Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Find a diet to live by is an important step to your healthy 40s. (Image by Abd Foteih via Flickr. Creative Commons License)

Forty is that magical year that marks the entry into the second half of life. The 40s are that in-between decade in which hormonal change has begun but fertility is still possible. It is the decade in which child care, elder care, management of work life, relationship life, and home life are all on the front burners of a very large, very hot stove. The one part of a woman’s life in this decade that often gets short shrift is self-care. The best 40th birthday gift a woman can give herself is a promise to begin these 40 things before 50 so she can have a healthier, more satisfying second half of life.

Members of the Medical Advisory Board of Women’s Voices for Change have generously contributed to our carefully curated 40 Things for Every Woman in Her 40s. For the next two months we will use Medical Monday to focus on this project. We look forward to your questions and comments. We know that this is a community of many voices and the conversation has much more meaning when we hear from each of you.

1.

At 40, become aware of your body’s hormonal rhythms. Hormonal change begins in the late 30s and may produce a change in menstrual cycles, a decrease in fertility and occasional hot flashes. This is the time to become informed about what is normal for women in this decade. Have a discussion with your healthcare provider about what to expect and how to manage the symptoms that are common. Women in their 40s have more options than women in the past had. They have more positive role models for managing the hormonal unknown and a wider range of choices for control of symptoms. Information and preparation are vital. Hormonal change will continue for many women into their late 50s. Nothing is more frightening to women than the concept of childbirth. . . until they are prepared and go through the process. Think of this as Lamaze training for the birth of your adult self! Find new friends who will serve as guides, teachers and mentors as you go through the menopausal transition. You will add to their lives with the experiences you have that were once part of their lives. They, in turn, will give you wisdom and support from a community of wise women that you can become part of.

2.

Reach your optimal BMI now. BMI stands for body mass index. It is a number based on your weight and height. In general, the higher the number, the more body fat a person has. It is true that BMI measurements have no way of measuring where body fat is located in the body. And studies have indicated that belly fat—the fat around abdominal organs—is more dangerous than fat beneath the skin in other body areas. Obesity in women over 40 is associated with an increase in many serious medical problems. Reaching a healthy weight at this age will decrease the risk of stroke, heart disease, cancers, joint disease and diabetes. In addition, the nation spends an estimated $190 billion a year treating obesity-related health conditions.

Cawley J, Meyerhoefer C. “The medical care costs of obesity: an instrumental variables approach.” J Health Econ. 2012;31:219-30.

3.

Remove the toxins from your diet now. The 21st-century American diet has become a very unhealthy one. Avoid fast foods, all highly processed foods, chemical sugar substitutes, sugar and soft drinks. For example, soft drinks are one of the most consumed beverages in the United States, second only to water. Not only are these drinks full of sugary calories, but they have been designed to be addictive: the sugar in the sodas causes too much insulin to be quickly produced. Insulin moves sugar from foods and drinks into the bloodstream, where cells use the sugar for energy. However, too much sugar at once causes the body to turn that sugar into fat for storage, generally as belly fat. Research links consumption of sodas as a primary cause of obesity.

Institute of Medicine. “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.” Washington, DC: National Academies Press; 2012.

4.

Find a diet to live by that helps you maintain an optimum weight and has foods that are not just for fuel but foods with nutrients that the body needs to repair cellular damage, limit inflammation, and keep the immune system healthy. The Mediterranean diet is easy enough to follow. More fish, less red meat, antioxidant-rich fruits and vegetables, whole grains, nuts, olive oil instead of butter and other unhealthy fats. Research has shown that the traditional Mediterranean diet reduces the risk of heart disease. The MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay), developed by Martha Clare Morris, Ph.D., a Rush nutritional epidemiologist and her colleagues, is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Both diets have been found to reduce the risk of cardiovascular conditions, like hypertension, heart attack and stroke

But only the MIND diet had significant benefits in neurodegenerative delay even with moderate adherence. The MIND diet has 15 dietary components including 10 “brain healthy” food groups (blueberries, green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and one glass of wine a day) and five food groups that it recommends to avoid (red meats, butter and stick margarine, cheese, pastries and sweets, and fried/fast food). The study is part of a small body of research investigating how nutrition can improve brain health and stave off the cognitive decline and memory impairment that comes with Alzheimer’s disease and other forms of dementia. The really important news is that starting this diet early improves the outcome.  So, 40 is your time to think about what you eat and to change your diet for a longer, better quality life.

More info: Alzheimer’s and Dementia

5.

Think before you have that drink that contains alcohol. The 40s are a decade of significant stress and many women in this decade have turned to “just a glass of wine to unwind.” They go out with other mothers for “wine and whine hours” or “Mommy’s Book Club” nights where more than one drink is certainly expected, have just a glass before dinner then another with dinner and over time many develop alcohol overuse syndrome. The National Institute on Alcohol Abuse and Alcoholism has a wonderful site, www.rethinkingdrinking.niaaa.nih.gov that provides non-threatening and non-judgmental facts about low-, moderate- and high-risk drinking patterns and how to “rethink drinking.” Alcohol does not need to be avoided but it needs to be understood and managed. Women are at greater risk than men for developing alcohol-related problems. Women have greater risk of damage to the brain and other organs from more concentrated levels of alcohol and its toxic by-products. In addition, those calories from alcohol add to that difficult to control BMI. Think before you drink. (See Dr. Allen’s review of “Almost Alcoholic” by Robert Doyle, M.D)

National Institute on Alcohol Abuse and Alcoholism NIH Publication No 03-4956 Revised 2008.

Send us YOUR ideas for how to change your life at 40 to make the second half of life, the best half of life.

Dr. Pat