A diet with good quantity and quality of protein and one high in B complex foods may help delay the onset of menopause by supporting the pituitary gland, which regulates the ovaries and the female cycle. (It appears that strict vegetarian women and those with low cholesterol levels have an earlier menopause than more omnivorous women; further research in this area may help us to understand more about diet, cholesterol, and menopause.) Some of the protein foods suggested are fish, milk products such as yogurt and cottage cheese, eggs, whole grains and legumes, nuts, and seeds; foods high in B vitamins are green vegetables, whole grains, wheat germ, and yeast. Good levels of pantothenic acid, choline, and inositol also aid the adrenal and pituitary functions. Special foods that offer high amounts of vitamins, minerals, and energy include brewer's yeast, molasses, lecithin, and kelp (or other seaweeds). These can be used with milk or juice to make a high-nutrient drink.

Osteoporosis is a loss of bone minerals, density, and bone strength, particularly of the spine and long bones of the arms and legs; it is a common problem of menopausal women. Osteoporosis is a difficult problem to diagnose. Regular x-rays are not that sensitive, and they reveal bone loss only after it is fairly significant. The new technique available to measure bone density, photon absorbtiometry, is more sensitive at assessing early osteoporosis. Generally, though, women should be aware of early warning signs, such as periodontal disease, changes in the curvature of the spinal column, such as a "dowager's hump," or pain in the middle or lower back. The most important factor is preventing the loss of bone calcium; this is much easier than correcting bone loss after it occurs.

To prevent osteoporosis, it is wise to eat a good diet and maintain an adequate calcium intake through foods and supplements in the years before menopause. Many people eat a diet that is much higher in phosphorus than in calcium. This can lead to improper bone metabolism and loss of bone calcium. Meats, nuts, seeds, poultry, boneless seafood, and even whole grains have a much higher phosphorus than calcium content. Soda pops have added phosphates, increasing their phosphorus level. One advantage of using milk products is that they have a very good calcium-to-phosphorus ratio, with actually slightly more calcium. Eggs and many vegetables, especially the green leafy veggies, also have lower phosphorus content.

Premenopausal women should regularly consume 1,000-1,200 mg. of calcium per day. Supplementing some calcium without phosphorus will usually balance out these nutrients. Adding about 500-1,000 IUs of extra vitamin D and 500-800 mg. of magnesium per day will help the calcium be best utilized and protect against osteoporosis. Adequate boron, a trace mineral, in the diet and supplements to include 2-3 mg. is also shown to aid calcium utilization. A diet containing good amounts of fish, leafy greens, whole grains, and dairy foods will support healthy bones. Phosphorus, zinc, copper, and manganese are also important to building strong bones. If osteoporosis is present, research suggests that estrogen therapy may help slow its progress and even improve the bone health, though it also poses risks. Fluoride, 2-4 mg. per day in foods or even taken as a supplement, has been shown to strengthen bones, but it, likewise, may have other concerns.

When estrogen is used during or after menopause, it is wise to follow a program similar to that suggested for users of birth control pills (if the woman still has a uterus, a progestin agent should also be used to simulate the natural cycle and to protect the uterus from cancer development). Extra vitamins C, E, and B6, extra zinc, and minimum copper intake are the main suggestions. It is clear that estrogen or hormone replacement therapy does prevent osteoporosis, possibly better than any other program, especially with a good diet, adequate calcium intake, and plenty of exercise. Regular exercise has clearly been shown to minimize bone loss, especially postmenopausally. Weight-bearing exercises, such as walking, tennis, or golf, help to strengthen the bones, probably more than swimming. When taking estrogen, usually less calcium is needed than when no hormones are used. Still, a natural program such as the one described here will help prevent osteoporosis and ease the symptoms and transition of menopause. (For more on osteoporosis, see the Calcium discussion in Chapter 6.)