doctors are increasingly confronted with the social, psychological and physical consequences of excessive alcohol consumption. It is not difficult to diagnose the pot-bellied person who shakes as he breathes stale alcohol, but it is difficult to recognize the excessive drinker decade earlier.

* Marital problems e.g Violence towards the family
* Problems at work - repeated absence on Mondays.
* Problem drinkers are much more liable to accident at home, at work and on the roads.
* A relative with alcoholism-alcoholism is a family disease
* High risk occupation - commercial travellers, company directors, entertainers, journalists, soldiers, and doctors.
* Mental disorders - anxiety, depression and attempted suicide
* Physical disorders - gastritis, liver disease There are some blood tests which will show whether a patient is alcohol dependent.

There are psychological treatments such as aversive therapy and behavioral modification therapy to treat alcohol dependents. These therapies are effective but takes a long time to produce the expected results.