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.

Your bones are alive!  Many people don’t realize that bone tissue is constantly shifting between breaking down and re-building. Most of the adult skeleton is replaced about every 10 years. If this were not so, a broken bone would never heal. The down side to this remodeling process is that as we get older the cells that break down bone tissue start to work at a faster rate than those that re-build it. This can lead to a serious bone loss disease known as osteoporosis.  Women typically experience this progressive condition with the onset of menopause (50+). Men maintain stronger bones for longer but can also experience severe bone loss later in life (70+).

So what can we do to help keep our bones healthy? 

Weight bearing and strength training exercise along with proper nutrition and supplementation are weapons we can use in the fight against these diseases.  Let’s review what is considered weight bearing and resistance exercise and then I will give you a few easy things you can do throughout your day to keep your bones stimulated and shifting in the right direction.

Bone Strengthening Exercise 

Bone strengthening activity is any activity that forces muscles to pull or tug on the bones with some force or load.  This can include weight-bearing activities, like walking, jogging and jumping as well as strength training exercises. One thing to keep in mind is that the stimulation of bones is joint specific. Thus, you must direct these forces towards the different parts of your body; making sure to balance the exercises that target your legs and hips with those for your shoulders, arms and spine. See this article, for more specifc joint exercise tips. Exercise Do’s and Don’ts … on a Joint-by-Joint Basis

Here are a few easy ways to stimulate your bones throughout the day with nothing more than a stable wall space: 

1.      Heel Drop: After a leg warm up (i.e. marching in place or going for a short walk), stand tall facing a wall with your hands lightly supported on the wall for balance.  Engage your core muscles (chest lifted, shoulders back and down, waistline pulled inward and pelvic floor lift). From this position lift and drop your heels down in a light bouncing action for 30 seconds (15 to 30 reps). To advance this exercise you can add a light jump off the floor. Stretch the calves as illustrated after completing the drops.       

2.      Push-Away: Face the wall and place hands in push up position on the wall. Bend your elbows and lower your torso towards the wall.  Push off the wall slightly the catch yourself back against the wall. Increase the intensity of this exercise by inclining the body to a greater degree.  Repeat this push and catch action for 30 seconds (15 to 30 reps).     

3.      Shoulder & Spine Press: Stand or sit with your backside against the wall (head, shoulders, hips). Position your arms in a ‘goal post’ position. Inhale deeply and as you exhale press your arms and spine into the wall.  Modify by placing hands down at your sides and lowering the hips. Hold that position for 30 seconds (3 to 5 deep breaths).   

*Always check with your physician before beginning a new exercise program and warm up your muscles prior performing strength specific exercises.

In some ways medicine seems so advanced. In other ways, medical science is still in the beginning stages of discovering the big picture of how our body uses nutrients and how they all interact in our bodies. There are so many little components and processes that haven’t been completely explored, and many that cannot be directly observed.

Nothing works in isolation in our body. Identifying all of the processes one antioxidant or nutrient is part of or responsible for is an incredibly difficult task. Add to that the physiological differences in every unique human body and we are left making healthy decisions using general guidelines and recommendations rather than hard numbers.

To figure out what levels of any nutrient, dietary supplement or food may be best for you given your health status, activity level, current dietary intake and goals, it is important to sit down with a registered dietitian (RD) who specializes in your area of need or type of goal. If you want to lose weight, go to someone who specializes in this, if you have Type 1 diabetes and you are an athlete, go to a RD who works with diabetic athletes. There really is no substitute for a thorough analysis, including laboratory tests of existing nutrient levels that can then be integrated into a specific diet and supplement plan to get you on the right track to a balanced, nutrient-rich body.

Following the general guidelines is a good place to start, if you don’t feel a full nutrient-by-nutrient workup is in order. Recommended Daily Intake values for common vitamins and minerals are in most retail brands.  Be sure to check the brand out thoroughly though, so you know you’ve picked a quality brand that uses quality ingredients.

As always, the type of supplement you choose should depend on personal preference and compliance – what will you continue to take on a regular basis. Because, after all, if you don’t continue taking it regularly, there’s really no point in buying it to begin with!  If you are tired of swallowing yet another pill, try taking liquid supplements instead.  It does make taking your essential supplements each day a little easier, and the quality of ingredients tends to be higher grade in order to make them work well in liquid form.  Plus, they’re easy to mix into protein shakes, morning smoothies, or to take as a straight shot!

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

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.

(Getting them active just might help you get active as well.)  Read Part 1 Here

In Part 2 of getting active with your kids or grandkids, let’s explore two more items that might be sitting around.  Here are some fun tips on using these ordinary play things as indoor and outdoor toys or props to get you moving and enjoying different forms of movement.

2 PERSON PARACHUTE – Remember the wonder as a kid with a parachute? Maybe it was in a class at school or at home. There are so many fun uses for a parachute that create lasting smiles and activity. If you don’t have a parachute try using a big sheet and get some of the same effects. 

Inside:

•        Create a tent, cave or fort.

•        Use as a target or backstop.

•        Use as a ball retriever/return.

•        Pretend it is a popcorn maker or pan and use to make food.

•        Define a space to perform locomotor movements around the parachute (walking, running, leaping, swimming motions, sliding, flying movements, hop.)

• Find out how many (stuffed animals, children…) can fit under, around or on the parachute.
   
• Experiment with light/heavy and big/ little things to bounce on the parachute.
   
• Use it to practice movement concepts such as body awareness, space awareness, effort awareness, and relationship (examples; directions, pathways, speeds, levels.)

Outside:

•        Use it as a sail on a ship.

•        Define a space to perform locomotor movements around the parachute (walking, running, leaping, swimming motions, sliding, flying movements, hop.)

•        Use as a kite to catch the wind.

•        Collect loose parts and carry them around.

•        Use as a privacy barrier.

•        Use as a target or backstop.

•        Use it as a ball retriever/return.

•        Use as a hammock.

•        Use as a sled.

•        Create a tent, cave or fort.

•        If you have more than one child, try the classic parachute dome - everyone grabs a hold of the outside edge of the parachute and quickly moving it up over your heads and over your bodies so you all end up in the center while the parachute is still up over your heads and behind your backs on the ground.

JUMP ROPES

Inside:

•        Use to hang targets.

•        Create shapes (letters, circles, square, body image, etc).

•        Place one or more on floor and practice motor skills.

•        Suspend off the ground and practice motor skills.

•        Practice movement concepts.

•        Pretend to take the dog for a walk and this is your leash.

•        Use it to play limbo.

•        Use to hang sheets over to create a fort, tent or tunnel.

Outside:

•        Practice individual or partner jumping.

•        Tug-o-war.

•        Practice skipping and jumping over the rope.

•        Pull other objects.

•        Use to hang targets.

•        Place one or more on the ground to practice motor skills.

•        Suspend off the ground and practice motor skills.

•        Use it to play limbo.

•        Use to hang sheets over to create a fort, a tent or tunnel.

Reference: www.beactivekids.org

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.

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.  

There has always been a lot of buzz surrounding antioxidants. Antioxidants are compounds that can potentially protect the body from free radical induced cell damage, compounds that are produced in the body when we eat, when we are exposed to UV rays, cigarette smoke and pollution for instance. And though free radicals aren’t always bad, free radical damage  contributes to aging and may impact the development or progression of body system malfunctions.

But, antioxidants do much more than just protect the body from free radicals, they can also tame inflammation in the body, act as cell-signaling agents, and some even up or down regulate gene expression.

It is clear that antioxidants are vital to a healthy body but where can you find them and how do you know if you are getting enough? Antioxidants are found in a variety of foods including fruits, vegetables, nuts, seeds, whole grains and some meats and fish.

And though there are thousands of different antioxidants that exist in nature, scientists don’t know the exact mechanisms of action of many of these. Therefore, the best advice is to eat a diet rich in a variety of spices, vegetables, fruits, nuts, seeds and whole grains to ensure a diverse intake of antioxidants. And, consider food first, as opposed to popping antioxidant supplements (though some specific ones may help decrease the progression of certain ailments as is the case with lutein and zeaxanthin and age related macular degeneration). There may be a synergistic effect among antioxidants or antioxidants and other compounds in food. Because scientists don’t know the exact “dose” of antioxidants that may help decrease aging, the best advice for now is to do the best you can to eat a wide variety of foods naturally rich in antioxidants at each meal, and take a general multivitamin to bolster your diet with antioxidant vitamins A, C, and E.

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.

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

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

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

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

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

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

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

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

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.

Walk, walk, walk….is that all we ever talk about?

This month it is! At least once a week anyway…

After introducing the beginning walkers plan last week, we thought it would be fun to talk about all the very cool places and reasons you can use to motivate yourself to new walking accomplishments.

So maybe it’s not very fun for you to walk around the same neighborhood you always do, or you’re getting tired of the junior high track circle for your daily walks.  It’s hard to know whether a new park, walking trail or city route will be to your liking or geared to your level, if you’ve never done it before.  Who knows what you’ll encounter along the way, right?

But what we can report, with ever increasing assurance, is that if you can find green, or natural areas (around a lake or beach, through a wooded area, or a naturally landscaped park) to walk regularly, your brain will benefit along with your body.  More and more studies have shown, with a high level of consistency, that natural settings while walking lessen stress even more, and actually improve your ability to concentrate.  Even children with attention issues performed better on cognitive tests after walking through parks and arboretums.

Are you familiar with “brain fatigue”?  It’s that over-stimulated, distracted, too much at once kind of feeling where you can’t seem to turn your brain off, but can’t really concentrate effectively on any one thing; where more things irritate or frustrate you than they should. 

Walking in general is good for reducing stress, but walking in green and natural spaces (as opposed to the concrete, traffic-riddled sidewalk jungle) actually engages the brain in a helpful and effortless way, allowing for calm and reflection, combating attention fatigue and providing stress recovery.  A naturally scenic walk and a dose of B-Complex vitamins can do your body and mind a world of good when you need to be clear headed, focused and calm.

Check out sites like www.mapmywalk.com , or the sister-site, www.mapmyhike.com that have hundreds of alternate walking and hiking routes posted by users and verified by these sites in a fair number of cities across the country.  Seeing that someone in your area forged a route nearby yours that you can now feel comfortable trying, just might increase your motivation to go create and submit your own “perfect walk”.

Ref. http://well.blogs.nytimes.com/2013/03/27/easing-brain-fatigue-with-a-walk-in-the-park/

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."