Tufts University

Taking the "Strong Women" Message to Heart

Strong WomenFor Tufts' Miriam Nelson and Alice Lichtenstein, writing a book that provides women with accessible, applicable information on heart disease was both a professional and personal mission.

When two scientific luminaries like Alice Lichtenstein and Miriam Nelson sit down together, you might expect the immediate result to be a thorough dissection of the effect of trans versus saturated fatty acids on cardiovascular health (one of Lichtenstein's specialties), or maybe an in-depth discussion of the ways strength training can slow the progression of osteoarthritis (an area in which Nelson is an expert).

But at this moment, Nelson and Lichtenstein aren't discussing the myriad ways their respective research has shaped U.S. public health policy or swapping study findings.

Rather, the two nutrition experts are laughing together as Lichtenstein, who is wearing a sleeveless pink dress, proudly raises her arms in a body-builder pose to reveal a pair of toned biceps.

"This is what she did to me - Mim is an incredible motivator; she's the one who got me started!" Lichtenstein grins, referring by nickname to her colleague, whose groundbreaking research on the impact of strength training on mature women's health has spawned community-based strength training programs in 32 states.

Lichtenstein's well-defined arms aren't the two women's only successful collaboration. Their recently released book, Strong Women, Strong Hearts, is the seventh in Nelson's best-selling Strong Women series, which delivers practical information on how nutrition and behavior can positively impact various aspects of women's health.

Released this spring and co-written with Larry Lindner (former executive editor of the University's Health and Nutrition Letter), the colleagues' collaboration translates the latest scientific findings on cardiovascular health into accessible and applicable ways for women to decrease their risk of heart disease.

"Alice and I basically met in the hallway here at the HNRC [Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts]," Nelson says of the start of what she describes as her "incredible collaboration" with Lichtenstein. "Alice just looked at me and said, ‘I can't believe you haven't written Strong Women, Strong Hearts. I mean, there's nothing more important, in terms of public health, than physical activity and nutrition in reducing heart disease.'"

"Alice is the world's expert on this," continues Nelson, who earned her master's degree and doctorate at the Friedman School and has been teaching at Tufts since 1989. "I said, ‘It's your book to write!' She said, ‘I'm not gonna write a book, but let's work together.'"

In the summer of 2003, Nelson and Lichtenstein began to do exactly that. And in addition to their different areas of professional specialization, the two women brought different personal perspectives to the book.

"Whereas Mim came from a background where she was physically active, I came from a background where it just never happened - it wasn't part of my upbringing," says Lichtenstein, a New York City native and mother of two. "She knew what it was like to come back [to regular exercise] after having kids, whereas I knew what it was like to want to do something, but not really be quite sure how."

"I have three kids, who are all now teenagers," nods Nelson, whose Strong Women electronic newsletter goes out to 25,000 people. "Right when I had the first one, my physical activity level just plummeted, and I immediately had another and then another. I was pretty active, but not on a regular basis."

"But at some point you've got to make that commitment to get back on track, because otherwise it catches up to you[?]," she continues.

Finding the motivation to stay on track can be difficult, admits Nelson, who is an associate professor at the Friedman School and the Director of the John Hancock Center for Physical Activity and Nutrition at the School. But Nelson draws inspiration from Tufts President Lawrence S. Bacow, who leads a team of Tufts runners in Boston's historic marathon each year.

Bacow's approach to fitness and health? "[He says] ‘I'm a university president, I want faculty and students and staff to be fit and healthy and eat well, and so therefore I have to be that role model,'" Nelson says.

Strong Women

Bringing multiple experiences to the table worked out well for Lichtenstein and Nelson in terms of connecting with the book's target audience: "What we were trying to do was to reach as broad a group as possible," says Lichtenstein, now a regular gym-goer. "There are some [women] who want to step up and be more sophisticated in what they're doing, and there are others who need to take that first step."

"I see so many women who are ready to make that change, and they need that kick in the backside," agrees Nelson, who shared Lichtenstein's commitment to making Strong Women, Strong Hearts useful to women already committed to exercising as well as those who are newcomers to regular physical activity. The pair took a similar approach to communicating the nutritional aspect of cardiovascular health in their book's pages.

"[The aim] was to lay down very basic principles for healthy eating, specifically with respect to cardiovascular disease, and do it in a way that was flexible enough that almost anyone could adapt it to what their dietary patterns were, the same way anyone could adapt increased physical activity to whatever opportunities and preferences they had," says Lichtenstein, who has taught at Tufts since 1977, when she was one of the first faculty members at the University's Frances Stern Nutrition Center. She's now the Gershoff Professor of Nutrition Science and Policy at the Friedman School and Director of the Cardiovascular Nutrition Laboratory at the HNRC.

"Women [and] men are just bombarded with this messaging of what you should eat, what you shouldn't eat, and much of it is out of context," Nelson says. "Alice was so great - I knew this too, but she just drove it home: if you have a lousy diet and you add walnuts [which are labeled ‘heart-healthy'] to it, it's not going to make it any better. And if you have a really good diet and you add walnuts to it, it's not going to really make it much better."

"It'll just make you fatter, because you can't just keep adding ‘good' stuff!" Lichtenstein laughs.

"The body of research now is really pretty clear about the healthiest diet pattern of foods to eat for your heart health," Nelson continues. "So that was really fun, distilling all that research into a program."

The book also tackles what Nelson terms "the culture of food."

"For many people, their car is their dining room, and they eat at their desk, and they walk on the street and eat; that's where they're getting their pizza," Nelson says. "As opposed to just trying to bring back the family meal; trying to bring back eating without the television on; to bring back a variety of fresh fruits and vegetables at every meal - "

" - or even frozen fruits and vegetables!" Lichtenstein jumps in.

"Yes, frozen too," Nelson says. "[We're] really trying to get at the culture around good nutrition, because a lot of that has disintegrated."

"We do practice what we preach, and that made it, I think, a whole lot easier to write this," says Lichtenstein, who has served on the U.S. Dietary Guidelines Committee and the National Academy of Sciences' DRI (Dietary Reference Intakes) Committee and currently heads the American Heart Association's Nutrition Committee. "I don't think there was anything we ever wrote that we felt was phony, which is why I brought up the thing about the frozen vegetables: fresh is great, but frozen is just as good, and for some people, that's what works."

"We also incorporated a little on weight management, because it's an issue for everybody," Lichtenstein goes on. "What we're trying to say is, step back - these are just some basic guidelines that are going to help you, lifelong."

The book isn't designed to be a diet or weight-loss plan. Instead, the duo sees it as a resource to help establish a new culture of eating and exercise [or heart-healthy eating and exercise].

"I was very happy to be able to put in some sensible suggestions about what you can do that's not a diet that will help you moderate your weight in an environment that is working against you all the time," Lichtenstein says.

The book also contains statistics on women and heart disease that some might find shocking, such as the fact that a greater number of American women than men die annually of cardiovascular disease, and also that in the U.S., a woman dies of cardiovascular disease every minute.

Even before putting together the book, Lichtenstein was highly familiar with such sobering statistics. In fact, she's an integral component of the organization that releases them.

"Nothing surprised me because this is what I do for a living, and also because I am so involved with the American Heart Association and have been for so many years," she says. "Those statistics are actually compiled annually and reviewed by the Heart Association."

That's not to say, however, that Lichtenstein isn't surprised by information related to cardiovascular health.

"What has always surprised me - and there were a couple of papers published about this last year - is that when you ask a woman what she thinks her major health risk is, she's going to say breast cancer, whereas in reality, breast cancer hits about one in eight women, and cardiovascular disease hits one in two," she says.

"It may just be what physicians were taught while they were in medical school, but there seems to still be this gap so that physicians don't necessarily reinforce [cardiovascular disease risk] with women," Lichtenstein says.

"They don't always take it seriously," Nelson agrees. "We interviewed women who were being turned away at emergency rooms, told they had indigestion, didn't have heart disease…this is 2004! I was in disbelief."*

Nelson and Lichtenstein hope their book will help to create a culture in which incidents like that one are less common.

"One thing that's a hallmark of the professors that do work in the Friedman School is that many of us are committed to solid research, but then also policies that help to implement that research, and then also practices and dissemination to try to change behavior," Nelson says. "The nutrition scientists at the HNRC," Lichtenstein concurs, share those multiple commitments.

"Thousands of women will read this book, and millions of women and men and medical professionals will hear me talk on radio, television, and do newspaper interviews around women and heart disease," Nelson says. "Whether they even read the book or not, there's a whole awareness - and hopefully ultimately a change in behavior."

Profile written by Patrice Taddonio, Class of 2006

Patrice Taddonio, a native of Holland, Pennsylvania, is an English major and a communications and media studies minor. Currently the Tufts Daily's head features editor, she interned with the Improper Bostonian magazine during her sophomore year, and worked as a temporary text editor with the Associated Press at this July's Democratic National Convention. A member of the Class of 2006 and a songwriter, Taddonio has also performed on guitar and vocals at on-campus venues and at Boston-area benefits.

Photos by Melody Ko.

This story originally ran on July 4, 2005