Are you of the age or meet the criteria to need a bone mineral density test? Read further to see if you should be investigating this critical test with your primary care physician.

Bone mineral density (BMD) tests examine bone health and can help determine a person’s risk for fractures and identify osteoporosis. The most common and accurate test used to measure BMD is the dual-energy x-ray absorptiometry machine (DEXA or DXA), which compares the bone density in your hip and spine against established norms. DEXA uses a small amount of radiation though experts indicate the radiation risk is very low.

Who should get tested?

The U.S. Preventive Services Task Force recommends all women over age 65 and those who are under 65 but have a high risk of developing fractures get tested. In addition the NIH recommends bone density testing be considered in people with medical conditions putting them at high risk of fractures due to low bone density and those who have taken glucocorticoid medications for 2 months or more.

Why get tested?

BMD testing will determine if you have low bone mass thereby helping your physician determine preventative care and treatment options if necessary.

If you have any questions about bone density testing, talk to your primary care physician, and you can decide between you if a BMD test is right for you now or possibly in the future.

References:

NIH Osteoporosis and Related Bone Diseases National Resource Center.

Recently the updated clinical practice guidelines for bariatric surgery were released, cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery (ASMBS).  

For us practitioners it was a welcomed document since the last guidelines were published in 2008. In those five years, we have learned a lot more through research and we are always looking for the best practices and recommendations to treat weight loss surgery patients. There has been a lack of standards as you may know since recommendations vary between surgeons and practices. If you talk to friends or family who have had weight loss surgery at a different location than yourself, you know what I mean.

The new guidelines are somewhat lengthy and technical. I would like to point out the postoperative items of interest that I have shared with my patients. Many of these are not new, but have new research to substantiate the recommendation. (My comments follow.)

• Patients should adhere with principles of healthy eating, including 5 daily servings of fresh fruits and vegetables. (Eat your fruits and veggies before eating starchy carb foods.)
   
• Minimum protein intake should be 60 grams/day and up to 1.5 grams/kilogram ideal body weight per day. (Your RD can individualize your protein needs based on your age, weight, and gender.)
   
• Take your supplements daily. Your supplement needs depend on the type of surgery you had and your individual lab values. (Get your blood work done as ordered by your bariatric provider. Just because you feel good doesn't mean you don't have to take supplements. Supplements are not optional.)
   
• Fluids should be consumed slowly, preferably 30 minutes after a meal to prevent gastrointestinal symptoms and in sufficient amounts to maintain adequate hydration, more than 48 fluid ounces. (Water is always a good choice. Flavor it with slices of lemon, lime, or cucumber.)
   
• Exercise should include moderate aerobic activity of a minimum of 150 minutes per week and a goal of 300 minutes per week including strength training 2 to 3 times per week. (Do what you can, just get started. Any physical activity is better than no physical activity. You have got to do something and stick with it to maintain weight loss.) Read more on exercise after surgery
   
• All patients should be encouraged to join and attend support groups. Patients who regularly attend support group have better weight loss.  (Better yet, be a support group leader. Then you have made a commitment to attend group.)
   
• Regular postoperative dietary counseling with an RD means greater improvement in eating behaviors. (Your RD is important in your long-term success. Stay in contact with her/him.)
   
• If you have an adjustable gastric band, adherence with follow up visits is associated with greater weight loss. (The band doesn't work by itself. In order to keep it properly adjusted and stay in the "green zone" you need to attend your follow up appointments for tune- ups.)
   
• Out of control eating and grazing are associated with lower weight loss and weight regain. (Your pouch may not hold a lot of food at one time but if you eat every hour you can eat a lot of food over the course of a day. Ask yourself if you have physical signs of hunger or do you just want to eat.)
   
• Drinking alcohol after gastric bypass and gastric sleeve surgery results in accelerated alcohol absorption, higher blood alcohol levels, and longer times to eliminate the alcohol from your body. (If you decide to drink alcohol, be very cautious. These two surgeries are not good mixers with alcohol. NEVER DRINK AND DRIVE.)

Please keep in mind that these are guidelines and recommendations, not absolutes. Follow the guidelines provided by your bariatric team since they know you and are best suited to meet your individual needs.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.

*Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient- 2013 Update: Cosponsored by American Association of Clinical Endrocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.

Spring has sprung! This hopefully means you’ll be outdoors more, walking, gardening, biking and all the things good weather and longer days bring.  Though your focus has turned to enjoying outdoor opportunities for healthy exercise and soaking in the spring sunshine, don’t forget about things like osteoporosis prevention, or management if you’ve already been diagnosed.  It's never too late to start getting adequate calcium and vitamin D, as well as strengthening bones with exercise.

Best form of Calcium?  Calcium Citrate
Calcium citrate has been shown to be the best form of calcium to supplement your intake. The citrate form absorbs faster and more thoroughly than calcium carbonate, and can be taken with, or without food, making compliance much easier. Look for one with 1000 mg of calcium and 1000 IU of vitamin D included in the formula. The combination aids your body’s use of calcium even further, which is all the better for your bones.

Vitamin D is also Important
Though we can manufacture vitamin D in our body when our skin is exposed to sunlight, many of us still don’t manufacture enough.  Sunscreen, darker skin, clothing and advanced age can all minimize how much vitamin D we produce.  That’s why it is important to ensure you are still getting enough vitamin D through food and/or supplements. The best form to take is vitamin D3, which is the form your body produces from sunlight.

Nutrient Rich Foods
What else can you do to ensure you are maintaining your bone mass?   Eat foods rich in soy.  Soy beans, tofu and soy protein shakes may all help build your bones.  You can also incorporate magnesium-rich foods in your diet.  Like calcium, magnesium is a mineral stored in bone tissue, and is important to maintaining bone strength.  Eating nuts, spinach, oatmeal, potatoes, beans, wheat germ and avocado are all great ways to boost your magnesium intake. 

Bone Strengthening Exercise

Weight-bearing Exercises. Any exercises where your legs and feet support your weight qualify as weight-bearing.  These exercises work directly on the bones in your legs, hips and lower spine to slow mineral loss.  If you have osteoporosis, you should avoid high-impact activities such as running, jumping, or jogging.  For example:

• Walking
• Dancing
• Gardening
• Hiking
• Low-impact aerobics 

Resistance Exercises. Any activity that uses muscular strength to improve muscle mass, strengthen bones and reduce mineral loss is considered resistance exercise or strength training.  Compression fractures resulting from osteoporosis often lead to a stooped posture and increase pressure along your spine, resulting in even more compression fractures. Exercises that gently stretch your upper back, improve your posture and focus on strengthening the muscles between your shoulder blades can all help to reduce stress on your bones and maintain bone density.  Try these: 

• Free weights
• Weight machines
• Resistance bands
• Water exercises (water acts as the resistance) 

Flexibility Exercises. Stretching is always very important as part of an overall fitness program.  It’s important for joint and bone health by reducing pain and stiffness, and supporting good posture.  It is best to do stretching once your muscles are warmed up to prevent injury, at the end of your workout for example.  Always stretch slowly and gently, without bouncing.  

Review Revealed Few Benefits

In a meta-analysis that examined 14 well-conducted studies, which compared those who went for their health check against those who did not, researchers found that general health checks did not provide any beneficial effects on morbidity, hospitalization, disability, worry, additional physician visits or absence from work. However, one out of the 14 studies did find that health checks led to a 20% increase in new diagnoses per participant over a six-year period compared to those who didn’t get health checks. And, a few other studies also found small beneficial effects on self-reported health from getting health checks.     

Those who got health checks were not necessarily those who needed them the most

But, despite the surprising findings of this meta-analysis, most of the studies were old and used now outdated treatments. In addition, some of the cutoff values signaling treatment is necessary have been updated. Also, the participants who voluntarily get regular health checks are not necessarily those who need treatment the most. And finally, physicians may screen patients at other times for specific diseases such as cardiovascular disease and catch a disease prior to a scheduled health check.

Talk with your physician

So should you or shouldn’t you? While you ponder annual health exams, talk to your physician about when you need to be seen and consider screening tests recommended by NIH. Specific screening tests can catch some diseases early so treatment is started right away. Screening tests recommended by the U.S. Preventative Services Task Force and NIH can be found by clicking here.  Also, in some cases, your health insurance may be cheaper if you follow their guidelines for health screenings so be sure to check with them as well.  

Also, click on the links below for recommended age specific health screening tests:

Men ages 40 – 64

Men over 64

Women ages 40 – 64

Women over 64

Read Part One Here

As with all exercise programs, we need to consider the potential risk of injury or dropout. The main risk of HIIT training, as in any advanced training protocol, is the inherent mechanical stress that high intensity movements can create on the joints and connective tissues. In order to hit those higher intensities you will be performing some extreme movements like jumping, bounding, sprinting, burpees, mountain climbers and suicide push-ups. These moves may not be appropriate for everybody; in particular those with compromised joints. To minimize this risk you will need to prepare your body and progress into the program properly. If you plan on adding HIIT to your regime you will definitely want to build up and condition your speed and power muscle fibers—with HIIT Pre-Conditioning Exercises.

HIIT Pre-Conditioning Exercises

1. Regenerate your jump-ability
2. Train your turnover time
3. Clean up your core control

Regenerate Your JUMP- Ability

If you haven’t done any high impact or jumping for a while you may find that you have lost your ability to propel and descend your body properly. Women may also find that jarring causes the dreaded “ring around the crotch line”. So it may take some re-training to get your body mechanics and pelvic floor muscles back in order. One of the best preconditioning exercise is to simply stand with your hands on a wall or sturdy chair back and perform a set of heel drops (bounces). Concentrate on absorbing the shock with tall upright spinal alignment and a lifting contraction in the pelvic floor muscles. Keep you knees and hips slightly bent.

Once you are comfortable doing heel drops you can progress to low jumps where you bend through the ankles, knees and hips and spring up a small distance off the floor (extending the joints), then land with a shock-absorbing bend in the same three joints. Think about keeping the spine erect and pelvic floor muscles lifted. Progress this by either jumping higher, further (bounding) and /or in more rapid succession. These exercises should be practiced several times a week using 1 to 3 sets of 30 seconds.

 

Train Your Turnover

Turnover is the speed and agility of foot movement, or the number of times your feet strike the ground per minute. To train your turnover you need to keep track of the amount of footfalls you can complete in a 60 second period.  You can start with marching in place and work your way up to sprinting in place or running up and down on a platform.  Again you should practice this drill several times a week using 1 to 3 sets of 60 seconds.

 

Clean Up Your Core Control

Core control is your ability to move your limbs and body through space without compromising spinal alignment. As we perform high intensity whole body movements the core muscles (muscles surrounding your spine, shoulder girdle and pelvis) are taxed well beyond their normal function. Add speed and a little competition and you have the recipe for disaster in terms of form and execution.  Thus it will be important to condition your spinal support muscles prior to attempting the types of moves often used in HITT based workouts.  To do this start with holding wall planks for 30 to 60 seconds, then progress to hand and knee planks, forearm planks and planks with one or more limbs either lifted or moving. Vary the planks as well including front, rear and side positions. Practice this drill as many days a week as you can. Since the core muscles are an endurance group, you need to train them often with minimal external load (in most cases your body weight alone against gravity is plenty).

By pre-conditioning your jump, sprint and core control you will soon find that you have the strength and endurance needed to protect your joints as you challenge your system with these exciting and effective HIIT workouts. When in doubt, modify or opt out of any particular move you find too stressful! If you are not ready for them they can cause more pain than gain; and the last thing anyone wants from a new training program is to wake up the next day feeling like a dead duck rather than a spring chicken!

Don’t forget to feed your joints with the proper nutritional support to get the most out of your body over the long haul such as a liquid glucosamine and chondroitin supplement for healthy joint support.

Moveable joints, where bones come together and help us move, like our knees, hips and shoulders can become damaged over time due to wear and tear, disease, excess body weight and injuries. As a result, your joints may feel stiff, painful and become swollen. But, there are several steps you can take to prevent wear and tear on joint tissue.

STAY PHYSICALLY ACTIVE. Though some forms of physical activity – playing football in the NFL for years for instance, can add to wear and tear on joint tissue, normal levels of regular physical activity can help keep joints healthy by improving or maintaining bone density, muscle strength, joint flexibility and balance. Just be sure to protect your joints with protective pads when necessary and stop if they hurt more than tollerable discomfort from the exercise itself.  Swimming is great exercise and is particularly low-impact on joints. See more on joint-related exercise do's and don'ts here.

EAT HEALTHY.  Doing so will do more than just keep your weight within normal limits (being overweight puts stress on joints), but, it will also provide a variety of nutrients necessary for strong bones and muscles. In particular, adequate levels of vitamin D and calcium are necessary for bone health while protein is essential for building and maintaining muscle strength.  Having strong muscles around joints helps support the joint structure itself.

TAKE SUPPLEMENTS. And finally, the dietary supplements glucosamine and chondroitin sulfate can reduce moderate to severe knee pain in some people. Chondroitin helps absorb water in cartilage and both chondroitin sulfate and glucosamine block the enzymes that break down cartilage and some studies suggest they may also help build new cartilage tissue. Click the "recipe" link to read about a great recipe for a fun, refreshing way to take this supplement!

As a dietitian you might think I never have to battle with my weight. You would be wrong.

I have lost 25 to 30 pounds and regained it four times. I have lost 20 pounds in the last 6 months, 17 of those in the first four months, and I now weigh what I weighed in 1991. That was a long time ago and I was a lot younger. People keep asking me for my secret or what diet did I use. I have been working with weight loss surgery patients for the past 10 years and I am walking the talk. Here is the "secret."

"Secret #1"- I know from patients that boredom eating is the biggest emotional eating issue. I keep myself busy. Often too busy. Evening TV is not my friend. The TV and the sofa are not a good combination for me. I have a list of things to do in the evening that don't involve being a couch potato.

"Secret #2"- I eat very few meals out, maybe 1 to 2 times a month. I pack my lunch to work every day. I eat my dinner at home. I do not eat fast food. When I do eat out, I dine. I focus on the company, conversation, and atmosphere. The food has become secondary.

"Secret #3"- I do not keep problem foods in the house. Yes, I have my "difficult to control foods" and if I eat them, it's in a controlled situation with a controlled portion. If I have those foods in the house, they call my name and earplugs don't always work. If you don't buy it, you can't eat it. The first line of defense is in the grocery store.

"Secret #4"- I eat mostly the same foods. I drink a protein shake for breakfast six days a week. I eat a salad with a protein food on top for lunch six days a week. I eat a protein food and veggies for dinner. I eat Greek yogurt, fruit, and veggies for snacks. Sundays I break from the routine but I still stick to healthy food choices. I do not eat the food that comes into the breakroom at work since most of it is empty calories.

Now I have had people tell me that I don't enjoy my food....wrong. I eat foods that I like but that don't tempt me to overeat. I'm not going to waste my calories on food I don't like. People have told me that I have taken the "fun" out of eating. Food is not entertainment. Please tell me what is fun about diabetes, sleep apnea, hypertension, heart disease, gout, back pain, knees that need to be replaced, etc. Fortunately, I don't have these health problems but I work with people every day who do and I see the pain, agony, and expense they cause.

"Secret #5"- I go to bed early and usually get 7 to 8 hours of sleep a night. Remember, I keep myself busy from Secret #1 so I am  pretty tired when I climb into bed. If  you don't get enough sleep you have a greater release of the hormone that says, "I'm hungry." And that hormone is hungry for high calorie foods, not carrots.

"Secret #6"- This is the kicker....I exercise six days a week. I thought about all the times I regained the weight lost and realized every single time it was when my exercise slacked off. Research shows that in order to sustain weight loss you have to be physically active 30 to 60 minutes most days of the week. I walk  briskly 30 to 45 minutes six, sometimes seven, days a week. I do strength training three days a week. I go to Tai Chi two times a week. I climb the stairs at work every day. I get up from my desk every 45 minutes and walk up and down the hall. I park at the far end of the parking garage. I wear a pedometer to make sure I get my 10,000 steps a day. I look at my work schedule for the week and write my exercise time in my planner just like an appointment. Do I work out like I did in 1991 when I was at my fittest? Not even close, but I do something and that is the key. I have arthritis in my lower back and although the exercise causes discomfort, without it I have pain. Anything is better than nothing when it comes to physical activity. Just get up and move. Our bodies are not meant to sit all day and it is killing us.

Am I perfect? No, but I am on track about 95% of the time with my food choices and 99% of the time with my exercise. I am still working on eating slower and that is a constant effort.

So, all these "secrets" come down to eating healthy and moving more. Use your weight loss surgery to help you manage your eating. It is a tool but you have to do the work. Work on focusing on eating to live rather than living to eat. The more you practice the easier it gets.

Eat Smart...

Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.

What is bariatric weight loss surgery?

Bariatric surgery is a term that covers a wide range of weight loss procedures. A bariatric surgery is an option for people who have tried many traditional ways to lose weight with no success. National Institute of Health recommends bariatric surgeries for obese people with a BMI (body mass index) of at least 40 or for people with a BMI of 35 with serious medical conditions such as diabetes, high cholesterol and others. Those procedures consist of reducing the size of the stomach with a gastric band or even removing a part of the stomach   which is called gastric sleeve or by rerouting the small intestines to a small stomach pouch which is called gastric bypass surgery. A few possible advantages of bariatric surgery are significant weight loss in the long run, improvement of cardiovascular risks and recovery from diabetes (actual results vary from person to person).  However, bariatric surgery won’t make you lose weight without a healthy nutrition and an exercise plan.

Nutrition after a bariatric procedure

After bariatric surgery it is very important to adapt your lifestyle to achieve maximum results and facilitate weight reduction. A very good tip is to change your diet even before you have bariatric surgery so you can be prepared. You won’t be able to eat the same foods you ate before, at least not for a few months, depending on your recuperation and type of surgery.

Stage 1:  Liquids

Right after the surgery,  in the hospital, you will receive a clear liquid, sugar free diet. Do not use a straw to drink the liquids, using a straw can increase your gas problems and make you uncomfortable. The first few sips is normal to be hard to swallow but it will get better with time.  The portions may be regular size, but normally you will be able to consume about 4 ounces every waking hour, remember, your stomach is a lot smaller now. As soon as you will be able to tolerate it, your surgeon will decide if you can move to the next step, full liquids, which includes fat free cream soup, pudding, sugar free yogurt (no fruits) etc. You might be sent home after you tolerate a stage 1 diet, but this depends for every hospital and surgeon.

Stage 2:  Pureed or mushy  foods

This diet will go on for about 4 to 6 weeks and may vary by surgeon and the bariatric surgery type. It is very important to eat about 500-700 calories a day and at least 60 grams of protein as the proteins take an important role in your recovery. You should eat small and frequent meals;  your new stomach can only hold about an ounce at a time. It is also very important to drink enough fluids to prevent dehydration.

A Few Extra Tips:

• Eat your meals and sip your liquids very slowly
• Make sure you chew food very thoroughly
• Protein is very important during your recovery from surgery, make sure you eat at least 60 grams of protein every day
• Drink at least 7-8 cups of water or any other sugar free liquid between your meals every day to keep you hydrated
• It is important to drink only between meals
• Don’t eat high fat foods

Stage 3: Soft and healthy foods

After about 6 to 8 weeks you may introduce into your diet soft solid foods, it is important to continue to eat 4 to 6 small meals every day. Focus on high protein foods and avoid foods that are high in fat, sugar and fiber.  You may start to introduce one solid food per meal every day depends how you can tolerate it and remember to chew well so the food will be nearly pureed by the time you swallow. Some examples of food items for this stage are:  eggs, light yogurt, soft fish, lentil dishes and soup.

Stage 4: Solid foods

Eventually you will probably be able to eat most foods, just in smaller portions;  however, you should be making healthy food choices including lean meat or vegetable protein incorporating fruits and vegetables as you can and avoiding junk foods. The volume you can eat will always be limited so choose foods wisely.

A few more tips that you will have to take into consideration permanently

• Do not drink with a straw because it will overfill your stomach with fluid and air
• Avoid alcohol or drink wisely, you will feel the effect of alcohol more severely and it’s a source of unwanted calories
• Avoid carbonated beverages because it will fill your stomach with air and will make you feel uncomfortable
• Drink less caffeine, it can affect your iron absorption and lead to dehydration
• Eat slowly and be aware when you’re full and stop eating or you will develop chest pain and may vomit (dumping)
• Take your supplements EVERY DAY!  Because you are not able to absorb as much nutrients from food, it is very important to take your supplements every day such as calcium and vitamin D, multivitamin, iron (if recommended/needed), B-Complex and or B-12. 
• Exercise daily
• Join a support group both online and in person

Guest post by Dr. Jeremy Korman, M.D. at L.A Bariatrics within Marina Del Rey Hospital, a bariatric surgery center of excellence.

The blues are something everyone experiences at one point in time or another. And though you may feel like you are stuck or blah for an extended period of time, you can change your outlook and feel better by training your mind with these 3 steps.  However, actual depression is an illness and should be treated by a health professional.

1. Keep Healthy Company - Stay Away from Negative People
   Complaining is contagious. If you hang around complainers or negative people, it will rub off on you. Sometimes we have no choice but to keep company with those who are down and out on life such as family members or coworkers. And, you have two choices with these people – engage minimally by walking away or tuning out when they complain (let them know you are going to do this – the less you listen the less they’ll start ranting in front of you) or spend less time around them overall (if possible). Aside from keeping negativity at arms length, be sure to seek people who have a positive outlook on life and spend more time with them.
    
2. Speak Positively - Fake It Until You Make It!
   You’ve probably heard the phrase “if you think you’ve lost, you have.” And there is quite a bit of truth to that simple saying. What you think and the words you speak have the power of prediction. If you keep thinking you aren’t qualified for a particular job for instance, you’ll probably never bother applying for it. And even if you do apply and interview, the interviewer will be able to tell how confident you are in your ability to fulfill the job responsibilities. If you walk through a field looking for weeds you will probably never see the beautiful wild flowers. Likewise, if you are looking for people to be mean to you or expecting nothing to change at your workplace and instead for your job to suck and your boss to give you bad reviews, well, that will likely happen.  
   
   In addition to training your brain to refocus on something good or positive when thoughts of something bad or negative take over your mental energy, also intentionally speak positive affirmations. Fake it until you make it! Tell yourself you will get a new and much better job, you will get over an illness or your son will straighten himself out. Talk yourself into believing that good things are in your future and they may just happen!
    
3. Don’t Look Back - You Can't Change the Past
   The fiasco Manti T’eo has been going through (regardless of what you believe about it) should teach us at least one very valuable lesson: put the past in the past. Everyone makes mistakes and the more you focus on them the harder it will be to focus on your future. Whatever it is, get over it and spend your thoughts, time and energy on the future.

The Link between Feeling Blue and Low Levels of Vitamin D

Studies show low vitamin D levels may be associated with depressive symptoms in those with a history of depression. And though the exact relationship between vitamin D and mental disorders isn’t clearly understood at this time, it may explain why light therapy is an effective treatment option for seasonal affective disorder.  Sun lamps provide UV rays that can stimulate vitamin D production in the human body.  Ever wonder why you feel better after being outside in the sunshine?  It may be because of the vitamin D being absorbed through your skin!

If you suffer from depression, first speak to your treatment team about your options and ask your physician if you need to be tested for vitamin D deficiency. Vitamin D deficiency and insufficiency are rampant in the U.S. because it is found in few foods and use of sunscreen, shade and cloud cover limit UV exposure and darker skin pigment provides natural protection from UV rays. Also, many people don’t readily absorb vitamin D or manufacture it in their body, especially older and obese individuals. Vitamin D is not a miracle cure for symptoms of depression but treating low or deficient levels may help.

References:

Issues Ment Health Nurs 2010;31: 385-93.

Mayo Clin Proc 2011;86:1050-5.

Ever want to do yoga but not sure which format is right for you?

Today there are many styles of yoga, all of which date back to a practice established in ancient India many thousands of years ago. In the earliest times it was used as a spiritual practice to help control both the mind and body for a greater purpose of meditation, concentration and self-enlightenment. In Hinduism, Buddhism and Jainism the word yoga means "spiritual discipline".

As the practice expanded it was influenced by various gurus leading to the many different styles of yoga we see today.

Yoga Benefits

In the West, the term "yoga" is typically associated with Hatha yoga and its asanas or postures. Hatha yoga focuses on the physical and is more typically used as form of exercise rather than a spiritual practice. Since the late 90s, the popularity of yoga in the USA has been on the constant rise. The number of people who practice some form of yoga has grown from 4 million (in 2000) to over 20 million (in 2013). It is no wonder that the practice of yoga has swelled in the fitness capitals of the world with claims of physical benefits such as reductions in heart disease, high blood pressure, chronic joint pain and back fatigue as well as mental benefits such as improvements in mood disorders, stress reduction and substance abuse. (1- 4)

Practice Yoga with Care

With that said there are some important things to be aware of when it comes to yoga safety and effectiveness. I have some concern with the growth and popularity of yoga programs in the general health club setting. Many of the traditional yoga poses and sequences involve mastery of movement and may take years to perfect to the end range positions (for example a full plow, headstand or cobra). If a novice comes into a class and these poses are being practiced it may be tempting for him or her to try them. Some poses can actually cause or irritate existing injuries in the spine (or other compromised joints) if not practiced and progressed properly. An extensive survey of yoga practitioners in Australia showed that about 20% had suffered some physical injury while practicing yoga. Headstands, shoulder stands, lotus and half lotus (seated cross-legged position), forward bends, backward bends, and handstands produced the greatest number of injuries.(5.)

Look for a Experienced Yoga Instructor

There are modifications for all yoga poses. This is where a well-versed and engaged instructor can make a huge difference. It will be important for the instructor to recognize the individual limitations within the group and offer appropriate modifications. It will also be important for the students to accept and respond to those cues and recommendations. It is also a good idea to have various levels of yoga classes available on the schedule. That way if a person is entering a beginning level class they can be confident that the instructor will not be offering or demonstrating advanced variations. Thus the most important thing to do to ensure a safe and effective yoga experience is to match your level of experience to the class. Gentle, restorative or beginning yoga would be best for the novice exercisers. The more advanced classes would and should be labeled as advanced or may be titled things like power, strong, Bikram(hot) or Ashtanga yoga. And most importantly students must learn to listen to their body and joints throughout any class.  If a move or pose or stretch causes joint pain, it is not appropriate and should be modified or discontinued immediately.  If a pose is so difficult that you feel the need to hold your breath, it is probably too advanced and should also be modified.  Most moves or poses can be easily modified by simply reducing the range of motion or by adding support (i.e. a hand support to thigh or yoga block)

Visit the following link to take a fun yoga quiz that can help you better define the type of yoga class you might like best.  www.proprofs.com/quiz-school/story.php?title=what-type-yoga-may-best-suit-you

1. Streeter, Chris C. et al. "Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study." Journal of Alternative & Complementary Medicine. Nov 2010, Volume 16 Issue 11, p1145-115
2. Yoga could be good for heart disease. Simultaneous focus on body, breathing, and mind may be just what the doctor ordered. (2010). Harvard Heart Letter: From Harvard Medical School, 21(3), 5.
3. Tilbrook Helen E et al. (2011). "Yoga for Chronic Low Back Pain: A Randomized Trial". Ann. Intern. Med. 155 (9): 569–578.
4. "Siginificant benefits of yoga in people with rheumatoid arthritis, study shows". Sciencedaily.com. 2011-05-28. Retrieved 2012-11-28.Chuang, Ling-Hsiang et al. (2012). "A Pragmatic Multicentered Randomized Controlled Trial of Yoga for Chronic Low Back Pain: Economic Evaluation". Spine 37 (18): 1593–1601. doi:10.1097/BRS.0b013e318254593
5.  Penman, Stephen; Marc Cohen, Philip Stevens, and Sue Jackson (2012). "Yoga in Australia: Results of a national survey". IJOY, International Journal of Yoga 5 (2): 92–101. doi:10.4103/0973-6131.98217

If you have IBD (irritable bowel disease), you may have an increased risk of developing certain vitamin and mineral deficiencies. In fact, studies show even those with mild IBD can develop nutrient deficiencies. And, you definitely do not want any vitamin or mineral deficiency left untreated since they could lead to several problems such as anemia, brittle bones and delayed wound healing.

Chronic inflammation and medications for IBD are both contributing factors that can impair the absorption of certain nutrients. And though doctors don’t have any specific accepted guidelines to follow for assessing vitamin and mineral deficiencies in IBD patients, they can look for typical signs and symptoms of deficiency and rely on your assessment of your health.

WedMD has helpful information for sufferers of IBD at http://www.webmd.com/ibd-crohns-disease/eating-plan-for-inflammatory-bowel-disease. 

They mention to stay aware of the following:

• Inflammatory bowel disease can make it hard to get the nutrients you need.
• It is important to eat a healthy, varied diet to help you keep your weight up and stay strong.
• Some foods can make symptoms worse. Not eating these foods may help reduce your symptoms.
• No one diet is right for everyone with an inflammatory bowel disease. Keep a food diary to find out which foods cause problems for you. Then you can avoid those foods and choose others that supply the same nutrients.
• Because you may not be absorbing all the nutrients from the food you eat, you will need to eat a high-calorie, high-protein diet. This may be easier to do if you eat regular meals plus 2 or 3 snacks each day.
• You may need to take vitamin and mineral supplements to help you get the nutrients you need.

According to some physicians, folate, iron and vitamin D should be assessed annually in all IBD patients regardless of whether or not they have any symptoms of deficiency. In addition, patients with a history of anemia should have a full iron panel, folate and B12 assessed while those with osteopenia and osteoporosis should have their vitamin D monitored regularly.

If you are an IBD patient, ask your physician about specific tests you should take for vitamins and minerals. In addition, talk to your doctor about how to treat or prevent nutrient deficiencies and which supplements or prescription medications may be best if you do have a deficiency. Some physicians may recommend liquid dietary supplements because they are easy to take and absorb. In other instances you may need a prescription dose of a particular vitamin or an intramuscular injection.

Guest Post Provided by Marie Spano, MS, RD

References:            Inflamm. Bowel Dis. 2012;18:1961-1981.

There are 8 different vitamins in the B-Complex family. Though each has it’s own functions within the body, all help your body convert the food you consume into usable energy. In addition, the B vitamins work together as a team.

1. Thiamine or B1 - helps in the conversion of carbohydrates into energy reserves
2. Riboflavin or B2 - precursor to coenzymes involved in the growth and repair of skin and tissues lining the gastro-intestinal tract, as well as the synthesis of amino acids
3. Niacin - necessary for normal breakdown of fats and fatty acids, and energy release from carbohydrates
4. Vitamin B6 - converted into the main enzyme responsible for amino acids & protein metabolism
5. Folic Acid - essential especially for pregnant women for baby's development
6. Vitamin B12 - plays a role in entire nervous system, promotes energy metabolism and support healthy heart function
7. Biotin or B7 - supports the metabolism of carbohydrates, fats and proteins for energy and often associated with hair, skin and nail health
8. Pantothenic Acid or B5 - converts to Coenzyme A in the body, which is important for many reactions involving energy metabolism

B vitamins from Diet

B vitamins are found in a wide range of foods from dairy products and eggs to meat, grains, vegetables and beans; therefore, a deficiency in any B vitamin is rare. However, some individuals may consume lower amounts of specific B vitamins than they need for optimal health. In particular, those who are dieting or cutting out specific food groups, individuals with a limited food intake such as those who have had bariatric surgery, vegetarians, vegans, gluten free, alcohol-dependent individuals and those with malabsorption issues all have an increased risk of falling short on their nutrient needs.

Vitamin B-12 Deficiency More Common

One of the more common B vitamin deficiencies is B-12, which affects from 1.5 – 15% of the population. Some of the symptoms of B12 deficiency include weakness, fatigue, constipation, appetite loss, weight loss and tingling in the hands and feet. Those most at risk for B12 deficiency include older adults, people with gastrointestinal disorders such as celiac disease or Crohn’s disease, individuals who have had weight loss surgery and vegans.  B12 becomes increasingly important with age with risk of decreased absorption which can lead to deficiencies in both B12 and Folic Acid.

Vitamin B12 is involved with energy metabolism, heart health and nervous system function. 

B Vitamins for Energy

B vitamins work together in the body to convert food into energy metabolism, support mental focus and reduce the effects of stress. Because they are water soluble and not stored in the body, they must be replenished daily to maintain optimal health.  Many energy drinks on the market contain B vitamins for the energy they provide.  However, most energy drinks also contain sugar and/or caffeine so are not considered a good source.

Vitamin B Supplements - Do you need them?

If you are deficient in one or more B vitamins or your intake is suboptimal, it is possible to improve your overall health if you consume more foods rich in B vitamins or take a dietary supplement. But, always talk to your health care professional first prior to taking any new supplement.

References:

JAMA. 2002 Jun 19;287(23):3116-26.

Dietary Supplement Fact Sheet: Vitamin B12. Office of Dietary Supplements, NIH.

It is well known that obesity is a risk for poor cardiovascular health. Hypertension, hyperlipidemia, diabetes, congestive heart failure, and stroke are common problems associated with obesity. Carrying excess body weight makes the heart work harder and this can cause structural changes and enlarge the heart.

Standard recommended treatment for poor heart health includes medications and weight loss. We know the weight loss can reduce blood pressure and cholesterol levels but how does bariatric weight loss surgery compare with traditional treatment to decrease cardiovascular risks?

Effects of Weight Loss Surgery on Heart Health – A Review

A review of the literature produced several studies and results from systematic reviews involving the effect of weight loss surgery and heart disease risk factors. Although several of the studies involved a small number of people, the results all point to a decrease in risk factors after bariatric surgery.

The Swedish Obese Subjects (SOS) study followed 2010 obese subjects who underwent bariatric surgery and 2037 matched obese controls who received the usual care. Surgery patients included gastric bypass, banding, and vertical banded gastroplasty. At 10 years after surgery, improvements were still noted for blood pressure, blood triglycerides, and diabetes. There were fewer cardiovascular deaths in the surgery group compared to the control group, 28 vs. 49 deaths. This study concluded that compared with usual care, bariatric surgery was associated with a reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

Research has shown that Bariatric surgery can significantly reduce risk factors

Cleveland Clinic researchers conducted a systematic review involving almost 20,000 patients who had weight loss surgery and examined 73 bariatric surgery and cardiovascular risk factors. Prior to surgery about 44 percent had hypertension, 44 percent had high cholesterol, and 24 percent had diabetes. After surgery 63 percent had improved blood pressure, 65 percent saw a decrease in cholesterol levels, and 73 percent had improvement in their diabetes at a mean of almost 5 years after surgery. In addition, the heart remodeled, or became healthier. Researchers in this study concluded that bariatric surgery can significantly reduce several risk factors for cardiovascular disease and can improve the structure and function of the heart in much less time than standard weight loss and/or medications.

The American Heart Association (AHA) made a statement in 2011 concerning bariatric surgery and cardiovascular risk factors.  Read Here http://circ.ahajournals.org/content/123/15/1683.long#sec-23

Bariatric surgery is not without risks but the benefits to reducing cardiovascular risk factors warrants a discussion with your physician about possible surgery.

Eat Smart...

Vicki Bovee, MS, RD

Resources:

Ashrafian H, Et al. Effects of Bariatric Surgery on Cardiovascular Function. Circulation. 2008;118:2091-2102.

Cleveland Clinic. Weight Loss Surgery Should Be Considered Life-Saving Procedure for Overweight and Obese Patients with Cardiovascular Risk Factors. Retrieved from http://my.clevelandclinic.org/media_relations/library/2012/2012-10-18-cleveland-clinic-study-finds-bariatric-surgery-reduces-heart-disease-risk-factors-and-improves-heart-function.aspx

Sjöström L, Et al. Bariatric Surgery and Long-term Cardiovascular Events. JAMA. 2012;307: 56-65.

Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association.2011 Apr 19;123(15):1683-701. doi: 10.1161/CIR.0b013e3182149099. Epub 2011 Mar 14.Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough PA, Ren Fielding C, Franklin BA; American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism.

The research studies presented here are summarized from credible, peer-reviewed journals. Conclusive evidence about the effectiveness of any treatment is rarely found in a single, individual study. Anyone who is considering starting or changing a medical treatment should consult with their doctor.

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Have you ever questioned whether it is a smart idea to exercise during the cold and flu season? Or wondered if a good sweat might actually clear some of your cold symptoms? 

Although research has shown that breaking a sweat can protect you from having certain cold or flu related sick days, it has not shown it to be much help once you are already sick. In a study done by David Nieman Ph.D., out of the Human Performance Lab at Appalachian State University, it was found that regular exercisers experienced 43 percent fewer sick days than those who didn’t exercise. Regular exercisers also reported less severe symptoms during the days they did have colds. Yet, there have been no human studies to date that have shown exercise to shorten cold or flu symptoms once a person is already sick.

With that in mind, below is the normal rule of thumb for exercising during an illness, *as reported by the Mayo Clinic:

• Light to moderate exercise is usually OK if your signs and symptoms are all "above the neck" — symptoms you may have with a common cold, such as runny nose, nasal congestion, sneezing or minor sore throat.
• Consider reducing the intensity and length of your workout.
• Don't exercise if your signs and symptoms are "below the neck" — such as chest congestion, hacking cough or upset stomach.
• Don't exercise if you have a fever, fatigue or widespread muscle aches. *http://www.mayoclinic.com/health/exercise/AN01097

Did You Know:

On an interesting internal note: It is not uncommon for your heart rate at rest to accelerate when you are fighting off a fever or virus. This raise in resting heart rate is a normal response when the body is fighting infection, bacteria, etc. Your resting heart rate, measured in beats per minute, indicates the amount of effort (contractions/beats) your heart needs to maintain all your systems, without the additional demands of exercise or movement. It varies from person to person  (average rate being 60 to 80 beats per minute).

Overall your resting rate is an indicator of cardio-respiratory fitness but it can also tell you on a day-to-day basis if your body is struggling with outside factors such as stress, over training and/or illness.

If you learn to monitor your heart rate on a regular basis, your normal resting rate can act as an indicator of whether or not you should exercise. Know that the energy spent in exercise may take away from the your body’s ability to heal. Thus a rate of 10 or more beats above normal could be a sign that you should choose hydration and rest rather than sweat and exercise; at least until you are feeling a bit better.

Side Bar: How to find your resting heart rate

It is best to measure your resting heart rate when you first wake up and are still lying in bed.

1. Locate your pulse with your index and middle finger at your radial artery (palm up - thumb side of your wrist).
2. Find a steady beat and start counting. Your first beat is count ‘zero’.
3. Continue counting for a full 60 seconds. You can also try a shorter 10-second count and then multiple that number by six. 

Though not everyone will have the same set or level of nutrient deficiencies, if you have been diagnosed with Celiac Disease or are following a gluten free lifestyle, you may want to check with your practitioner to see which if any, areas of nutrition need your focused attention. 

Malabsorption of nutrients, stemming from intestinal villi atrophy and the inherent lack of certain nutrients in a specifically gluten-free diet both can lead to a need for certain nutritional supplements to help guard against common deficiencies.  The length of time you had Celiac disease before you were diagnosed,  the extent to which your small intestine was damaged, leading to the degree of malabsorption of nutrients, and any medication that may block nutrient absorption all affect nutrient levels in any one person. 

Most commonly, iron, zinc, vitamin D, and several B vitamins, along with fiber, calcium and magnesium are lacking in a gluten-free diet or are poorly absorbed in a person suffering from Celiac disease. This is in part due to many gluten-free foods not being fortified or enriched with these nutrients that would exist in a diet allowing gluten.

Critical Nutrients:

Calcium & Magnesium – Bone issues are common in celiac patients with osteoporosis in over 25% of all cases at the time of diagnosis, and even higher at 40% with osteopenia, making risk of fractures 30% higher than normal.

Vitamin D – Supports the immune system, and common decrease in the function of small intestine absorption seen often in Celiac patients, can compromise vitamin D activity and function.  In turn, absorption of adequate calcium is also impaired.

Iron – Before taking an Iron supplement, always get tested first.  Iron deficiency anemia is the most common extra-intestinal symptom of Celiac disease, however, it may be corrected after adhering to a gluten free diet.

Folic Acid – Important in the formation and maintenance of all cells, folate works with B12 to make and keep cells healthy.  Gluten-free products are lower in folate than their gluten-containing counterparts.

Vitamin B12 – Vitamin B12 becomes harder for our bodies to absorb as we age. Add the complication of absorption in someone with celiac disease and the correlation to deficiency gets much higher.

Vitamin B6 - Damaged intestinal villi for those with Celiac cause issues with B6 absorption as well.  B6 is involved in over 100 enzyme reactions in the body, mostly related to protein metabolism.

Fiber – If your gluten-free diet happens to be completely grain-free as well, a lack of fiber could be a health concern.  A prebiotic fiber source may be helpful for providing added dietary fiber and for promoting the growth of good intestinal bacteria.

The best possible course of action to make sure you’re getting the right nutrients at the right amounts and how many, if any, nutrients you may need to supplement is to rely on your gastroenterologist for testing, and develop a program with your gastroenterologist and dietitian to cover nutrient gaps with diet and supplementation. 

Should your doctor and/or dietitian recommend a vitamin/mineral regimen to bolster your health and raise levels of key nutrients, be absolutely sure that the supplements you are taking are Certified Gluten Free, as many tablets and pills contain small amounts of fillers which could contain gluten.  A liquid supplement is less likely to have those fillers and is more bioavailable, since it does not need to be broken down in the stomach first.  This will help improve your overall health and may help reverse nutrient deficiencies developed over course of undiagnosed Celiac disease.

Sources:

Doherty C, Dennis M. Nutritional Supplements For Celiac Disease: What you need to know.  New England Celiac Conference 2011.

Malterre, Tom, MS, CN.  Digestive and Nutritional Considerations in Celiac Disease: Could Supplementation Help?  Alternative Medicine Review Vol. 14, No. 3, 2009.

Put on your RED ladies and gentlemen...

Negative Effects of Stress

We all know chronic stress doesn’t feel good. But did you also know it can make it harder for your body to lose weight and decrease you gut’s ability to absorb and digest nutrients? When you’re working so hard to maintain a healthy body and eat right, it can be discouraging to feel like something you have no control over is affecting you negatively. But fear not! Small amounts of stress relief throughout the day make a big difference. So the next time you think you don’t have time to work on stress-reduction, pick something off of this list that you can do in just ten minutes!

photo source: health.asuw.org
 

10 Way to De-Stress in 10 Minutes or Less

Here's a list of stress-free things you can do in ten minutes or less. Make your own list and tack it up where you'll be reminded to do something daily to keep you relaxed.

1.  Take a ten minute walk, preferably outside. Just ten extra minutes a day of walking can help you to reach your heart-healthy cardio goals and clear your mind.

2.  Stretch. Even a few minutes of stretching a day can help alleviate muscle aches and pains.

3.  Make a 10-minute playlist of your favorite relaxing songs. Put your headphones on and tune out the world. Consider it music meditation.

4.  Meditate. I know, this is easier said than done. Start by setting a timer for just one minute and focus on your breathing for that time. Close your eyes and feel the sensation as your breath moves in and out. If you can get through one minute, you can begin to build up to five, then ten minutes.

5.  Make a 10-minute playlist of your favorite dance songs. When you get home from work, put on the music and dance around. You’ll burn some extra calories and get out any stressful energy from your day.

6.  Write in your journal or grab a piece of scrap paper if you don’t have a journal. When you’re done, you can just rip it up and throw it in the recycling. No one will see it, but it will help you get those chaotic thoughts out of your head.

7.  Cozy up to your child, friend, partner, or pet. We don’t always have time or money for a massage, but the simple act of touching another living being can reduce stress. Give your daughter a hug, pet your dog, or spend a few moments on the couch cuddling with your husband.

8.  Sit down to a cup of caffeine-free tea. Having a daily habit like this can be a great way to take a breather. Give yourself at least ten minutes to sip and enjoy without the pressure of thinking about anything else.

9. Turn off your computers, cell phones and TV. When was the last time you had all your technology devices turned off? Being connected to others at all times can be wonderful. It can also be an extra cause of stress. Give yourself at least ten minutes a day where you pretend technology doesn’t exist.

10. Buy a hula hoop and spend 5-10 minutes practicing with it each day. The rhythmic sway can help loosen your hips and create a relaxing state for your mind.  

11. Take a B Complex vitamin - B vitamins work together in the body to convert food into energy metabolism and reduce the effects of stress.

Never underestimate what you can accomplish in just ten minutes a day!

Guest Blog Post by Iris Higgins, gluten-free cook book author and blogger of www.thedailydietribe.com, hypnotherapist with master's degree in psychology plus a Women's Wellness Wizard. 

While there are plenty of potential routes to go with bariatric surgery, the process of preparing for weight loss surgery is fairly uniform for most patients. Your surgeon will provide specific instructions to follow, however the general preparation can be broken down into four core categories: meeting with specialists, lifestyle changes, “the week before” and “the day before.”
 

Meeting With a Variety of Doctors and Professionals

There are a number of healthcare professionals you will meet with during the process of preparing for weight loss surgery. Depending on your health, you will meet with some combination of specialists, including a dietitian, psychologist, cardiologist or pulmonologist to ensure the surgery is appropriate and can be accomplished safely. The nutritionist and psychologist will help you manage your post-surgery expectations and implement healthier eating and lifestyle habits.

Lifestyle Changes

When preparing for weight loss surgery, there are a handful of lifestyle changes you may be required to make. You should stop smoking at least six months before the surgery and reduce your caffeine intake. Many surgeons will also ask you to lose 10-30 pounds before the bariatric surgery to ensure you are serious about keeping the weight off.  Also make sure you sure you have plenty of psychological support both before and after surgery.  Having support to keep you grounded and in check is essential.

The Week Before

The week before the bariatric surgery includes a variety tasks to complete. The most common steps include:

• Purchasing post-surgery supplies. This typically includes a variety of nutritional supplements such as calcium and vitamin D3 and a Multivitamin, bandages, Neosporin and certain types of easy-to-eat foods.

• Find someone to drive you home and help out for a few days. After your surgery, you aren’t going to feel like doing a whole lot. Make sure you have a friend or family member who can drive you home. They should also be available for a few days to help out as needed.

• Fill all postoperative prescriptions. Nothing is worse than getting home after bariatric surgery, only to realize you forgot to fill your prescriptions – especially your pain medication.

The Day Before

Effectively preparing for weight loss surgery ensures you don’t have to do much the day before. All you need to do is get packed. Your surgeon will give you a list of items to bring with you. Common items you will need to bring include:

• Comfortable clothes
• Insurance card
• Driver’s license
• List of current medications
• Toiletries
• Socks/robe
• Lip balm

This list is not meant to be all-inclusive, so always talk to your surgeon about any concerns or questions you may have. If you’re preparing for a weight loss procedure, best of health and good luck in your new healthier lifestyle to come!

by guest blogger Jason Knapfel who manages web content for Oregon Weight Loss Surgery in Portland, Oregon.

Those who develop Type 2 diabetes usually had prediabetes at some point - where blood glucose levels are higher than normal.  The good news is there are steps you can take to prevent or delay it progressing to Type 2.

If we pay close attention to our bodies and schedule regular checkups, like a yellow light signaling caution, warning signals will appear. And prediabetes alerts us when our blood sugar is higher than normal though not high enough to be diagnosed with Type 2 diabetes. However, those with prediabetes are more likely to develop Type 2 diabetes and may already have some of the problems associated with the disease. Therefore, it is very important to recognize the symptoms that may be associated with prediabetes:

Symptoms of Prediabetes:

• Frequent thirst
• Frequent urination
• Blurred vision
• Extreme fatigue
• Frequent infections
• Cuts/bruises that are slow to heal
• Tingling/numbness in the hands/feet
• Recurring skin, gum or bladder infections

Get Tested!

It can be easy to ignore these symptoms, especially if they develop gradually. Therefore, if you have any of the risk factors outlined below you should ask your physician about getting tested. Doctors will use a fasting plasma glucose test, oral glucose tolerance test or an A1C test or combination of tests.

Risk factors for prediabetes and diabetes include:

• High blood pressure
• Low HDL cholesterol and high triglycerides
• A family history of diabetes
• A history of gestational diabetes or giving birth to a baby weighing 9 lbs or more

In addition to taking a look at the risk factors and symptoms, the American Diabetes Association offers this risk factor test you can take to determine if you may have an increased risk: Type 2 Diabetes Risk Test

Preventing Progression to Type 2 Diabetes - Lose Weight and Exercise!

How can you prevent Type 2 diabetes? The two single most important preventative steps you can take today include losing weight and exercising. In fact, research shows that you can lower your risk by an astounding 58% by losing 7% of your body weight and exercising moderately for 30 minutes per day, 5 days per week.

Get Your Z's

In addition to losing weight (by eating a healthy diet) and exercising regularly, sound sleep is essential. Research shows that regular sleep deprivation can contribute to insulin resistance and therefore, higher blood sugar levels. Plus, sleep lost stresses the body and makes losing weight more difficult. Aim for at least 7 hours of quality sleep per night (this means the time you are actually asleep, not from the time you get into your bed until the time you get out).

The National Diabetes Education Program has designed a national awareness campaign to target people at risk for type 2 diabetes. The campaign will create awareness that type 2 diabetes can be prevented through modest lifestyle changes and losing about 5 to 7 percent of body weight. More about Small Steps on Diabetes.org.