Summer’s right around the corner ~ how have you been in the past about sunscreen use?  Is it something you do every day all year?  Or are you unconcerned with sun damage?  Most of us are somewhere in between.  Here are some reminders and facts to help motivate you to be conscious of your skin this summer, and to treat it with the same protection you would your head if you were riding a bike!

One great resource is the Environmental Working Group (EWG) which has released a 2013 Sunscreen Guide, for help choosing the healthiest sunscreen options.  They include the methodology of their research, so you know how they arrived at their recommendations too.  Some things they mention to look for when choosing sunscreen:

Choose a Broad Spectrum Formula - Avobenzone and/or Zinc Oxide are the UVA specific blocking ingredients.  The sunscreen you choose can’t be broad spectrum without working to block UVA and UVB rays.  

Choose SPF 50 or less – Did you know that the FDA has long contended that anything higher than SPF 50 is “inherently misleading” (in a 2007 report and in a 2011 proposal to prohibit higher than SPF 50 labeling) and other countries like Australia and Japan have capped SPF values off at 30 and 50 respectively.  SPF only applies to the length of time you are protected from UVB rays anyway. And high SPF ratings mean that the formula is balanced improperly to UVB protection at the loss of UVA protection (there’s only so much that fits in a formula!)

Another way to protect yourself is to adjust your attitude about sun exposure and sunscreen use:

• Do not use sunscreen as a tool to prolong your time in the sun.
• Cover up! Hats, shirts and sunglasses are the best protection.
• Avoid sunburn!
• Do not use a tanning bed or sunbathe.
• Protect kids! Early life sunburns are worse, so keep little ones out of the hot sun.
• Pick a sunscreen with strong UVA protection.
• Don’t forget to get your Vitamin D level tested!  If you are deficient, your health care professional may have tips and different expectations for your sun exposure levels.
• Examine your skin. Check your skin regularly for new moles that are tender or growing. Ask your primary care doctor how often you should see a dermatologist.

Overall, be safe this summer – incorporate a variety of sun protection techniques – you’ll still get plenty of sun even being careful!  Check out these other helpful articles about summer sun, vitamin D and sunscreen use:  To Sunscreen or Not to Sunscreen, That is the Question..,  Balancing Summer Sun and Vitamin D Intake for Your Family

http://www.fitsugar.com/Safest-Sunscreens-Recommended-Environmental-Working-Group-23146248

http://www.ewg.org/2013sunscreen/skin-cancer-on-the-rise/

http://www.ewg.org/2013sunscreen/

www.Chooseskinhealth.com

www.melanomafoundation.org/prevention/facts.htm

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

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

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

An effective treatment for GERD is lifestyle modification includes:

·         Weight loss

·         Increased physical activity

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

·         Eat smaller meals

·         Don't lie down 3 hours after eating

Digestive Problems? Take These 10 Steps

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

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

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

Eat Smart...

Vicki Bovee, MS, RDN, LD, Bariatric Expert

Vitamin and Nutrition Management Vital After Bariatric Weight Loss Surgery

Resources:

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

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

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

Everyone loves a backyard summer meal….which most definitely involve the grill.  Grilling is a great, low fat means of preparing food, it does pose some health risks.  The formation of cancer-causing compounds called heterocydic amines (HCA’s for short) are created when meat is cooked at high temperatures.  But don’t worry, you can still enjoy the best bits of barbecue by safely minimizing the formation of HCA’s.  Here’s how!

Marinate, marinate, marinate – A marinade full of herbs, onions, garlic and flavor will protect the meat on your grill, and cut down on the formation of HCA’s as it cooks.

Microwave, microwave, microwave?  I know it sounds a little odd, but actually is the single most effective way to reduce HCA’s – If you microwave your meat for even just 2 minutes prior to grilling, it will decrease the formation of HCA’s by a whopping 90%!  Pour off the liquid formed during microwaving and you’ll decrease HCA’s even a little more.

Is it done?  While we all know it’s critical to cook meat to appropriate temperatures, slower and lower is the best way.  Consider wrapping your meat in foil and letting it cook slowly on the grill to seal in moisture, then touch it up with nice grill marks at the end.  You do want to avoid “charred” meat – the black crisp of what used to be meat?  That’s where the carcinogens concentrate.  

Fight back with vegetables.  Same rules apply, nice grill marks, no charred blackness.  The phytonutrient / antioxidant boost from colorful veggies like red and yellow peppers, zucchini, carrots and such, help offset any free-radicals you may have encountered.  For more great tips on healthy backyard meals, check out this article -  How to do Healthy Barbecue and Grilling Recipes

Enjoy your summer backyard fun, grill healthy and don’t forget the sunscreen!

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

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

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

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

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

Have Celiac or Gluten Intolerance?  You are not alone!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now more than ever the health forecast for our children is gloomy at best. With technology taking over children’s free time and entertainment, activity along with healthy eating has taken a back seat. Given that most households have working parents, fast-food has replaced home cooked meals. But the future is not all doom and gloom as there are things that parents can do to offset the ravages of unhealthy habits, and it begins at home.

If you’re a working parent you know only too well the challenges of raising kids. Fifty years ago life was simpler and the demands on children and parents were much less. Fast-food was a rare occurrence and playing outdoors was the norm. Fast forward to 2013, and we find children are sitting for hours at a time and junk food trumps healthy choices. Finding ways to get children active and eating better can seem impossible at times. However, with patience and a bit of strategy, there are easy ways to get your kids thinking healthy. Consider the following:

1. Be a role model. Children mimic what they see. If you come home at the end of the day, grab a bag of chips and sit on the couch watching television, your children will do the same. It’s imperative to model healthy behavior. The long-term benefits for your children will be endless. Begin with keeping healthier food options in the house. Avoid processed foods and keep fresh fruit around if possible. After dinner, develop a habit of family walks. The younger you start children, the more likely they will be to carry on the tradition long after they leave home.

2. Limit screen time. This is not a new suggestion but one that certainly bears repeating. The longer children sit in front of a screen, the greater the chances of them struggling with obesity and disease later in their life. Consider setting a timer for your kids. For older kids, trust that they will follow your house rules by making it clear.  “For every hour of screen time, you need 30 minutes of non-screen time.”  The idea is to set whatever rules you feel can successfully and realistically implement.

3. Make dinner time a family affair. If both parents work, making time to create a home-cooked meal can be overwhelming, but keep in mind that soup and sandwiches are still far better than a burger and fries.  Take 30 minutes on the weekend, perhaps on Sunday during dinner time and plan for the week’s meals with the family. The more children are engaged, the greater the chances of them enjoying healthier foods. There are many fast and easy meals available (the internet is a beautiful thing for this) that are not only more nutritious but won’t break the bank.

4. Find ways to be more active as a family. For example, create a Family Fun Day where one member of the family is in charge of planning a fun family activity which might include a bike ride, a charity walk, going to a park, etc.  

5. Talk about the importance of making healthy choices. Unfortunately, once your children leave the house, healthy choices will be up to them. Society does not make healthy living easy. Therefore, educating your kids on food options will help them to make better decisions when away from home and put healthy eating on the top of their priority list.   Read more  Top 5 Healthy Snacks

Now more than ever, children need to be educated on the importance of healthy habits. Because we live in such a frenetic society, health falls to the bottom of the list. Teaching health and wellness to kids should become as important as academic studies. If they don’t have their health, excelling at anything will be difficult. The earlier children learn about healthy eating and increased activity, the better the chances of a bright, healthy future.

Guest post by Nicki Anderson who is the health and fitness columnist for Chicago Suburban Newspapers, Tribune Company/Naperville Magazine and contributor to numerous magazines and websites including, MSNBC.com, Forbes.com and FitnessMagazine.com, Real Simple, Prevention, Women’s Health and Women’s’ Running, Men’s Health and Fitness and Anatomy Now.  For more information about Nicki visit,  www.nickianderson.com and follow her on Twitter.                                                   

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.

We all know breakfast is the most important meal of the day. It jump-starts your metabolism and provides energy to power you through the day, so it’s important to choose a breakfast that will give you that sustained energy.

A frittata is like an omelet but easier to make.  You start it on the stove but finish by baking in the oven.  Great for dinner too and leftovers the next day!  This recipe is rich in protein, vitamins, and of course, flavor. The eggs provide protein and healthy fat to keep you sustained throughout the morning, as well as choline to get that brain-power rolling. Tomatoes are rich in lycopene and vitamins C, A, and K. Carrots are best known for being rich in beta-carotene, but they are also rich in vitamins A and K. Essentially, this frittata is a bundle of vitamins packed into one delicious breakfast (or lunch or dinner!), and the recipe yields enough to feed a group (or yourself with ample leftovers for the rest of the week.)

Vegetable Frittata

Ingredients:

1 tablespoon extra virgin olive oil

½ medium yellow onion, diced

1/2 medium sweet potato, grated (leave the skin on)

1 carrot, grated

1 zucchini, grated

2 garlic cloves, minced

3 large eggs

1 cup unsweetened nut or seed milk (hemp, almond, etc.)

½ teaspoon dried oregano

¾ teaspoon sea salt

1 tablespoon packed fresh basil, minced

2 large tomatoes, sliced in thin rounds

Freshly ground black pepper, to taste

Directions:

1. Preheat the oven to 375 degrees F.
2. Heat a large oven-safe skillet over medium heat. Add olive oil and sauté the onions for 5 minutes, stirring occasionally to prevent burning.
3. Add the sweet potato, carrot, zucchini, garlic, and 1 tablespoon of water. Stir briefly, then turn heat to medium-low and put a top on the skillet. Allow to cook for 15 minutes, adding 2 more tablespoons of water about halfway through.
4. While the vegetables are cooking, whisk together the eggs, milk, oregano, and salt. Mince the basil and slice your tomatoes so you’re ready to add them as soon as the vegetables are done.
5. After 15 minutes, take the skillet off the heat and pour the egg mixture evenly over the vegetables. Sprinkle the basil evenly and layer the tomatoes on top. Add freshly ground black pepper, to taste.
6. Put in the oven and bake for 40 minutes. Serve hot. 

More recipes from Iris!

Blueberry Pancakes (Gluten-Free and Vegan)

5 Ingredient Quick and Healthy Sweet Potato Leek Soup

How to Make Antioxidant Rich Gluten-Free Shrimp Salad

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. 

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

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.

(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.

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.  

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