Getting them active just might help you get active as well! 
Read Part 1
Read Part 2

In Part 3 of getting active with your kids or grandkids, let’s explore yet two more items that may be available to you. Try experimenting using these two toys in new ways. By adding some fun new uses for these ordinary play things you will enjoy different forms of movement that they provide. Have fun and be creative!

FRISBEES

Inside:

•        Create an obstacle course.

•        Use for target practice.

•        Secure to shoes and use as skates to practice sliding.

•        Secure to hands and use as paddles.

•        Secure to rope and use as moving target.

•        Use as personal space or “home base” markers.

•        Use for treasure hunts or relays.

•        Use as a steering wheel.

•        Balance on body parts.

•        Use as stepping stones, lily pads, etc.

Outside:

•        Throw and chase.

•        Hang from trees as targets (can add bells for auditory reinforcement).

•        Carry water, sand or mud.

•        Use as water skis.

•        Use for treasure hunts or relays.

•        Roll, spin or flip them.

•        Use as steering wheel.

•        Secure to sticks to use as long handled paddle.

FOAM POOL NOODLES

Inside:

•        Secure to the ground and use as balance beams (may need to assist the children).

•        Secure to the floor to practice motor skills.

•        Suspend off the ground to practice motor skills.

•        Practice movement concepts such as body awareness, space awareness, effort awareness, and relationship (examples; directions, pathways, speeds, levels).

•        Use to pull objects.

•        Use as weights and lift them like you are exercising.

•        Use it to play limbo.

•        Cut them into small pieces and practice motor skills. When cut small folding the noodle slightly in your fingers and releasing them causes them to fly away from your body with a snap sound creating instant fun.

•        Cut them in half and use them like drum sticks.

•        Use them to hang sheets over to create fort/tent/tunnel.

Outside:

•        Use them as hurdles to jump over or for backyard croquet.

•        Use them to practice striking objects (stationary, suspended, tossed).

•        Have a pirate sword battle.

•        Use as paddles on a boat and row.

•        Use to build forts.

•        Use it to play limbo.

•        Ride them like a horse.

•        Throw them like a javelin in the Olympics.

•        If hollow, use them like a hose to pour water.

•        If hollow, put a rope through them and use as boundaries, hang sheets from, balance on and move.

Reference: www.beactivekids.org

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.

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

Ever wonder whether you're getting the most out of your daily walk?  Wonder if there's a proper way to hold your body to get the most benefit?  While there are many and varied ways of walking, from speed walking to a leisurely stroll, there are basic body positions that will help keep your body safe and maximize your walking effort.

HEAD POSITION – Chin parallel with the ground, not tucked to your chest or tilted out.  Eyes/Focus should be straight ahead.  Looking at the ground is not good form as it pulls your chin toward your chest and tilts your head forward too far.  Your head and neck should be aligned naturally, with your head held high and neck at a natural extension. 

ARM/SHOULDER POSITION – Your arms should swing freely with each stride, with a slight bend in your elbows. Your shoulders should move naturally with the swing of your arms.  Be careful to watch your shoulder position. It is common for shoulders to inch toward your ears, breaking the long line of your neck position, and adding tension in your shoulders.  Make a conscious effort to keep shoulders loose and down.

CORE POSITION – Keep abdominal muscles engaged, with stomach muscles gently tightened as you walk.  This will also help keep your back straight, which is important to keeping all parts in good form as you walk.

FOOT POSITION and STRIDE – Walk with a smooth, even stride, rolling your foot from heel to toe. Your stride can be extended over time, with proper stretching before and after each walk, and lengthened each walk once you have had time to warm up. 

 Whether you’re just beginning a walking program, or you’ve been at it for years, it’s never a bad idea to remain conscious of proper form during each walk.  It’s the best way train your brain to default to the feel of good form and optimize the health benefits of each walk.  

And if you are experiencing joint discomfort either from walking or need to start a walking program to help ease your joints, try a glucosamine and chondroitin supplement.  A liquid form of glucosamine and chondroitin is readily bioavailable to your body, and can help with joint stiffness and inflammation to keep you walking for years to come.

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.

HIIT is the hot, new workout concept of choice!

Over the past few years it has steadily grown in both popularity and purpose. Currently there are numerous HIIT based programs being taught, each with their own unique fitness twist and branding. Some of these include Tabata, R.I.P.P.E.D., Stacked, 4321 Fitness, PEAK 8, Jillian Michaels BODYSHRED, and the BEACHBODY INSANITY program. The list continues to expand while gaining huge consumer and club attention. Which is why it is more important than ever to understand not only what HIIT is, but also how to prepare and condition to perform it properly.

What is HIIT?

Let me start by defining HIIT, which is an acronym that stands for High Intensity Interval Training (or intermittent training). It is an exercise strategy that alternates short high intensity exercise (that makes you breathless) with less intense recovery periods (that brings your breathing back to a more normal rate).  If you have ever done wind sprints or Fartlek training you have a good idea of what these intervals feel like. 

What’s new about interval training?

Not much in principle but quite a bit in terms of the research and evidence that supports the many advantages HIIT can offer. This includes a long list of benefits from increasing metabolic rate (calories burned at rest) to reducing anxiety, staving off belly fat and improving insulin sensitivity.  Studies have show a traditional 60-minute workout can be whittled down to 20 minutes of HIIT, while yielding the same (or greater) calorie burn and weight loss results… Making HIIT the ultimate microwave workout.

Is there a down side to HIIT training?

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.

Read Part Two of our HIIT series on HIIT Pre-Conditioning Exercises

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

Remember to protect and nourish your joints no matter what kind of exercise you do especially when doing these kind of high impact exercises.  Glucosamine and chondroitin are not just for when you are having joint issues but are also good to use as a preventative.  Try a liquid glucosamine and chondroitin that is fast absorbing to keep joints flexible and to help maintain healthy cartilage.

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!

FACT: Physical inactivity doubles the risk of heart disease

Get up and "get your walk on" today!  It's National Walking Day, brought to us by the American Heart Association.  They have developed a great program of  helping people all over the country find walking clubs and walking paths to keep you walking every day. Visit MyHeartMyLife.org to learn more about motivating yourself, friends, coworkers and family to make walking an everyday healthy activity.

We hope you will encourage and challenge (in a friendly way) everyone you know to take up a walking habit, and maybe even exchange a not-so-healthy habit for the joy and health benefits of walking every day.  The benefits to making walking part of your everyday routine are astounding ~ your heart will thank you, as will many other parts of your body!

As spring aproaches and turns into summer - weather will start to improve and the excuses will start to dissipate with the rain. We will continue all through the month to bring you healthy walking information - from what shoes to wear, to proper form for best workout benefit, to walking even with joint discomfort, in the hope that we can movtivate and move you to keep your feet moving, one in front of the other, every single day!

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.

All of us know people, or are people that spend too many hours seated in front of a computer screen in our offices.  Whether you operate in a home office or corporate setting, exercises do exist that can help retain muscle tone and help battle the forced sedentary day to day work life that can be detrimental to your health and waistline. 

HANDS AND ARMS

Arm Pump.  Be a cheer section for 1-2 minutes!  Raise your arms straight over your head and then elbows out fists toward your shoulders in a pumping motion…it’ll get your heart rate going and help keep your arms and shoulders loose.  Do this exercise with a full water bottle in each hand for additional strength training.

Tricep dips. Put your arms behind your back, gripping each side of your chair firmly at the sides – slowly raise and lower yourself using just your arm strength.  Note:  This is rather dangerous on a chair with wheels; make sure you have a chair with rubber grips on the bottom and no wheels!

Shadow Box. Also known as a great, healthy and constructive way to relieve frustration!  Stand up and take a couple jabs at the air, til you feel better.

FEET AND LEGS

Toe Raises.  Lift your toes, but keep your heels planted firmly on the ground.  This one can be done sitting or standing, and you can really feel it in your shins and calves!

Hip Flexions.  While sitting in your chair, lift your foot a few inches off the floor while keeping your knee bent at a 90 degree angle.  Hold for as long as you can, and repeat with the other foot/leg.

Football Feet.  Football players warm up and practice rapidly tapping their feet in place as fast as they can, stimulating a run.  This is great while stuck at a desk; try it for 30 seconds at a go, and see how quickly your heart gets pumping!

TORSO

Butt Squeeze.  This is a self-explanatory one….squeeze and hold your rear-end muscles for a count of ten, then release.  Do as many reps as you can.

Side Twists. To help keep your back flexible and aligned, side stretches are excellent.  Whittle your waist by engaging your core and side torso muscles by raising your arms over your head, or planting hands on hips, lean gently over to each side as far as you can safely go (without falling out of your chair!) A few times on each side and you should be able to feel it, and keep the benefits going by doing this exercise at least 2-3 times throughout the day.

Don’t worry about looking silly, and see if you can get your coworkers to participate too.  That way you can cheer, bend, leg-lift and run in place along with everyone else looking for a little extra healthy balance in their long office day!

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

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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January and February are all about eating right and exercising to either get back on track or start a new healthy lifestyle. But starting off too strong can quickly lead to burn out, especially when it comes to gym time. Here are two keys to exercising smart in 2013. This will help you to maximize your results and keep you exercising all year long.

• Walk on Non-Workout Days:
  Walking is a great fat burner. I know it doesn't feel like you're doing much because you're not working up a sweat or burning as many calories as on the elliptical. But if you're walking at a fast pace, then you should be in the fat burning zone the whole time.Try adding in an extra 30-45 minutes of fast walking on days you’re not exercising, and see if the pounds start to melt away easier than before. If you can't find the extra time in your day, try shorter bursts of walking throughout the day. Get off the subway a stop earlier for an extra five minutes of walking, or walk to the post office instead of driving. Those extra steps add up and they really do make a difference.
   
• Vary Your Workouts:
  When you do the same type of exercise over and over, your body gets used to it. Have you ever felt like you're in great shape, but then tried a new type of workout and found yourself huffing and puffing? The best way to keep your body working hard is to keep it on its toes. Try yoga one day, walking the next, and kickboxing for your third workout. Soccer players, for instance, are always doing something different. At practice, you jog, sprint, jog backwards, jump, kick, etc. Your body never gets used to what you're doing. And in keeping your body guessing, you keep your weight loss from plateauing.

If you're trying to lose weight, try working out 3-4 days a week and adding some variety to your workouts. On the other days, just walk! And remember, whether you live a very sedentary lifestyle and you're starting from square one or you work out every day, something as simple as starting to walk more can make a big difference!

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. 

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.

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.