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	Summary Med J Aust 2000; 173 Suppl 6 November: S109 Doctors who treat women aged 40 and over should emphasise the links between diet, lifestyle factors and psychological well being, and these factors should be essential components of any treatment regimen. Consuming a variety of foods, particularly grains, vegetables and fruit, results in a diverse intake of vitamins, fibre and phytoestrogens in a manner that can be considered "natural" for humans. Several studies indicate that high dietary intakes of vitamins A, C and E and fibre are associated with lower breast cancer rates, while taking these as supplements is not. However, it may be that this favourable association is not a consequence of diet per se, but rather a result of other factors such as lower body weight, more exercise, and exclusion of other, adverse foods by women who chose a "healthy" diet. There is also evidence that a diverse, but balanced, diet is associated with cardiovascular benefits. It is essential that a distinction be made between nutrients consumed in food and as supplements taken as powders or pills. Women need to understand that the latter are not "natural" therapy, but rather pharmacotherapy, which can have adverse effects and should be evaluated with the same rigour as conventional pharmaceuticals. Phytoestrogens fall into this category, and taking phytoestrogen supplements as milk concentrate, flour or in tablet form can not be justified at this stage. There is no evidence that phytoestrogen supplements are more effective than placebo for relieving menopausal symptoms. Further, safety, particularly in terms of oestrogenic effects on the breast, has yet to be established. Of specific concern is the use of phytoestrogen supplements in women who have had breast cancer, and potential interference with the therapeutic effects of tamoxifen. Calcium intake and weight-bearing exercise are important in the prevention of bone loss; doctors should emphasise that it is never too late to implement change. Australian women aged 45-65 years have an average intake of less than a standard serve a day of calcium-rich foods such as dairy milk, yogurt and cheese,1 compared with the 3-4 serves of dairy foods daily needed to achieve the recommended daily intake (RDI) of calcium. Intake of fish, an important source of omega 3 polyunsaturated fatty acids and zinc, is low at only 12g per day,1 compared with the National Heart Foundation's recommendation of at least two fish meals per week (standard serve of 80-120g).2 Zinc appears to be important in maintaining the immune system. Australian women should optimise their intake of zinc through food sources (eg, oysters, lean red meat and fortified breakfast cereal) and be wary of unnecessary tablet supplements. To summarise, all women need to be encouraged to eat a diet that is low in saturated fat, contains more grain-based foods (eg, breakfast cereals, breads, pasta, rice) as well as fruits and vegetables and foods rich in calcium and zinc (see Box 3). There is societal acceptance that increasing weight and reduced activity with increasing age are inevitable. However, with adequate physical activity and attention to energy intake, this is not necessarily the case. Nevertheless, redistribution of body fat to the abdomen from the gluteofemoral region occurs during and after menopause. The extent to which oestrogen therapy prevents this fat redistribution and the mechanism by which it occurs warrant investigation. There is a complex relationship between depression, body image, weight gain and diet. However, the data consistently show that maintenance of adequate physical activity and a nutritious, but energy-appropriate, diet are the keys to maximising physical health and psychological wellbeing. The relative plenitude of energy-dense food and the sedentary life style that characterise First World countries are overwhelming problems. For most women, daily chores no longer require significant energy expenditure, and they need to engage in additional activity to achieve an activity level commensurate with energy intake. This requires time and motivation, and may seem unnatural, futile and frankly unachievable for many women. To modify behaviour in midlife is a major task. Obesity is associated with depression in women, but is not in itself a psychiatric diagnosis; behavioural strategies may benefit those who are obese. Although women aged 40 and over need to ensure they are eating well and exercising, the necessary mindset is highly dependent on lifelong behaviour. It is never too late to achieve health benefits from optimising diet and activity. Further, women exert a profound influence on societal behaviour, and are, in general, still responsible for the fundamental eating pattern within their families. Favourably modifying the eating and exercise patterns of women aged 40 and over is likely to have a positive effect on their dependents and partners. The bottom line is that nutrition, physical activity, mood and wellbeing in women are integrally related and must be addressed both by individual women and by the community to prevent disease and to maximise quality of life.
	3: Suggested sample meals and snacks* Breakfasts - Fresh fruit    Fortified breakfast cereal plus low fat milk    Rye toast with ricotta, fresh fruit slices and cinnamon - Fruit juice    Fortified breakfast cereal with low fat milk    Multigrain toast with baked beans - 2 slices wholegrain toast with margarine    Fresh fruit salad and yoghurt Morning snacks - Low fat grain and fruit based bar - 2 tablespoons dried fruit and walnuts - Vegetable platter including olives and walnuts Lunches - Pasta with a fresh tomato sauce, a few olives, garlic and herbs    Small bread roll - 2 slices wholegrain toast brushed with olive oil with sardines or tuna plus tomato and basil - 1 pita bread salad and hummus    Fresh fruit Afternoon snacks - Banana smoothie made from low fat milk, banana, honey and low fat yoghurt - Carton of low fat yoghurt - Fruit bagel Dinners - Fish grilled with olive oil and herbs, polenta, eggplant, zucchini and peppers with tomato    Fresh figs and ricotta and honey - Pasta with tomato, garlic, vegetables, herbs and a little olive oil plus salad with an oil and vinegar dressing    Strawberries and kiwi fruit sprinkled with chopped almonds - Marinated lean Moroccan lamb with chickpeas and couscous, sweet potato, and spinach    Fresh fruit platter with spiced yoghurt Suppers - 1 cup low fat milk - Raisin toast with margarine - Toasted muffin, margarine and sliced banana *These suggested meals and snacks incorporate the dietary recommendations for women aged 40 and over. They have low amounts of saturated fat, include some monounsaturated and polyunsaturated fats, high amounts of fibre and calcium, and protective factors from a variety of foods such as seafood, fruit, vegetables and grains.
	Australian Bureau of Statistics. National nutrition survey: foods eaten, Australia, 1995. Canberra: AGPS, 1998. National Heart Foundation of Australia. A review of the relationship between dietary fat and cardiovascular disease. Aust J Nutr Diet 1999; 56 Suppl: 4.      to recommendations... An initiative of The Jean Hailes Foundation Supported by Uncle Tobys Readers may print a single copy of these pages for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 2000 Medical Journal of Australia. We appreciate your comments.