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.

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.

Need a recipe for healthy gluten free pancakes?  Try this one!

There is nothing I like better than a lazy Sunday morning with blueberry pancakes for brunch. This recipe is simple and is my absolute favorite pancake recipe. It’s fluffy, buttery, and filling, without any of the traditional ingredients. No wheat flour, no butter, and no eggs. Yep, this recipe is gluten-free and vegan, yet tastes as good as any pancakes you’ve ever had. Don’t believe me? Make the pancakes for your family and watch as they gobble them up!

Fluffy Gluten-Free and Vegan Blueberry Pancakes

Ingredients:

1 ¼ cups almond flour

½ cup potato starch

2 teaspoons baking powder

½ teaspoon salt

2 tablespoons sugar (optional)

¼ cup unsweetened applesauce

2 tablespoons oil

½ cup non-dairy milk

Directions:

1. Whisk together the almond flour, potato starch, baking powder, salt and sugar.

2. Whisk together the applesauce, oil and milk. Pour the dry ingredients into the wet and stir until completely mixed.

3. Heat a skillet on medium and add a little oil, then cook each pancake for a few minutes per side, until browned.

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. 

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.  

Getting them active just might help you get active as well!

As we enter spring and summer seasons, here are some fun tips on using ordinary play things as indoor and outdoor toys or props to get you and your kids - or grandkids - moving and enjoying movement.

HULA HOOPS – Did you know there are many different ways to use a hula hoop to get moving? The traditional way of using your hula hoop is excellent exercise and movement. Here are some other fun ideas that will get you moving with the same hula hoop.

Inside:

• Use for target practice (wall, floor, held).

• Play musical hoops.

• Practice motor skills.

• Practice movement concepts.

• Use as personal space or “home base”.

• Use as a steering wheel.

• Play partner games.

Outside:

• Roll and chase them.

• Spin them.

• Twirl them around body parts.

• Use as target practice (tree, fence, held)

BILIBOS – The dome shaped open-ended toy that encourages imagination and creativity. It is the toy that when you saw it you wondered to yourself, “What is that for?”

Inside:

• Jump off of them.

• Spin them.

• Toss balls or other items into bilibo as a low target.

• Use as stepping stones.

• Use for scooting.

Outside:

• Use as stepping stones.

• Use as a carrying container (individual, partners, small group).

• Connect them to a rope to pull people.

• Connect them to a rope to carry loose parts, water or mud.

• Hang them from trees as a target.

• Do teamwork activities (holding hands, move the bilibo around the circle without letting go of hands).

• Use as personal space or “home base”

Remember to eat healthy snacks too!

Reference: www.beactivekids.org 

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

See where to get your next B-Vitamin Boost Here!

Feeling drained and lacking energy? Analyze your B vitamin intake.  Together, the group of B vitamins commonly referred to as the B-Complex group work together to produce energy in cells throughout your body.  Fall short of getting enough, and you may feel a lack of energy.

Though B vitamins are prevalent in a variety of foods, you may not be getting what you need if you cut out certain food groups from your diet, if you are on a low carb diet or don’t get enough variety in your diet.  There are also certain circumstances that deplete your body’s available B vitamins or that don’t allow for proper absorption, such as gastric bypass surgery, aging, alcohol consumption, excessive caffeine consumption and excessive stress.  Vegetarians and vegans typically do not get enough vitamin B12.  A B-Complex supplement is a great idea if you know you fall into dietary, circumstantial or malabsorptive reasons that your body may not be getting enough B’s.

• All B Vitamins – Fortified cereals.  Can’t go wrong here, just be sure to stay away from the sugary ones, most are good source of fiber too.
   
• Vitamin B1 (thiamin) –  Necessary for energy production.  Chronic alcoholics are most likely to be deficient in thiamin.   Top food choices: grains (cereal, bread, etc.), pork, beef, rice, nuts.
   
• Vitamin B2 (riboflavin), Vitamin B3 (niacin), and Pantothenic Acid – Deficiencies for these three B’s are not very common in the U.S.  If you consume an adequate amount of protein (vegetarian or vegans may not), you are most likely getting enough B3.
   
• Vitamin B6 (pyridoxine) – Like all B’s it helps to convert energy from the food you eat in to a usable form in your body, and it also contributes to red blood cell formation and is necessary to proper nervous system function.  A poor diet, some medications and conditions could cause a shortage of this vitamin.  Top Food Choices: chicken, pork, peanut butter, black beans, almonds.
   
• Biotin – Important to skin, hair and nails, energy conversion from food and nervous system function. Pregnant women, malnourished people and those who have lost a large amount of weight quickly can all be affected by a deficiency.  Top Food Choices: cooked eggs, wheat germ, peanuts, cottage cheese, and whole-wheat bread.
   
• Vitamin B12 – An outlier of the B vitamin group, B12 is the only one that can be stored in the body. Strict vegetarian/vegan diets run the risk of B12 deficiency since it can only be sourced from animal-based foods, as are those who have had certain kinds of gastric bypass surgery in which parts of the small intestine where B12 is absorbed have been removed.  Top Food Choices: liver, salmon, clams, trout, beef, yogurt, haddock, tuna, milk, and cheese.

What happens if you get B vitamins from food and from a supplement?  Can you get too much?

Because B vitamins are water soluble, what your body needs will be excreted, so there’s a low risk of getting too much. Look for a good liquid multivitamin or B-Complex supplement that contains at least 100% of the recommended daily intake for each vitamin. It’s the best way to insure you get all the essential vitamins and nutrients you need to stay healthy.

Learn how to snack in a healthy way!

Snacking can help keep hunger pangs at bay and contribute to your overall nutrition intake if you choose wisely. Think of a snack as a “mini-meal,” a smaller portion of something you might have at mealtime. By doing this you are likely to think of healthier foods versus “snack foods” like chips, cookies and less than healthy baked goods.

Though there are many health snack ideas, here are my top 5:

• Nuts – nuts contain heart healthy fats, fiber and an array of vitamins and minerals.

* Keep in mind that children under 3 should not eat nuts or nut butters due to the potential for food allergies. By age 3 you can introduce nuts slowly one type at a time (check with your pediatrician). Never give small kids whole nuts as they can choke on them.

• Cereal –high fiber, low sugar cereal is a great snack option for kids and adults alike. It’s portable and filled with vitamins, minerals, fiber and antioxidants. Plus, you can eat it by the handful or put it in a bowl and add some milk or vitamin D and calcium fortified milk alternative such as a higher protein soy milk.
   
• Fruit – fruit is packed with vitamins, minerals, fiber and antioxidants. Try topping cereal or yogurt with berries, serve slices of apples topped with cheese and try in season fruit like watermelon to stay cool and hydrated on hot summer days.
   
• Vegetables – start your little ones on vegetables early and they’ll develop a lifelong taste for produce. If plain veggies sound boring, add a little natural peanut butter or dip veggies in hummus or guacamole for a delicious snack.
   
• Dairy – add string cheese, yogurt and cottage cheese to your snack list and you’ll be doing your bones a favor. Dairy foods are packed with bone building calcium and some yogurts and cottage cheeses also contain vitamin D (check the label). This is especially important for growing kids who are not only growing upward but are also building bone density (we build bone density up until our early 30s).

If you are preparing snacks for kids, let them pick out a new fruit or new vegetable to try. By giving them a choice, they are more likely to dig in. Also, set a snack spot aside in the refrigerator and cupboard. Keep healthy snacks at eye level and put the less than healthy ones behind other foods in the back your cabinets and refrigerator – doing this will encourage you to reach for better options. 

Congratulations!  You've just had bariatric surgery and you're excited to get started with your new life (or you are researching for after your surgery).  Part of that new life includes exercise.  If you want to keep the weight off, you need to make physical activity a regular part of your life.  It may be one of the most important lifestyle changes you make for long-term success. Where do you start?

Start with walking a little bit at a time...

• While you are in the hospital, the nursing staff will have you up and walking as soon as possible to help with your recovery. When you get home, you may be fatigued and that is normal. You've just had surgery! While you are at home recovering, the goal is to walk every day and every day walk just a little bit further. Maybe you can only walk to the end of the driveway and that's OK. As time goes on you will be able to walk further and longer. Just keep working at it.

Download your free Beginner Walking Chart Here!

• If you like to go to the gym or have exercise equipment at home, you will be fine on a treadmill or stationary bike right after surgery. You will want to avoid the cardio equipment that can put a strain on those recovering abdominal muscles, like a rowing machine and an elliptical if you use the arm attachments. You will want to get clearance from your surgeon for swimming or other pool exercise. Those incisions need to be healed and your surgeon will give you the go-ahead when he/she feels you are ready.
   
• Strengthening exercise is crucial to maintain muscle mass but you need to allow those core muscles to heal.  General recommendations for abdominal surgery are not to lift over 10 pounds (about the same as a gallon of milk) for two weeks. In the practice where I work we also recommend no abdominal exercises (crunches) for a month. Always check with your surgeon for clearance with any activity that involves lifting or putting a strain on those abdominal muscles.
   
• Just move!  Any exercise is better than no exercise. New recommendations from the American Society of Metabolic and Bariatric Surgery (ASMBS) include a minimum of 150 minutes a week of cardiovascular exercise with a goal of 300 minutes a week, plus strength training two to three times a week. Do what you can but do something. I have patients who are running half marathons a year out from surgery and would never have imagined that it was possible before their surgery. You may never run a half marathon but I am willing to bet you will be more active, walking further, and have more energy as you travel down the road of weight loss.

Be sure to take your supplements each and every day to help keep your energy levels up as well as getting enough protein.  B vitamins are especially helpful for energy and even help metabolism.  

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Liquid Supplements Bariatric Expert

Part 3 of our Buying Local Series - read Part 1 and Part 2

Buying local has become a term we are all getting used to as we become aware of the personal, community and economic benefits of choosing locally owned businesses first. What better way to support your local economic climate than supporting your local farms. If you are not a dig in the dirt and a get your hands dirty gardening type then how about supporting a local CSA Program through a local farm near you?

Community Supported Agriculture or CSA

CSA stands for Community Supported Agriculture. Purchasing locally grown produce and other farm products gives the consumer fresher, tastier and more notorious food while supporting your local economy - buying direct from local family farms and supporting their business and investing in your community.  Here are the basics:

• A farmer offers a certain number of "shares" to the public.
• Typically the share consists of a box of vegetables, but other farm products may be included.
• Interested consumers purchase a share (aka a "membership" or a "subscription") and in return receive a box (bag, basket) of seasonal produce each week throughout the farming season.

Support of Local Farmers & Community

With the CSA model you are directly supporting the success of the farm.  When you purchase your farm share at the beginning of the season you become a shareholder in that farm, the farmers can invest the money in the growing season and it fosters the idea that “we are all in this together.” Since the first CSAs started in 1986, more than 2,500 have sprung up across the country, their memberships numbering in the tens of thousands, according to www.localharvest.org. With their increasing popularity, many farms offering a CSA program have waiting lists.

By being involved in a CSA program you support the farmer, but you also accept some of the risks of farming. If the weather doesn’t cooperate and a crop doesn’t do as well, there will be less for the shareholders. But if the harvest brings in an abundant crop of a certain item you will receive more than normal amounts of that one item.  The CSA model helps connect the farmer and the shareholder by encouraging the idea that “we are all in this together”.

Learn to cook and eat new foods

I have personally been involved in a CSA program for the last 6 years. I can’t wait for “sign up” season every year. I can visualize my beautiful box of nature’s bounty as I open it up and see all the beautiful vegetables and fruit my local CSA offers. I look at it as a privilege for my family to receive such wonders from our local farm land. We don’t currently have our own garden so this option allows us to eat fresh, local and teach our daughter about supporting local farms. We learn to cook with new items that arrive in our box and explore new recipes for items we never purchased at the local supermarket before becoming involved in a CSA.

Every CSA program is a bit different in choices or selection, delivery and payments.

• Some CSA programs allow you to pick up your farm share at their farm once a week or from a drop-off pick up site, delivery of your farm share can be to your door, or a “Market basket” option where you pick up your share or select your share from the weekly local farmers market.
• A newer option is the workplace CSA option. With this option you sign up for your shares with a handful of coworkers and the farm delivers all the shares to your workplace once a week. This economical option allows for the workplace staff to conveniently pick up their share at their workplace and allows for the farm to deliver multiple farm share boxes to one site for pick up.
• Many CSA’s are even offering options and add-ons that include more than seasonal vegetables such as, meat, eggs, dairy products, flowers, fruit, bread, pasta and coffee.

Make sure you have realistic expectations and an open mind

For some people, belonging to a CSA has become the “in” thing to do. But before you go CSA shopping, make sure your expectations are realistic. Remember the risk-sharing aspect of a CSA: You might pay your CSA share in January and, depending on the weather, might not get in return the quantity or variety you expected. You will be eating seasonally so if eating something new isn’t something you like to do then you will want to search out a CSA that gives you the option of picking the selection you want or one that allows you to have “farm credits” and pick out your produce at the local farmers market.

In addition, produce from an organic-minded CSA doesn’t always look as picture-perfect as that on the grocer’s shelves. If you’re put off by a blemish on a tomato or by carrots that aren’t uniform in size, a CSA might not be for you. Buying produce from a CSA isn’t the same as going to a Whole Foods Market and picking the best of everything. Blemishes aside, if you’re seeking a diet with a smaller environmental impact, you’re up for a little culinary adventure and you are ready to taste some of the best fresh local produce - CSA membership is a great local alternative.

CSA's benefit the community by helping to ensure the survival of small farms — and thereby a local supply of food — at a time when local farmers face increasing competition from supermarkets.

To find a CSA near you visit http://www.localharvest.org/csa/.

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.

There is a fair bit of conventional wisdom about how much vitamin D your child might need, and where they will get it. Primarily, that vitamin D levels will take care of themselves as long as children play outside to get sun exposure to some degree and drink milk regularly.  Surprisingly, this isn’t necessarily true. 

“We’re seeing evidence of vitamin D deficiency in infants and children of all ages as well as adolescents and adults,” says Carol Wagner, M.D., FAAP, professor of pediatrics at the Medical University of South Carolina. “We know more about vitamin D than we did even five years ago. Because of lifestyle changes and sunscreen usage, the majority of the population shows signs of deficiency as determined by measured vitamin D levels in blood.”

Vitamin D helps calcium absorb and helps your body retain calcium and phosphorus, both critical for building bone.  Vitamin D is important at all stages of life, but especially as children grow.   For more information on how vitamin D3 works with other vitamins in your body, check out this article.

To meet the new 400 IU recommended daily intake for vitamin D, it helps to know what foods at snack and meal time can help add an extra kick to any Vitamin D supplement you or your children may already be taking. Vitamin D₃ is the preferred form when supplementing for optimal bioavailability, but it also helps if you can get your kids involved and be creative with the food choices you offer.

Think Presentation - Food presentation makes a big impact on kids.  Make healthier snacks, more fun by creating shapes, arranging by color or spelling words or initials with the food you offer.  A cute idea to add more vitamin D containing egg yolk or oily fish would be egg salad or tuna salad sandwiches, cut into stars or other fun shapes.

Be Prepared - Being on the go or traveling can really limit healthy options, so be prepared in the car with things like vitamin D fortified cereal bars and individual servings of fortified orange juice.

With a little planning, the vitamin D your kids need can come from a combined one-two punch of a quality supplement and fun vitamin D packed snacks and meals, making the risk of deficiency much less of a worry.

ref. http://www.healthychildren.org/English/healthy-living/nutrition/pages/Vitamin-D-On-the-Double.aspx

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.

Looking for a tasty new way to take your daily multivitamin?

With Wellesse Liquid Multivitamins, you can get creative with your daily multivitamin. This simple vegetable juice gives you an extra boost of beta carotene from the carrots while the ginger soothes your stomach. Add your multivitamin and a few drops of stevia for extra sugar-free sweet flavor, then mix it all with sparkling water to create a rich and creamy drink reminiscent of a carrot cream soda. Except this time it’s good for you!

Multivitamin Packed Carrot Cream Soda

Ingredients: 
3 carrots
1 1-inch slice of fresh ginger
1/2 cup sparkling water

2 tablespoons Wellesse Liquid Multivitamin
5-10 drops liquid stevia

Directions:

1. Juice the carrots and ginger. Add more or less ginger depending on your personal preference. Ginger has anti-inflammatory properties, so I use more when I have a headache. 
2. Stir in the sparkling water and stevia. Add ice if desired. 

Serves 1

For another great way to take your liquid multivitamin try making your own Vitamin Water here!

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. 

Why adopt a walking program?  Aside from numerous health benefits:

·         Its free!

·         No special equipment is needed

·         Its adaptable to most all fitness levels

·         Its low-impact

All month long we will be taking a more in-depth look at the benefits of starting a walking program.  To get you started, here is an example of a Beginners Walking Program.  It outlines a way to work your way up to top energy expenditure in a healthy, natural way.

How much a person exercises in terms of energy spent, not how long he or she spends exercising, is ultimately what matters.

People who exercised equally in terms of energy output got the same benefit, regardless of whether they ran or walked, Williams and Thompson report in the American Heart Association journal Arteriosclerosis, Thrombosis and Vascular Biology.

“A person would need to walk 4.3 miles at a brisk pace to expend the same amount of exercise as running 3 miles, and it would take about twice as long (an hour and 15 minutes by walking instead of 38 minutes by running),” Williams says.  

So even though walking might take a little longer, it still exhibits the same viable health benefits as running, and is much more widely adaptable to a larger range of fitness levels and abilities.  Try it ~ such a simple think like walking just might change your life!

When I hear people say they need to get back on track or get refocused, my first recommendation is to start tracking food intake. But recording isn't just for those folks, it plays an important part in your diet progression right after surgery too.

There is so much research on the benefits of recording to prove it makes you more successful, and if you've kept an honest record, you know this to be true. Notice I said an honest record. I've had people tell me they don't record "the bad stuff".  It's not calorie-free because you didn't write it down or had selective amnesia.

1.  Track Protein Intake as well as Calories

Many people think the most important thing to track is calorie intake, and for some people, it is. But after bariatric surgery, it's equally important, if not more important, to track your protein intake. Recommendations vary depending on your surgeon, but typically the goal is 60-90 grams of protein a day. This can seem daunting in the early post-operative stages if you've had a gastric bypass or sleeve. This is a time when it is critical to track your protein intake. Further out from surgery, it might be more important for you to know where your calories are coming from: the distribution between protein, fat, and carbohydrates.

2. Use Easy Electronic Tools to Track

There are different tools to track your intake. Paper and pencil is better than nothing but to have any sort of meaningful analysis you have to look up your foods for their nutrient value. Let technology do the work for you. All you need to know is what did you eat and how much, and let technology figure out the rest. In a study presented at the American Heart Association meeting last year, a group of 210 obese adults tracked food and activity intake with either a handheld electronic device or a paper diary. Those who used an electronic device had significantly more weight loss than those using a paper record.

Most of us have cell phones and 15 percent of us have a health app for our Smartphone. There are also online programs like WebMd and Spark People and 27 percent of internet users track weight and fitness goals online. If you have looked at using an app or an online program you know there are a multitude of choices. So, how do you pick the best one for you?

3.  Know what you need to track

There are many free programs available or apps that are a minimal investment. You will need to know what is important for you to track. Are you good with the basics of calories, protein, fat, carbs, and exercise or do you want more detailed information to include fiber, sodium or other nutrients? Read the reviews, comments, and look at some sample pages. Most programs allow you to enter custom foods or labels, but a feature I find helpful is the one that allows me to enter a meal. For example, when I make a leafy salad I usually use the same veggies. I entered my salad into my meal program as Vicki's Salad. Now when I eat it, I can just enter Vicki's Salad rather than spend the time entering each salad component.

4.  Take the time to set it up right for most accurate tracking

It may take a while for you to be comfortable with the program or app you select. Initially you will be spending more time recording as you enter your custom foods. If you don't like the program after a few days or a week, it's easier to switch to another before you get too many of your custom foods entered. If you have a lot of time invested in setting up your database, you will be less likely to switch and if you don't like the program, you will be less likely to use it. Keeping track with technology isn't time consuming after you've got your custom foods and meals entered. You should be able to track your food and activity in less than five minutes a day. Recording as soon as you have eaten something makes it easier than trying to remember at the end of the day and you will less likely to forget what you ate.

It's also a great idea to track when you take your supplements especially those that you need to take more than once such as calcium.  
Set a reminder on your phone to help remember or use a post it note if you don't have a smartphone.  

Whichever program or app you settle on, just use it. Remember, research continues to show that people who record are more successful.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Nutrition Expert

Here are a few apps to try and most have fitness trackers as well:

Spark People Diet and Food Tracker

MyNetDiary Calorie Counter

MyFitnessPal

WebMD Tracker

Shroomies Nutrition Menu

www.MyFoodDiary.com

Resources:

Pew Research Center, Pew Internet & American Life Project. (2011). Half of adult cell phone owners have apps on their phones. Retrieved from www.pewinternet.org

Styn M. Et al. (2012, March). Overweight, obese adults use electronic device to stick to diet, exercise. Meeting report presented at American Heart Association scientific meeting.

Is motivation like an on/off switch for you?  Do you perceive that you are either motivated or you aren’t? Perhaps it’s time to take a look at that way of thinking, and exchange it for a more comprehensive, holistic view of how motivation fluctuates in daily life.

Think of it like a fuel gage – your car never runs at a full tank all the time does it?  It fluctuates based on how many miles you’ve driven, what kind of driving you’ve done, and how many times you’ve filled it up on the trip.  Motivation works the same way.

Joshua C. Klapow, Ph.D., a clinical psychologist at the University of Alabama at Birmingham and author ofLiving SMART: 5 Essential Skills to Change Your Health Habits Forever. "I tell people not to waste precious time and energy on staying highly motivated because motivation has a natural rhythm. Most people see a drop in motivation as a signal of failure, but it's not," he says.  Allowing motivation to run its natural cycle and at the same time having a set of habit-changing lifestyle skills (such as a meal plan for the week, or various indoor/outdoor, home/gym alternatives to exercise), you'll stay on track until the next upswing in motivation comes back around.

INSTANT INSPIRATION

POP QUIZ YOURSELF.  You can plug in any behavior that requires you to stay motivated.  "Answering these questions often helps to boost motivation just enough to remind you of why you started the diet in the first place," Klapow says.

If I stop, how will I look in six months or one year from now?
If I stop, how will I feel in six months or one year from now?
If I stop, what will my health be like?
If I stop, how will my family and friends be affected?

DIVERT TO OTHER POSITIVE ACTIONS.  If you're struggling to stick with your original healthy intentions, practice integrity in other areas of your life, suggests Andre Farnell, a certified strength and conditioning coach and owner of Better Body Expert. Clean out your closet (finally), pay off a debt, and make good on other promises to friends, family, or co-workers. Practice sticking with commitments you've made in other areas of your life in order to strengthen your own subconscious belief that you are able to uphold the promises you've made to yourself, Farnell says.  Once you strengthen that subconscious belief in your own abilities to follow through in other areas, motivation is bound to swing back around to the healthy commitments you’ve made to yourself.

FOCUS ON FEELING.  Don’t sabotage your motivation by focusing on hard facts like body pounds, food ounces or days/hours in the gym, says Simon Rego, Ph.D., director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York. Concentrate on your mood after you've eaten a healthy meal or how you feel after a great workout—motivation doesn't always have to come before you accomplish an activity, Rego says. "If you focus on how you feel each time you exercise, you'll get all the benefits of burning calories, plus the reinforcement of remembering how good it felt to do it, which should increase your motivation to do more."