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Fall 2006

UCLA physicians offer their take on the WHI findings released so far

Low Fat Diet

"WHI set out to study the effects of reducing all fats as a way to prevent cancer and heart disease. It's no surprise that a diet that lowered every fat-good and bad- didn't show any cardiovascular benefit," notes Karol Watson, M.D., co-director, UCLA Cholesterol and Lipid Management Center. "For heart health, we still recommend a life-long healthful diet, low in saturated fats and transfats, and moderate in monounsaturated fats and healthful polyunsaturated fats, like fish oil."

Calcium and vitamin D

"The WHI findings are not going to change our guidelines for calcium and vitamin D, since these supplements have already been shown to clearly benefit maintaining bone mass and preventing rickets," explains Carolyn Crandall, M.D., M.S., internist at the Iris Cantor/ UCLA Women's Health Center. Compliance during the study was not stellar. "If you want the calcium and vitamin D to work on your bones, you've got to take it," she quotes one WHI researcher as saying. Current guidelines recommend that postmenopausal women take 1,200-1,500 milligrams of calcium a day, and 400-600 IU of vitamin D to help absorb calcium.

Hormone therapy

Because the study showed an increased risk of breast cancer and stroke, menopausal hormone therapy (estrogen or combined estrogen and progestin therapy) is now prescribed on a case-by-case basis, considering all of a woman's risk factors. WHI researchers also suspect that the risks and benefits of hormones may vary depending on age and how close a woman is to menopause. And more recent findings suggest that taking estrogen alone, especially in women who have had a hysterectomy, may not carry the same risk of breast cancer as does taking estrogen and progestin. "We would only consider using estrogen or estrogen plus progestin in a woman with severe hot flashes to control symptoms in the short-term," Dr. Crandall says. "We would no longer routinely use it for long-term therapy to protect bones or prevent heart disease."

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