If you have had occasional heartburn, you know how uncomfortable it can be, and about 20% of Americans experience heartburn at least once a week.

People who experience chronic heartburn may have GERD, or gastroesophageal reflux disease, often called acid reflux. This reflux is caused by stomach acid that flows back into the esophagus. Over a period of time, complications from chronic reflux can lead to complications with swallowing and increase the risk for esophageal cancer.

Nearly all studies conducted have found a relationship between obesity and GERD. The increased incidence of GERD and excess weight is believed to be caused by excess belly fat putting pressure on the stomach, and the higher the weight, the more likely one is develop GERD. Treatment for GERD includes lifestyle changes, medication, and/or surgery.

An effective treatment for GERD is lifestyle modification includes:

·         Weight loss

·         Increased physical activity

·         Eliminating foods that typically cause reflux such as; alcohol, caffeine, chocolate, fried foods, spicy foods, cooked tomato sauces, mint, an carbonated beverages

·         Eat smaller meals

·         Don't lie down 3 hours after eating

Digestive Problems? Take These 10 Steps

Your doctor may also recommend medication, either by prescription or over-the counter. And if you are obese, your doctor may recommend you have bariatric surgery to resolve your problem.

Roux-en-Y gastric bypass surgery has been consistently shown to improve GERD symptoms. At this time it's not clear if the improvement is due to weight loss or related to the actual surgery itself which creates a pouch. Adjustable gastric banding may or may not improve GERD so many surgeons do not recommend this procedure because of conflicting data and outcomes. A more recent surgery, the gastric sleeve, has little long-term data on the improvement of GERD. The long, narrow pouch may actually worsen or cause reflux. For this reason, if someone has GERD a sleeve should be done with caution.

The best treatment for you is the one you discuss with your physician, and after weighing your options, you both agree to a remedy that meets your health needs and fits your lifestyle.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Bariatric Expert

Vitamin and Nutrition Management Vital After Bariatric Weight Loss Surgery

Resources:

Friendenberg, F., Xanthopoulous, M., Foster, G., & Richter, J. (2008). The association between gastroesophageal disease and obesity. Am Jour of Gastroenterology, 103, 2111-2122.

Kushner, N. & Kushner, R. (2012). Obesity & heartburn: What is the link?. Your Weight Matters: Obesity Action Coalition.

Prachand, V., & Alverdy, J. (2010). Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery?. World Jour of Gastroenterolgy, 16(30), 3757-3761.

Men take note! It’s your turn for a focus on preventive care and healthy lifestyle planning.  June is National Men’s Health Month.  This is a perfect chance for you to become aware of the health risks specific to men, and get support from your family and friends to pursue any testing or treatment you may have been putting off.  Your health and wellness is just as important as your female counterparts, so investigate your resources and start taking care of yourself the way you deserve.

“The purpose of Men’s Health Month is to heighten awareness of preventable health problems and encourage early detection and treatment of disease among men and boys.   This month gives health care providers, the media and individuals the opportunity to encourage men and boys to seek regular medical advice and early treatment for disease and injury.”  Check out the organization website for more info. www.menshealthmonth.org

 They have a handy screening checklist (Click here to view the list), page two shows what and when men should have checked, taking the guesswork out of preventive care issues like prediabetes.  Check out this article on preventive care Easy Steps for Prediabetes Proactive Care.  

The Mayo Clinic is also involved in helping men assess and be proactive about common health risks – Take a look at their Top 7 Threats to Men’s Health article here. 

All men, and everyone truly, should start with the basics of a healthy lifestyle — eat a healthy diet, stay physically active, quit smoking if you haven’t already, get regular checkups and keep safety top of mind in your daily activities.

Have Celiac or Gluten Intolerance?  You are not alone!

Learning that you have celiac disease or gluten intolerance may feel at first, like your world was turned upside down. If you are the only one in your family that needs to shift their diet in a new direction, you may begin to feel very alone.  The good news is that you are not alone, there are many people just like you, and connecting to this community of people can provide you with a strong sense of support as well as many new friends you can relate to. Support can be found in and outside of your home, you’ll just need to be proactive in finding it.  

Follow these tips to help you find the support you need (and deserve) in your journey.

·        Connect with the gluten free community online.  Seek out Pages, Groups and more on Facebook.  Participate in discussions, read other peoples stories, and share your own. 

·        Join community discussions on twitter using the hash tag #glutenfree

·        Follow gluten free blogs – you may be inspired by new recipes, and the stories they share. Don’t be afraid to reach out and connect to these bloggers through comments and on their social media pages. In most cases they will love to converse with you!

·        Follow the social media of your favorite gluten free food and product companies. Their pages will be full of conversation and activity. The Wellesse page is a great spot to connect with others!

·        Connect with your local celiac and or gluten intolerance group- and volunteer to get involved. This will give you the opportunity to make new friends locally.

·        Find a skilled and understanding doctor that takes every one of your symptoms seriously.  A doctor that brushes symptoms off is not worth spending time or money on.

·        Support celiac research- volunteer to participate in walkathons etc. for the cause. Through this process you will have the satisfaction of doing a good deed and will connect with others living with the disease.

·        Try out gluten free restaurants with friends and family.  This will allow you to enjoy your meal, while also spending time with those you love.   Tips To Safely Dine Out Gluten Free

·        Be honest. Tell your friends and family about the disease. Help them understand what happens to your health if you consume gluten.  With education and understanding of the disease they will naturally want to support you in whatever ways they can.  

·        Travel to gluten free expos-you may discover new gluten free products and make new friends!

·        Start a gluten free cooking club.  Invite friends over once a month and have each person bring a gluten free dish OR make a meal together.

·        Attend gluten free cooking classes.  Learning new skills will augment your confidence to make and enjoy delicious food that works within your diet.

·        Teach your family how to read food labels and shop for your favorite foods.  There will be times when you may need someone to pick something up for you at the store. If you teach your family in advance what foods are safe to buy, they will better be able to support you when you need a favor.

·        Teach your significant other and children how to make basic staple foods so that they can cook for you sometimes too!

·        Make your families favorite meals gluten free and you will discover they will become highly supportive of mealtime again without complaints.  This may seem like more work for you up front, but the truth is that it will make your life easier on the back end.

·        MOST importantly: Be Kind to Yourself – Don’t beat yourself up, get discouraged or expect perfect health at first.  You have the potential to be your own biggest support and worst enemy.

Need Information? Here are the Top Celiac and Gluten-Free Resources

Gluten Sensitivity vs. Celiac Disease – What’s the Difference?

Celiac Disease and a Gluten Free Diet - Watch for Nutrient Deficiencies in Both

Blog post by guest blogger, Brittany Angell, of www.realsustenance.com and author of "Essential Gluten Free Baking Guides Part 1 & 2". 

What is a Workplace Wellness Program? 

Wikipedia tells us that Workplace wellness is any workplace health promotion activity or organizational policy designed to support healthy behavior in the workplace and to improve health outcomes. Generally speaking, health promotion is defined as "the process of enabling people to increase control over, and to improve their health,"^[1] and health promotion can be carried out in the workplace as well as many other settings. Known as 'corporate wellbeing' outside the US, it consists of a variety of activities such as health fairs, health education, medical screenings, health coaching, weight management programs, wellness newsletters, on-site fitness programs and/or facilities and educational programs.

Workplace wellness includes organizational policies designed to facilitate employee health including allowing flex time for exercise, providing on-site kitchen and eating areas, offering healthy food options in vending machines, holding “walk and talk” meetings, and offering financial and other incentives for participation, among many other options. Workplace wellness has been expanded over the past decade to encompass the overall creation of a “culture of health” within the worksite.^[2]

A Win-Win for Both Employees and Employers

A Workplace wellness programs not only help employees embrace a healthier lifestyle – they also benefit the businesses that put them in place.  There may be many reasons why you would sign up and get involved in a workplace wellness program; but the bottom line is if the incentives they offer help motivate you, then you will experience better health because of the program.

Better health can mean a higher level of energy, creativity, commitment and better mental outlook. This can contribute to a happier outlook, less sick days, less doctor visits, etc. 

Workplace wellness programs can help you get healthier, even if that simply means learning how to reduce stress and muscle strain when you are on the job. Depending on what your company offers, it might also help to lose weight, lower your cholesterol and blood pressure, sleep better, and save money on prescriptions. Sometimes, all you need is a little motivation to get the ball rolling and a workplace wellness plan might be it.

Teamwork

Another great benefit of wellness programs is a built sense of camaraderie with your co-workers. You’ll have a chance to experience activities with them that aren’t related to work, whether in a walking club or sports team, by having lunch together, or by going to the gym. Social support is a very important part of weight loss and getting fit. By interacting with co-workers, you’ll have others to give you encouragement when you need it, as well as to hold you accountable to your goals. Plus, you’ll be motivated by seeing other’s positive results. By using a wellness program, you’ll be an important part of the team.

Personal benefits may include:

·         Weight reduction

·         Improved physical fitness

·         Increased stamina

·         Lower levels of stress

·         Increased well-being, self-image and self-esteem

Company benefits:

·         Enhanced recruitment and retention of healthy employees

·         Reduced healthcare costs

·         Decreased rates of illness and injuries

·         Reduced employee absenteeism

·         Improved employee relations and morale

·         Increased productivity

A U.S. Department of Health and Human Services report in 2002 revealed that at work sites with physical activity programs, employers have:

·         Reduced healthcare costs by 20 to 55%

·         Reduced short-term sick leave by six to 32%

·         Increased productivity by two to 52%

But there are also direct, work-related advantages for employees and employers. More than half of program participants reported that wellness benefits encourage them to work harder and perform better. In addition, 59% credited their participation in a wellness program with giving them more energy to be productive at work. The survey also found that 43% of employees reported missing fewer days of work because of their participation.

Exercise for Healthy Bones

Exercising You Way to Heart Health

So, how about strapping on that pedometer and just see how far you walk in a normal day and if the steps are not enough then getting out there and start moving more!  If your company offers a Wellness program then you should seriously consider enrolling.  If it doesn't’t, how about raising the question to your HR Department about starting one? How many of you participate in a Wellness Program? Leave us a comment after this blog and let us know your thoughts.

Guest blog post by Lori McKnight, B.A., busy mom and wife who enjoys living in the Pacific Northwest and has been a health and wellness advocate for many years.

Sources:

www.Wellnessproposals.com

http://wellnessproposals.com/guide-to-worksite-wellness-programs/benefits-of-worksite-wellness-programs/

http://www.sparkpeople.com/resource/wellness_articles.asp?id=246

http://hr.blr.com/HR-news/Benefits-Leave/Employee-Wellness/Workplace-wellness-programs-benefit-employee-reten

The conditions known as osteoporosis as osteopenia (“osteo” means bone) indicate that bones have become weaker. Often, both conditions are “silent” and without warning signs until you experience a bone fracture, neck or low back pain, bone pain or tenderness or stooped posture. 

According to the World Health Organization, osteopenia means bone tissue has lost minerals that make it hard and is therefore less dense and weaker (as measured by DEXA scan - dual energy x-ray absorptiometry, a test that uses a low dose x-ray to measure bone mineral content). Osteoporosis is a disease that happens when significant bone density is lost and bones therefore become weak and prone to breaking even from a minor fall or bump. Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis.

How can you prevent osteopenia and osteoporosis? Talk to your physician to see if you should get a DEXA scan and blood test for vitamin D. Also, be sure to meet the Recommended Dietary Allowance for calcium for your age group. If you are between 19-50 years old you need 1,000 mg per day. Men ages 51-70 also need 1,000 mg per day whereas women over the age of 51 need 1,200 mg calcium per day. How do your foods stack up for calcium content? Check out the calcium content of foods here. Adults ages 19 - 70 need 600 IU vitamin D per day those over 70 years old need 800 IU per day. Few foods have vitamin D in them. Check out a list of vitamin D rich foods here.

Treatment for osteopenia and osteoporosis often includes calcium and vitamin D supplements, weight bearing exercise (see a related article here Improve Bone Health with Liquid Calcium Supplements) and possibly taking prescription medications for bone density.

References

Rev Endocr Metab Disord 2010;11:237-51.

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.

Though you may think your bones are just a hard and dormant support structure for your body, they are actually  dynamic, growing tissue with new bone constantly replacing old bone. How can you keep your bones strong over time?   Feed them the right nutrients and engage in regular weight bearing physical activity.  Strong bones help protect your organs from injury, allow your body to move and support good posture. 

 Several vitamins and minerals are important for bone health. However, the top two that provide the most impact  are calcium and vitamin D. Calcium, the primary mineral found in bone, contributes to the strength and hardness of bone tissue. Over time, inadequate calcium intake can lead to weak, porous bones.

National survey data shows that many Americans are not getting enough calcium in their diet.  In women ages 19-30 and 31-50 only 28% and 33% are getting above the Recommended Dietary Intake (RDI) set for calcium. The best dietary sources of calcium are dairy foods and fortified nutritional foods such as protein shakes. Green leafy veggies also contain calcium but in very small quantities. For instance, 1 cup of broccoli contains only one-sixteenth of the recommended intake for the average adult aged 19-50!   So eat broccoli too, but be aware of the proportion of calcium coming from it versus other foods and take a calcium and vitamin D supplement if your doctor recommends it. Click here for an additional article about the benefits of calcium and vitamin D supplementation.

 Vitamin D helps your body absorb the calcium you consume. Most of us aren’t getting enough vitamin D either, which has set the stage for a vitamin D insufficiency and deficiency epidemic in this country. Few foods contain vitamin D. Most milk is fortified with it and it is also fortified in some brands of orange juice, yogurt and breakfast cereal. Egg yolks, liver and some types of fish naturally contain vitamin D. 

 In addition to eating a nutritious diet packed with calcium and vitamin D, everyone needs regular physical activity including resistance training (strength training) and weight bearing exercise. Lifting weights, rock climbing, gymnastics, running and walking are examples of activities that help build bone strength. If you choose to run or walk, be sure to lift weights for your upper body too so you build those bones as well.

 References:

Calcium and Bones. NIH.

What We Eat in America, NHANES 2005-2006.

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.

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.

Obesity can take a toll on the body, increasing a person’s risk for heart disease, certain types of cancer, fatty liver disease, osteoarthritis and many other diseases. And, to add insult to injury, obesity appears to launch an attack on the body’s defense network, the immune system. And, this attack appears to be multifaceted – there are several ways in which obesity may negatively affect the immune system, some of which haven’t been totally elucidated just yet.

Vitamin D Deficiency Link

• First, obesity is a contributing factor to vitamin D deficiency – a vitamin that has several effects on cells in the immune system. Vitamin D doesn’t just alter immune responses but a deficiency in this vitamin is associated with increased autoimmunity and an increased susceptibility to infection. Yet a recently published study found every 10% increase in BMI was associated with a 4.2% drop in vitamin D in the body. And therefore, monitoring vitamin D status in people who are overweight and obese may be critical for also maintaining a healthy immune system.
   
• Obesity also decreases the body’s production of specific immune system cells while altering the functioning of others. Is this due to vitamin D deficiency? This part of the picture isn’t quite clear. And, factors that can contribute to obesity – including over consumption of fat, sugar and calories can increase both inflammation in the body and oxidative damage to cell membranes (healthy cell membranes are critical because they are like gate keepers regulating what molecules can pass into and out of cells and therefore).

Given the impact obesity has on the body’s defense network, it shouldn’t come as much of a surprise that research often shows obese hospitalized patients are more likely to develop secondary infections and complications.

If you have pounds to lose, don’t fret. Start by cutting down on sugary snacks, baked sweets and fried foods. Add vegetables to every lunch and dinner and fresh whole fruit to your breakfast. In addition, drink at least 8 glasses of calorie free fluid per day and get exercising. If you don’t exercise now, start by taking the steps instead of the elevator everywhere you go and take the long route when possible (park far from the store entrance for instance). Build up your exercise routine slowly (by 10% per week) to give your body time to adapt and minimize the likelihood of developing injuries.

If you have struggled with your weight for many years and still unable to lose the weight you need to for your health, consider weight loss surgery.  Talk with your healthcare professional about the options available to you.  Bariatric Weight Loss Surgery can be the needed tool for those who are obese and are unable to lose the necessary weight.  It can be a critical step towards a healthier, longer life.

Keep in mind that malnutrition and deficiencies can occur even if you are overweight, due to poor diet and/or inability to absorb enough nutrients from food.

For those that have already had bariatric surgery, be sure to always take your recommended bariatric vitamins and supplements for the rest of your life to protect against deficiencies such as vitamin D and calcium for immune and bone health.  Vitamin D is very important for the absorption of calcium for strong bones to prevent osteoporosis.  Make sure to get your blood levels tested regularly.  

References

PLOS Medicine 2013;10(2):1-13.

J Clin Invest 2003;112:1796-1808.

J Investig Med 2011;59:881-6.

Clin Exp Immunol 2006;146:39-46.

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.

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.