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From joint and bone health to mental health, heart health to cancer prevention, we’ve tried to bring you the best advice available on every topic we’ve addressed in our year-long wellness series. Now it’s time to bring it all together. Here are the keys to good health.
Exercise And You: Why Working Out Works Out
Exercise works. Whether it’s cancer prevention or joint health, mental and emotional health or heart health, on every topic we addressed over the past year, exercise came up at one point or another as one of the best ways you can help take care of yourself.
FACT: Exercise helps keep your weight under control.
Yes, we know it seems like common sense, but keeping your weight under control is one of the single most important things you can do for your overall wellness. Being overweight can increase your risk of developing osteoarthritis, heart disease, diabetes, colorectal cancer, prostate cancer and even depression, stress and anxiety. It can also have a negative impact on self-esteem.
“You don’t have to be a tri-athlete or a marathon runner to achieve what most of us need to achieve,” says Dr. Clifford Nottingham, a family practice doctor with Carilion Family Medicine and the top doctor in this category in our most-recent Top Docs feature (July/August 2005). “You need to get your heart rate up, sweat a little bit and get some reasonable improvement in your cardiovascular tone.”
More tips:
• First, if you’re overweight, don’t feel like you have to lose it all at once. Even a small weight loss of five to 10 percent can significantly decreases the risk of both heart disease and diabetes.
“There’s nobody who can’t do something,” Nottingham says. “The truth is, if you’re starting at ground zero, there’s always something that you can do, and
the trick is to find what works for you. Try to find something that makes you feel good, try to find something that you actually enjoy.”
• Second, if you’re having trouble getting started, Nottingham says he often advises his patients to consult a personal trainer. You may not need the regular services of a trainer, but an initial consultation with these experts can go a long way towards starting you on the road to a more fit you.
• Finally, especially if you’re prone to putting it off or skipping sessions, consider finding a workout buddy. The accountability factor will rise if you’ve got someone else depending on you, and it usually helps make exercise more fun too.
“It really helps to have a partner,” Nottingham says. “It really keeps you going.”
FACT: Exercise keeps your joints healthy
Exercise keeps your joint muscles strong, which will ultimately help support those joints and prevent and delay the onset of osteoarthritis. The key to remember here is that amount and kind of exercise have to be taken into consideration.
“Mobility remains very important, and it’s a matter of trying to get exercise to the right degree,” Nottingham says. “If you overdo it, you may have to pay the price of a lot of discomfort, and if you don’t do things you’re definitely going to have some discomfort and lack of mobility.”
Some ideas for balancing your routine include mixing in weight-bearing exercise with water exercise and other exercises that are not high impact. Make sure to avoid repetitive activities, especially if they can result in repetitive injuries to your joints. Extension and muscle-building exercises can also help increase stability and balance, which reduces the risk of falls that can cause bone breaks and helps your posture as vertebrae collapse during osteoporosis.
FACT: Exercise keeps your bones strong
Weight-bearing activities like running and jogging help prevent osteoporosis by increasing bone density. The counter argument here is that these same kinds of exercise can be hard on the joints, so again, a proper balance is essential.
“Unfortunately swimming and biking, which are two wonderful exercises otherwise, don’t tend to help with osteoporosis,” Nottingham says. “Something in which you bear weight is critical, and walking is something that, for the average individual, is very easy to do for osteoporosis prevention.”
FACT: Not all exercise is blood, sweat and tears
For example, yoga and tai chi are both non-aerobic exercise options, and these and other similar activities help with flexibility and mobility and are also often great sources of stress relief. Stretching programs are also beneficial.
“If you look at your dog, when your dog gets up from a nap, what’s the first thing he does? He stretches,” Nottingham says. “We really need to be doing the same thing. Particularly as we get older, we need to work on stretching and flexibility. … Yoga and Tai Chi are two [forms of exercise] that I often encourage folks to take a look at, but even just a home stretching program can help.”
FACT: Exercise helps you de-stress
Yes, exercise actually might help hold the blues at bay. 30 minutes of regular exercise three to five times a week may help ward off depression, and it is proven that exercise releases endorphins and raises dopamine levels, which increases the feeling of pleasure.
Exercise also increases oxygen consumption, which is good for brain function, and if you’re stressed you’re likely to eat more, so keeping stress-free helps keep your weight under control.
“Exercise seems to enhance our emotional status and emotional health,” Nottingham says. “Almost always, if I prescribe an anti-depressant, I prescribe exercise to go with that, with the advice that it’s going to make the medicine work better and hopefully you’re going to come off the medicine.”
FACT: Exercise can help you get a better night’s sleep
And a good night’s sleep goes a long way toward keeping you from being stressed, helping keep your heart in tip-top shape and helping keep your memory sharp and your brain healthy.
“Exercise helps you to get tired in a healthy way,” Nottingham says. “It’s also certainly important to try to be consistent with your sleep cycle and get to sleep at the same time.”
One word of caution – try not to exercise right before bed. A four-hour window between exercise and sleep is ideal since exercise can jazz you up and make it harder to sleep in the short-term.
FACT: Exercise improves your heart health
As mentioned, being overweight is not good for the heart, but exercise not only helps keep weight down, it also keeps the heart muscles strong and keeps blood pressure low and cholesterol levels where they need to be (it increases good HDL and lowers bad LDL).
“The other element is, if your body doesn’t have any excess weight to take around, it takes a lot of burden off the heart, lungs the kidneys and the other internal organs that have to support your body, not to mention the joints,” Nottingham says.
FACT: If you smoke, exercise can be a great distraction when trying to quit
If you’re trying to quit smoking, adding exercise to help occupy your newfound free time will not only help keep your mind off your cravings, it will further benefit your body in all of the ways mentioned above – talk about two (or in this case a whole lot more) birds with one stone!
Diets Work Too!
How Healthy Eating Helps Keep You Fit
Everywhere you look there are bits of nutritional information that contradict one another. One day carbohydrates are the root of all weight gain, and the next day the complex carbohydrates can protect you from a myriad of diseases. The diet world pendulum has swung from no fat to lowfat to healthy fat diets over the past decade. A person attempting to get their dietary house in order may find all of the information a little intimidating. We’ve waded through the current research to help clarify a few dietary issues and to separate fat from fiction.
FACT: Carbohydrates do not make you gain weight.
If you eat more calories than you burn, weight gain will occur no matter if the excess is consumed in the form of carbohydrates, protein or fat.
“It’s obvious that calories matter when it comes to weight loss regardless of the ratio of carbs, protein and fat in the diet,” says Monica Burgoon, a local licensed dietician. “I prefer to focus on the quality of foods in the diet and how this relates to poor health instead of counting calories and arguing about the ideal ratio of protein/carbs/fat for weight loss.”
Additionally, complex carbohydrates are a nutritionally good way to spend what calories you take in due to fiber content. Fiber helps the body stay healthy in a variety of ways, including lowering cholesterol and keeping the digestive system healthy, according to the American Heart Association (AHA).
Carbohydrates can also assist in the production of serotonin, a feel-good chemical that attaches itself to receptors in the brain. Examples of good carbohydrates that help release serotonin include whole grains and other complex carbohydrates. These kinds of carbohydrates provide a long, steady boost in serotonin levels, as opposed to the short spikes caused by simple carbohydrates such as sugar and caffeine.
Protein, carbohydrate and fat ratios aside, in the end it’s all about one number – the calorie.
“It’s a little old mathematical equation tweaked by what your body’s rate of metabolism is,” Nottingham says. “Short of that, it’s basically calories in and calories out.”
FACT: Not all dietary fats are bad.
The low-fat diet revolution that gripped the nation in the ’90s led by the likes of Susan Powter scared dieters away from all fats – even those that help protect the heart.
According to the AHA, Omega-3 fatty acids, “benefit the heart of healthy people, and those at high risk of – or who have – cardiovascular disease.”
Any additional cardiovascular protection is welcome, and omega fatty acids can be found in fatty fish like lake trout, mackerel, salmon, herring and sardines, according to the AHA. Omega fatty acid complex supplements are also available and can help people that don’t enjoy the taste of fish.
“This is a good way to stack the cholesterol numbers in your favor,” Nottingham says.
The superheroes – omega fatty acids – should be part of a well-rounded diet, but villainous saturated fats should be avoided as they do not contribute positive health benefits and can even be harmful. The AHA reports that eating too much saturated fat and cholesterol will raise blood cholesterol, and high blood cholesterol is a major risk factor for developing other types of heart disease.
Sources of saturated fat and cholesterol include foods that are favorites for many including whole fat dairy, fatty red meats, and fried foods.
“Unfortunately, living in the South [saturated fats are] pretty common,” Nottingham says. “If someone accidentally picks up Southern Living, people are going to get recipes with them in there.”
All is not lost though. Food can be enjoyable without added unhealthy fats. Try skim milk and low fat cheeses. While avoiding saturated fat, you still need to make sure to get enough calcium and vitamin D into your diet to protect bone health.
“The other thing I would suggest is that people at risk for osteoporosis shouldn’t restrict dairy too much or calcium intake and get plenty of Vitamin D,” Nottingham says.
FACT: All calories are not created equal.
Empty calories in the form of sugar and simple carbohydrates can take up a significant allotment of your daily calorie budget without offering nutrients or even filling you up for long.
“One of the hugest offenders are soft drinks,” says Nottingham. “If you look at the number of folks that eat reasonably healthy but go through a half or even a whole two liter of soda, that is a huge amount of yucky, empty calories that is more than your system can burn up.”
FACT: Eating water-dense foods can allow for weight loss.
Vegetables and fruits are water-dense, allowing you to eat more of them and feel more satisfied without as many calories. Soups can also be considered water-dense, but only if they are non-creamy.
One cup of chopped, raw broccoli has 31 calories and one-third of a gram of fat. An equal amount of lobster bisque weighs in at over ten times the caloric value at 360 with 29 total grams of fat – almost half the daily allowance.
In addition to filling up without many calories, vegetables offer nutrients that we simply don’t get enough of.
“The powerhouse foods are mostly plant-based so that they will be part of the diet if more vegetables and more of a variety of vegetables are eaten,” Burgoon says. “They include onions, garlic, crucifers (broccoli/kale/cauliflower), berries – especially blueberries, flax and sunflower seeds, raw chocolate, and herbs used for tea like nettle, rose hip, ginger.”
The bottom line according to Burgoon:
“If calories are being restricted for weight loss, it is very important that the foods that are eaten be nutrient dense and that vitamin and mineral supplements are taken to avoid deficiencies and maintain optimum levels of nutrients. For the diet, this means emphasizing a variety of non-starchy vegetables, some whole fruit, good quality protein foods and some good quality fats, and limited whole grains but not as flour products. Food intolerances and medications need to be considered because they may be associated with weight retention and other problems with metabolism.”
When Nothing Else Works
Facts You Need to Know About Weight-Loss Medications and Surgeries
If it’s not clear by now, losing weight is usually no easy task. Although we cannot stress enough the importance of diet and exercise, sometimes getting results requires more drastic measures.
Fortunately there are aids out there in the form of medications and surgeries that can help you get the results you need to maintain your overall wellness. However, both of these measures should be taken with a grain of salt – no matter how effective, lifestyle factors, at least for the time being, still seem to be the best way to drop weight, and even with the application of these procedures and medications, exercise and diet are still going to be a large part of the puzzle.
Weight loss medications
“Whenever considering medications for this type of situation, it’s always important for people to know that it’s only going to be part of the program,” Nottingham says. “They have to be committed to the nutritional and physical exercise component of what they need to do.”Currently there are two long-term prescription weight-loss drugs approved by the FDA, Xenical and Meridia. While Nottingham says both of these drugs are effective, they are by no means miracle pills, and they can be expensive and cause some unwanted side effects.
“Those are sort of the two drugs that most doctors would say are safest, the unfortunate fact is that they are not super powerful, they’re not super effective,” he says. “One of the major issues is that most insurance agencies won’t pay for them. Xenical also has some unwanted side effects, primarily with diarrhea.”
The reason for these side effects is that Xenical works much like the ingredient Olestra that is used in some low-fat foods by binding to fat cells in order to keep them from being absorbed. This also has the effect of decreasing the absorption of some fat-soluble vitamins and beta-carotene. The makers of the drug recommend users also take a multi-vitamin that contains D, E, K and beta-carotene to compensate.
Meridia, on the other hand, is an appetite suppressant and actually affects certain chemicals in the brain to make people feel full without eating as much. The main concern with Meridia regards patients with heart complications since this drug can cause mild increases in blood pressure and heart rate and substantial increases in some patients. Other more common side effects include dry mouth, constipation and insomnia, and sometimes headaches and increased sweating.
“These drugs are things that hopefully can be used to help jump start somebody while they are learning about the nutritional aspects and exercise part,” Nottingham says. “If we can help them psychologically to get started and drop some pounds, hopefully these other programs will kick in and they’ll begin to derive the same benefits from other lifestyle changes instead.”
Doctors like Nottingham are hopeful that the future will bring better and safer medications with fewer side effects, and Nottingham notes that there are already promising new medications on the horizon.
“The closest thing to the miracle pill are some of the agents being used to treat diabetes,” he says. “Byetta is this neat new agent that has a protein in it that has the effect of suppressing your appetite. It’s injected, but it has a very powerful reduction in appetite side effect. It’s actually the first diabetic medicine that has caused people to drop weight instead of gain weight. So there’s a lot of interest in taking it or some of the other drugs like it and using them for some new pharmacological weight-loss agents.”
Surgeries
The bariatric (weight loss) surgery, gastric bypass, reroutes the digestive system to reduce the amount of food a person can consume or process, resulting in weight loss. However, the procedure isn’t for everyone.
“There are some people that it just seems that nothing else works,” Nottingham says. “Their overall health is so compromised that this might be the best option for them.”
People with a body mass index (BMI) of over 40, or those with a BMI of 35 to 39.9 with related health problems, can be considered for gastric bypass according to the Mayo Clinic. A BMI of 35 to 39.9 means that the person is obese, where a BMI of over 40 indicates extreme obesity.
“Folks who have significant cardiovascular, endocrine or orthopedic types of problems may be having the issues because of the excess weight their body is forced to carry,” Nottingham says.
Since the amount of food that can be eaten and digested is severely limited after surgery, weight loss can be rapid. However, this is not an instant or effortless solution to obesity. Lasting results come from being continually conscious of your diet and exercising.
“I always tell people looking at this that it is not a quick fix,” Nottingham says. “It is going to change the pattern of your eating for the rest of your life, but you have to be in control of the foods you eat.”
As with any surgery, there are risks, but they can be mitigated by carefully selecting an experienced, knowledgeable surgeon.
“One of the things I tell folks selecting surgeons [is that] you are selecting them for their talents and to know when to operate and when not to operate,” Nottingham says.
Donna Springer:
“Your Body Is Like A Trophy.”
Long-time readers of The Roanoker may know Donna Springer as the cover model of our September/October 1976 issue. She was 40 then, and model-trim.
Today she’s just as dedicated to fitness, and many know her as the energetic woman riding next to you on an exercise bike at the Roanoke Athletic Club.
“Your body is like a trophy, you must work out or you will lose it,” she says.
For many, exercise is seen as a chore, but for Springer exercising is something she looks forward to.
“I exercise with a partner and afterwards we go out to eat,” she says.
Springer’s upbeat attitude about working out has helped her stay active for many years, but this grandmother of four also knows the value of not overdoing it with a heavy daily workout.
“You do what your body tells you to do,” she says. “My grandchildren swim, but I don’t. I use exercise equipment and do sit-ups, and avoid high-impact workouts.”
For those afraid to get back in the gym because they are not certain how to get things started, Springer offers some tips.
“Keep your heart rate up, get a membership to a gym, because if you pay for it you will use it, and having a friend go with you is always good,” she suggests. “As you get older, watch what you eat, it will affect your weight and cholesterol.”
Springer also stresses the importance of making exercising a job; the reward is better health and a longer, more fulfilling life.
Today Springer lives in Southwest Roanoke and has been employed as a sales associate at Safeguard Business Solutions for the past 25 years.
—David Lint
Wellness Volunteer Update: Mary Fowler is Still On Track
Last time we checked in with Mary Fowler in our July/August issue of the Wellness Series, she’d lowered her cholesterol, blood pressure and lost five-and-a-half pounds. Fowler achieved her results with help from Beth Anderson, a registered dietician with The Nutrition Resource.
Fowler took Anderson’s lessons regarding watching portion sizes and getting enough daily activity to heart. She has lost another 9.5 pounds and is fitting into her clothing more easily. As cold weather arrived, she donned a pair of pants from last winter expecting them to be tight but found the opposite.
“It used to be that when I put my jeans on [after the summer] I thought someone had come into my house and washed them with hot water and dried them on high heat because they were tight,” Fowler says. “It was nice this time to put them on and have them zip up without a hitch.”
Swimming and walking are still Fowler’s exercises of choice to help in her mission to improve her fitness and overall health.
“I have continued to walk more each month,” she says. “The first time I went walking, it was hard on my knees, but after the summer and the swimming, the walking has gotten a little easier.”
—AC
Wellness Volunteer Update: Peggy Overstreet
Reaches Her Goal Weight With Jenny Craig
When we last checked in with Peggy Overstreet in our July/August issue, she had lost more than 24 pounds and 17 inches through the Jenny Craig diet.
Her success continues, and as this issue goes to press in October, Overstreet has reached her goal weight by continuing to lose 7.6 more pounds for a total of 32 (43 if you count the nine pounds we recently learned she had already dropped before we even signed her up as a wellness series volunteer!)
Better still is the fact that Overstreet is no longer dependent on the Jenny Craig food alone to keep herself in tip top shape.
“I’m pretty much on my own now,” she says. “When I do [eat the Jenny Craig food], it’s more for convenience.”
Overstreet, who has continued to exercise every day throughout her weight-loss program, has made it look easy every step of the way and says keeping the weight off has not been as difficult as she expected.
“It’s been a little easier than I thought in the maintenance stage,” she says. “I was concerned once I leveled off it would be hard to maintain. I think the key there is the exercise.”
She says she is now enjoying her new body, and she doesn’t mind spending some extra money to treat herself for her success.
“I am trying to buy new clothes,” she says. “I have a trip planned with a girlfriend to go shopping.”
—JKW
Click to Lose: Links to Weight Loss
A basic search of the World Wide Web will yield over a million results for “weight loss.” Here are a handful of websites to get you on your way:
• The non-profit group Calorie Control Council offers free information regarding calorie content of everyday foods, a printable food diary and exercise and BMI calculators. www.caloriecontrol.org.
• The publishers of the book “The CalorieKing Calorie, Fat & Carbohydrate Counter 2006 Edition,” offer online information at www.calorieking.com. Free information includes a large searchable database of nutritional information on food, articles and recipes. Enhanced features such as menu plans, online diary and weight tracking are available for a fee.
• The Mayo Clinic provides free information on their website regarding weight loss with a calorie calculator and articles with basic advice on exercise, portion control and more. Visit www.mayoclinic.com, select “healthy living” on their homepage and then
“weight loss.”
• The free government website, www.mypyramid.com offers a customizable version of the food pyramid. You enter your age, gender and level of daily activity to get basic recommendations on how much of your daily intake of food should come from each of the food groups.
• On www.fitday.com, you can create a free account that allows you to track calorie intake, exercise, set goals and see nutritional information on
your foods.
• At www.nutradiary.com, a free online diary helps you track meals, set goals and view your progress over time. They also post links to articles about weight loss and fitness.
These are just a few of the thousands of websites that can help in your battle of the bulge. Just remember to check with your doctor before setting out on a low calorie diet or extreme exercise routine to make sure you’re good to go.