During her lifecycle, there are several phases in a woman’s life. Puberty and adolescence, pregnancy and lactation and menopause are three stages marked by significant hormonal changes. At each stage, a woman has special nutritional requirements.
Puberty and adolescence
Puberty can begin as young as nine years. Adolescence is defined as a time between puberty and adulthood. It involves both physical and emotional maturation. Adolescents seem to add inches overnight, hence it is believed to the fastest phase of growth in the entire lifecycle. Growth spurts begin at age of 10 to 12 for girls. Maximum growth lasts about two years. Peak growth occurs about a year before menarche, the onset of menstruation. In this phase the need for calories and proteins increases as adolescents have higher vitamin and mineral needs, particularly iron, calcium and Vitamin A.
Common conditions at this stage are oily skin, acne, dandruff, weight gain and eating disorders like anorexia nervosa. Other problems include menstrual cramps, mood swings and nutritional deficiencies. Food choices also undergo changes as adolescents seem to be influenced greatly by peer pressure. Acne can be checked if the diet is healthy and low in sugar, greasy foods, soft drinks and bakery products. A good intake of Vitamin A is effective.
Eating disorders among adolescent girls, who are pre-occupied with weight and appearance, shouldn’t be ignored. Menstrual cramps can be eased by a healthy diet, exercise and special nutrients like essential fats like gamma-linolenic acid, evening primrose oil, omega-3 fats (fish, flaxseeds and walnuts) and calcium. Excess weight issues should be addressed by increasing physical activity and making healthy food available. A diet based on vegetables, fruits, low fat dairy products, whole grains, nuts and seeds must be encouraged. Television viewing should be restricted and games and sports encouraged.
Adolescent girls and even women up to their 30s are prone to polycystic ovarian syndrome. This is associated with irregular menstrual periods, weight gain, acne, excessive hair growth, thinning of scalp hair and infertility.
It is a special time in a woman’s life which brings with it a special focus on nutrition and eating patterns, drawn from customs and traditional practices, and medical advice. A well-nourished woman can reduce the risk for maternal and foetal complications. Special dietary needs include:
* Increased caloric requirements must be met through high-nutrient and high-fibre foods like whole grains (millets, whole wheat, wheat germ, amaranth, ragi and oats), nuts, dry fruits, eggs, fatty fish, skimmed milk, fruits, vegetables etc.
* Protein requirements also increase marginally (15-20gm/day). A well-planned vegetarian diet should include pulses, soy, daals, sprouts, low fat milk, yogurt, tofu, nuts and seeds. Non-vegetarian women should aim to include at least one to two servings of fatty fish, eggs and lean meats.
* There is an increased need for vitamins and minerals like iron, calcium, folic acid, zinc and some B-vitamins.
* Those suffering from high blood pressure, gestational diabetes or other complications must remain in close contact with their physicians and nutritionists.
* Several foods are taboo during pregnancy due to traditional, cultural beliefs. Check with a qualified health counsellor.
The weight that a woman puts on during pregnancy is nearly all lean tissue (placenta, uterus blood, milk producing glands and the foetus). The fat she gains is needed for lactation. Pregnant women lose some weight at delivery and some in the following weeks, as the blood volume returns to normal and you get rid of accumulated fluids. Lactation, too, helps in weight loss. It’s advisable to get back to your ideal weight and avoid associated complications later in life. Strict dieting is not good during this phase, especially if you are feeding. A gradual weight loss of about half to one kg a week is safe, as it does not reduce milk output. A balanced diet and regular exercise helps reach an ideal weight. Supplement the diet with essential fats, iron, Vitamin C and calcium-rich foods.
Menopause occurs when menstruation stops. The process usually starts around 45-55 years. During menopause, fluctuations in estrogen levels can cause hot flushes (sudden intense waves of heat and sweating), night sweats, depression, anxiety, forgetfulness, headaches, mood swings, insomnia, vaginal dryness or inflammation, infections, urinary incontinence, difficulty in concentrating, weight gain and skin and hair changes. After menopause, a woman also faces a much higher risk of osteoporosis and heart disease.
A diet rich in whole grains, pulses, especially soy, fruits and vegetables, low-fat dairy foods, nuts and seeds with limited intake of sugar, salt, harmful fats (trans fats) and alcohol is recommended. Useful nutrients include calcium, magnesium, manganese, copper, zinc, vitamins B6, B 12, E and K, phyestrogens, essential fats and bioflavonoids.
The right amount of supplements is protective while extra may be harmful i.e. they become redox agents. Extra amounts can cause harmful oxidation and diseases. Folic acid, Vitamin B complex, and C are useful for prevention of heart disease. Vitamin D, calcium, iron, zinc are safe provided taken under supervision. Vegetarian women should take supplements of vitamin B12 and zinc under supervision. Women who are not exposed to the sun may need supplementation of Vitamin D. Finally, supplements must be taken under careful supervision of a qualified medical practitioner only. There are no substitutes or shortcuts to eating well and following a healthy lifestyle.
Healthy lifestyle choices, including a well balanced diet and regular exercise regimen, are the key for any woman to be at their best at any stage of life.
— The writer is a Clinical Nutritionist & Founder, theweightmonitor.com, Founder, WholeFoodsIndia & Founder President Celiac Society for Delhi.
Checks for healthy life
MAny a times we take our body for guaranteed, misuse it and still expect it to work efficiently. The fruits of a healthy lifestyle, an appropriate diet, activity and sleep pattern are appreciated in the later years of life. Besides maintaining a healthy lifestyle, regular health checkups can help to ward off or treat many diseases. The main objectives of preventive health checkups are:
* To arm yourself with appropriate and effective vaccinations.
* Early diagnosis and treatment of common treatable diseases.
* Early diagnosis and treatment of chronic disease to prevent long-term complications.
* Diagnosis of common malignancies in early and treatable stages.
A woman’s body undergoes many physiological changes like menarche, pregnancy, lactation, menopause etc. In addition, she may be exposed to many infections, age-related diseases and various cancers. She may also suffer from sexually transmitted diseases. A regular health checkup at every age has to be targeted towards specific problems faced during that period.
Adolescent and early twenties
Healthy food habits, a balanced diet and some physical activity inculcated in adolescent years can prevent obesity, diabetes, hypertension and other complications.
Immunisation: Rubella vaccination, if not previously immunised in childhood, a shot of MMR (measles, mumps, and rubella) is a must before planning a pregnancy. Vaccination against HPV (human papilloma virus), the causative agent of cervical cancer, is now available. Three doses provide protection against this most common cancer, the cancer of the cervix, among women in India. The best age for maximum efficacy is between 10 to 26 years i.e. before sexual activity starts. However, it can be taken up to 42 years.
Blood tests to diagnose anaemia and Vitamin D deficiency. Overweight girls should also have screening for diabetes and blood pressure.
PAP smear test: It is done for the detection of cancer of the cervix. Sexually active women should have annual PAPS starting from the age of 18.
Premarital checkup: A checkup and counselling session before marriage can alleviate many doubts and provide contraception advice.
Pre-pregnancy checkup: An assessment of haemoglobin, blood sugar, screening for common infections, thalassemia and Vitamin-D levels should be done. Vitamin supplements with folic acid should be started at least three months before pregnancy. Folic acid reduces the chances of foetal abnormalities. A rubella vaccine, if not taken, should be taken. Obese women should also lose weight, as obesity can cause hormonal imbalance and even hampers conception.
Antenatal health checkup: Regular checkups are important. The doctor will assess and treat anaemia, provide immunisation against tetanus and detect complications like high BP. At least one ultrasound in each trimester can also detect more than 90 per cent of foetal problems.
Reproductive years (20-40)
Annual examination, which includes pelvic examination and pap smears for the early detection of cervical cancer, is important. After three negative pap tests one may shift to three yearly pap tests. In addition, prevention of anaemia and appropriate contraception are important. A clinical breast examination and monthly self examination are also recommended.
Peri-menopausal & post-menopausal years (40 & above)
At this time the female body is again changing towards a gender-neutral phase. The age-related problems like diabetes, hypertension, breast and uterine cancers, joint problem etc start creeping in. Annual blood tests to rule out diabetes, anaemia, high blood lipids, hypothyroidism and Vitamin D deficiency are must. Mammography and pap smear are required every three years. Dental and eye checkup are also recommended every year. In addition, a bone mineral density scan should be done annually for the early diagnosis of osteopenia and osteoporosis after 50.
— The writer is senior gynaecologist based in Chandigarh