Now that you have diabetes, how do you stay your healthy, vibrant self?
Anyone, at any age, must become more diligent and aware once they’ve been diagnosed. However, older readers have many other considerations to contend with, and the balance between everything can seem overwhelming. What can you do to keep yourself on the right track?
Some advice is surprisingly simple, and some will have never been considered: take the stairs, try yoga, get rid of diet soda drinks, etc. These pages contain various tips and secrets that can become part of your daily routine and easily make sure that your diabetes is not going ignored.
Gourmet Cooking Secrets for People with Diabetes
Can people with diabetes eat healthfully and enjoy their meals at the same time? The answer is a resounding yes, says Chris Smith, author of The Diabetic Chef’s Year-Round Cookbook. Smith uses fresh, seasonal ingredients to create healthy, interesting meals full of flavor for individuals with diabetes and everyone else at the table, while reducing the salt, sugar, and fat that many have come to rely upon to add taste.
HEALTHY EATING…WITH DIABETES
Just like the rest of us, people with diabetes should eat nutritious meals that are low in fat (especially saturated and trans fat), moderate in salt, and very sparing in sugar, while emphasizing whole grains, vegetables, and fruit. However, because people with diabetes are at a greater risk for life-threatening complications such as hypertension, heart disease, and stroke, it’s particularly important that they keep blood glucose control while maintaining normal levels of blood pressure and blood lipids (cholesterol). It can be challenging to do all that while still preparing flavorful and appealing food. Here, the Diabetic Chef shares his secrets for preparing foods that are appropriate for people with diabetes and delicious enough for everyone.
HERBS AND SPICES ARE ESSENTIAL
Liven up your meals with garden-fresh herbs, many of which are available year-round. Fresh herbs are densely packed with flavor. You can use herbs in a variety of ways throughout the seasons.
•Fine herbs, such as thyme, oregano, dill, basil, and chives, are usually available in the spring and summer. These should be added as a finish (at the end of the cooking process) to release their delicate flavors and aromatic qualities. “Use fresh basil with summer tomatoes and olive oil for pasta or as a finish to a tomato sauce,” says Smith. “Use chives as a delicate finish to soups, salads, and sauces.”
•Hearty herbs (rosemary, sage), available year-round, can be added earlier on in the cooking process. Use them with stews, soups, and Crock-Pot dishes. They can withstand the heat of cooking without losing flavor and, in fact, the longer they’re cooked, the more mellow and flavorful they are, says Smith.
•Dried herbs must be rehydrated, so use at the beginning of the cooking process (adding as you sauté onions for a sauce, for example). Your homemade tomato sauce with dried oregano and basil tastes better the next day as the flavor of the dried herbs fully blooms and combines with the other ingredients.
Herb typically describes the leaves of a plant, while spices are derived from any other part—including the root, seeds, bark, or buds. Spices can be used to create a medley of flavors and can be evocative of different types of ethnic cuisines. “Spices bring great diversity to food,” Smith says.
OTHER TIPS FOR HEALTHFUL EATING
Overall, Smith points out that healthful eating is a matter of practicing what he calls “Nutritional MVP,” which stands for moderation, variety, and portion control.
From his cookbook, another suggestion is to learn how to do template cooking. Template cooking is taking one recipe and adapting it in different ways by using the same cooking method but substituting different ingredients, says Smith. “It gives you the freedom to be creative, which is the essence of good cooking.” It also brings much-needed diversity to meals, so you are not forever serving the same old thing. One example of a template recipe is the Herbed Chicken Breast (see page 117). “There are only seven ingredients in this recipe, but you can vary it with fresh, seasonal ingredients,” says Smith. “For instance, in springtime, you can exchange the olive oil for sesame oil and use lemongrass rather than garlic to create an Asian flavor. In summer, substitute fresh cilantro for the rosemary.”
Try different cooking techniques to bring out the essence of foods.
•Grill, broil, roast, sauté, or steam food to enhance flavor without added fat or salt. Slow-roast vegetables with a drizzle of olive oil in a four-hundred-degree oven to bring out their true flavors. Many develop a natural sweetness when roasted. Season with garlic or add herbs to vary the taste. Rather than sautéing garlic or onions with butter or oil before adding them to soups or stews, try roasting in the oven.
•Marinate foods in a few ingredients. “The herbs, lemon, and spice in the Simple Chicken Breast recipe create a vibrant flavor, and the extra-virgin olive oil allows the herbs and spices to reach their full bouquet,” says Smith.
•Sear meat (brown on both sides in a pan for a few minutes before placing it in the oven) to enhance flavor without adding extra fat or salt. “Any kind and cut of meat can be seared,” says Smith.
•Pair dishes with colorful sides. Instead of a plate full of brown items such as chicken and rice, liven up your plate with deeply colored fruits and vegetables that add variety and important phytonutrients (components of fruits and vegetables that are thought to promote health) to your diet.
•Keep the pantry stocked with these healthy ingredients.
›Oils: extra-virgin olive oil, sesame oil, and grapeseed oil.
›Vinegars: balsamic, champagne, rice, and aged sherry vinegar.
›Essential spices: cayenne pepper, chili powder, cinnamon, mustard, nutmeg, paprika, and pepper.
›Essential dried herbs: bay leaves, dill, basil, oregano, rosemary, thyme, and sage.
›Other essential products: chicken, vegetable, and beef broth, dried beans, whole gluten-free grains such as quinoa and amaranth.
›Essential fresh ingredients: lemons, limes, oranges, garlic, onions, shallots, carrots, tomatoes, potatoes, mushrooms, butter (salt free), sour cream (fat free), eggs, hard cheeses (Parmesan and Romano), mustard (grain, Dijon), capers, and olives.
›Chris Smith, the Diabetic Chef, is an executive chef working in the healthcare field. Author of two cookbooks, Cooking with the Diabetic Chef and The Diabetic Chef’s Year-Round Cookbook, he lectures widely about cooking for people with diabetes.
Eat Like a Viking to Manage Diabetes
Have you heard about the “new” Nordic diet? It turns out that Scandinavians who follow their countrymen’s traditional way of eating seem to live longer. But, sorry to tell you, the key is not Danish pastries and Swedish meatballs. They eat a lot of wholegrain rye bread—real rye bread, not the mushy “rye” found alongside white bread in supermarkets—and cabbage. But there’s more to the Nordic diet than that.
LIVE LIKE A VIKING
Anja Olsen, PhD, a researcher at the Danish Cancer Society, and a team of researchers collected information about the diets and lifestyles of approximately fifty-seven thousand Danes ages fifty to sixty-four. Over the twelve-year study period, 4,126 died. After accounting for lifestyle differences (such as exercise, weight, smoking, alcohol use, and education), the researchers found a strong correlation between eating traditional Nordic foods and length of life. For instance, men who followed the traditional Nordic diet most closely had a nearly 36 percent lower risk of dying during the twelve years of follow-up. And women who ate the most Nordic staples reduced their risk for death by 25 percent. These results appeared in the Journal of Nutrition.
Wholegrain rye bread, which most study participants ate daily (the median amount was two and a half slices) appeared to have the strongest protective effect, especially in men. This is not the prepackaged rye bread with additives and sugars found in most supermarkets.
Adding further to the chance of living longer, both wholegrain rye and cabbage help in the battle against obesity. And cabbage has been related to a decreased risk for both cancer and heart disease.
However, as in other Western countries, many Nordic folk today eat too much processed and/or fatty food, including pasta, french fries, pizza, and sugary desserts, and, as a result, may suffer from high rates of heart disease, diabetes, and cancer.
DANISH MODERN…NOT?
To encourage better health, Dr. Olsen recommends that we focus on old-style dietary habits as they’ve long existed in most traditional cultures, be they Nordic or from other countries. They tend to emphasize natural, whole, and often wild foods—in contrast to our modern approach of eating highly refined foods.
Luckily, you don’t have to be a Dane, Swede, or Norwegian to eat like one. Here are some ways you can enjoy the benefits of the healthy Nordic diet:
•Eat real rye bread. Whole grains such as rye, barley, and oats abound in dietary fiber, minerals, and antioxidants that protect against heart disease, type 2 diabetes, and cancer. In this study, wholegrain rye had the most positive impact on health—but it’s important to realize that this is not the rye bread we grew up with in the United States.
Instead, in this country, you’ll most easily find this European-style rye by looking for German wholegrain rye, such as the Mestemacher brand, usually found in the deli section of grocery stores, and also in health-food stores, health-oriented markets such as Whole Foods, and even online.
•Cut up some cabbage. Cabbage is packed with fiber and isothiocyanates (the sulphur-containing compounds found in cruciferous vegetables). Enjoy both red and green cabbage shredded raw in salads and slaws or lightly steamed.
•Root for root vegetables. Root vegetables, especially carrots, are rich in phytochemicals such as carotenes, which neutralize free radicals that damage cells in your body and may cause cancer. Parsnips and turnips are also good choices.
•Enjoy apples, pears, and wild berries. Wild berries, which are easily available in Scandinavia, are especially rich sources of substances such as omega-3 fatty acids, essential to normal growth and development, as well as antioxidants and phytoestrogens such as lignans, which help lower cancer risk. But even though wild berries contain many more of these healthful components, the berries you find in U.S. grocery stores—i.e., cultivated ones—are still a good source of these important nutrients.
›Anja Olsen, PhD, researcher, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Surefire Way to Stop Overeating: The Five-Point Hunger Scale
It happened again. You sat down to a meal or started to snack and, despite your intention not to overindulge, somehow kept eating until you were stuffed. Curses! Perhaps you’ve tried that “mindful eating” business in the past—paying attention to the physical and emotional sensations during every moment with food—because you’ve heard that it helps people avoid overeating. The problem is, that “every moment” aspect is tough to pull off. After all, sometimes you want to converse with your meal companions or look at the newspaper or just gaze out the window while you eat, rather than focusing fully on every single bite.
Well, there’s an easier way to achieve the same kind of control that mindful eating provides. It’s called the five-point hunger scale. The idea is to simply rate your hunger on the following scale:
1.Starved
2.Hungry
3.Comfortable
4.Full
5.Stuffed
The beautiful simplicity of the five-point scale is that, rather than thinking about it constantly while you eat, you need only give it a moment’s focus three times—before, midway through, and after any given meal or snack. Here’s what to do.
When you’re tempted to eat, before you begin, rate your hunger, asking yourself:
•Are you feeling ravenous, spacey, or light-headed? Do you feel like almost any kind of food would satisfy you? You’re at point one, starving, and you must eat—in fact, you have waited too long. When you’re feeling starved, self-control becomes extremely difficult, and you’re likely to end up overeating, after which you’ll feel guilty, so you’ll starve yourself again. In essence, you bounce back and forth from starving to stuffed all day, without ever feeling truly comfortable and satisfied.
Best: Don’t let your hunger reach point one.
•Is your stomach growling, letting you know that your body needs fuel? Has the feeling come on gradually? You’re at point two, hungry. Hunger is a slow sensation. It doesn’t jump into your brain all of a sudden, and it usually occurs around the same time that you’re used to having breakfast, lunch, or supper.
Remember: Point two is the perfect point at which to eat.
•Are you physically comfortable but still feel like eating—with a specific type of food in mind? You’re at point three, and you’re facing a craving, not true hunger. A craving is a psychological issue rather than a physical one, a spark sensation that comes on suddenly.
What to do: Don’t jump right into eating. Instead, consider what emotion is driving your urge to eat. Then try to satisfy that need with a food-free activity to see whether the craving goes away. Feeling lonely? Pick up the phone. Bored? Tackle a crossword puzzle, or clear some clutter out of your garage or closet. Stressed? Soak in the tub, or take a hike. If you still desire that particular food afterward, go ahead and indulge in moderation, eating only as much as you need to satisfy the craving.
Halfway through your meal: After you’ve been eating for five to ten minutes, put down your fork and rate your hunger again:
•Have your physical sensations of hunger lessened but still linger? You’re just past point two, on your way to three. Some people stop here, especially when they want to lose weight. But this backfires because it usually triggers a second eating period not much later.
Better: Keep eating!
•Do you feel pleasantly sated? You’re at point three, comfortable—which is ideal, especially if you’re trying to lose weight. If you stop now, you should have enough energy to last until your next scheduled meal. But if you’re enjoying your food, you don’t have to stop yet. It’s OK to keep eating slowly for a few more minutes.
•Are you on your way to discomfort? Is your waistband starting to feel snug? You’re at point four, full—and you should definitely stop eating now. Remember, it takes fifteen to twenty minutes for your stomach to send the signal to your brain that it is full. If you eat until your stomach feels full, you will be beyond full—in fact, you’ll be painfully stuffed, point five—by the time your brain gets that signal.
Twenty minutes after your meal: Rate your hunger level one last time:
•Is your belly a bit distended but not painful? Congratulations—you’re at point four, full. You stopped eating in time.
•Do you feel the urge to groan or lie down? Are you so full that you couldn’t put another bite into your mouth? You’re at point five, stuffed, and you definitely went too far. Your body would have been satisfied if you had stopped several hundred calories sooner, and you would have avoided the discomfort and weight gain that come with overeating.
Helpful: Don’t starve yourself for the rest of the day, but at your next meal, do pay closer attention to your midmeal hunger rating, and stop when you’re at point three.
For the first few weeks: While you’re learning to recognize how your body feels at each point, keep a written log of your hunger scale scores before, midway through, and after each meal. If you need a reminder, set a timer or program your cell phone to beep. Keep it up, and you’ll soon become adept at waiting to reach point two before you start eating (without delaying too long and hitting point one) and at stopping when you reach point three or four (without ever hitting point five). Once that happens, you’re on your way to a lifetime of sensible, pleasurable eating and easy weight control—an essential part of living well with diabetes.
›Osama Hamdy, MD, PhD, medical director, Obesity Clinical Program, Joslin Diabetes Center, and assistant professor of medicine, Harvard Medical School, both in Boston. He is a coauthor of The Diabetes Breakthrough: Based on a Scientifically Proven Plan to Lose Weight and Cut Medications. TheDiabetesBreakthrough.com.
Timing Matters!
When you eat is almost as important as what you eat:
•Plan on eating four or five daily meals—breakfast between six a.m. and eight a.m., an optional (and light) late-morning snack, lunch between 11:00 a.m. and 12:30 p.m., a midafternoon snack, and supper between 5:00 p.m. and 7:00 p.m.
•Plan your meals so that you get more protein at supper. It will stimulate the release of growth hormone, which burns fat while you sleep.
•Avoid all food three hours before bedtime. Eating late in the evening causes increases in blood sugar and insulin that can lead to weight gain—even if you consume a lower-calorie diet (1,200 to 1,500 calories a day).
›Ridha Arem, MD, an endocrinologist, director of the Texas Thyroid Institute and clinical professor of medicine at Baylor College of Medicine, both in Houston. He is a former chief of endocrinology and metabolism at Houston’s Ben Taub General Hospital and is author of The Thyroid Solution Diet. AremWellness.com.
The Right Way to Take Your Vitamins
Many of us take vitamins and other nutritional supplements. In fact, researchers from Harvard analyzed data from nearly 125,000 middle-aged and older people and found that an astounding 88 percent of women and 81 percent of men took supplements.
Unfortunately, a lot of us take nutritional supplements wrong.*
We don’t take high enough doses, or we take them at the wrong time of day, or we combine them with other supplements, foods, or drugs that can block absorption.
Good news: I’ve counseled thousands of patients on the best ways to take vitamins, and I can assure you that taking them correctly can be simple and straightforward.
What you might be doing wrong—and how to quickly fix the problem:
Vitamin mistake #1: You take a dose that’s too low. There are many nutrient-nutrient interactions that can reduce the absorption of individual nutrients by 5 to 10 percent. Example: iron cuts the absorption of zinc—the more iron in a supplement, the less zinc you’re likely to absorb.
My advice: Don’t take a multivitamin that supplies 100 percent of the daily value of nutrients, a level intended only to prevent deficiency diseases. Instead, take a multivitamin that supplies an optimal amount of nutrients—an amount that will easily overcome every absorption issue caused by nutrient-nutrient interactions.
For simplicity, use the B vitamins as your reference point. Look for a product that supplies about 40 mg each of thiamin, riboflavin, niacin, and vitamin B6 (pyridoxine), and 200 mcg of vitamin B12. These levels are safe and therapeutic, improving energy and mental clarity. When a product contains the above levels of these nutrients, it usually will have optimal levels of other nutrients as well.
Vitamin mistake #2: You take a dose that’s too high. It can be detrimental to your health to take high doses of vitamin A and vitamin E. Reasons: taking more than 3,000 IU of vitamin A (retinol) daily can increase your risk for osteoporosis, the bone-eroding disease. Vitamin E is actually a family of eight compounds called tocopherols and tocotrienols. Alpha-tocopherol—the compound commonly found in multivitamins—can be toxic in doses higher than 100 IU daily.
My advice: Take a multivitamin that contains no more than 3,000 IU of vitamin A total, with approximately one-half from retinol and one-half from beta-carotene (which turns into vitamin A in the body and does not cause osteoporosis).
Choose a multivitamin with no more than 100 IU of vitamin E. If you take the nutrient as a separate supplement for a specific condition, such as for breast tenderness, take it in the form of mixed tocopherols and tocotrienols.
Vitamin mistake #3: You try to take vitamins two or three times a day. Taking vitamins in divided doses—two or even three times a day—is ideal because the body sustains higher blood levels of the nutrients. But very few people can stick with this type of regimen.
My advice: Take vitamins first thing in the morning, with breakfast. (The fat in the meal will help you absorb vitamins A, D, and E, which are fat-soluble.) Yes, there’s a tiny trade-off of effectiveness for convenience, but it’s worth it.
Exception: If you take magnesium as a separate supplement, you might want to take it at bedtime for deeper sleep. Avoid magnesium oxide and magnesium hydroxide, both of which are poorly absorbed. Magnesium glycinate or magnesium malate is preferred.
Vitamin mistake #4: You take a second-rate formulation. Vitamins come in a range of forms—tablets, caplets, capsules, chewables, softgels, liquids, powders—and some are better than others.
Vitamin tablets, for example, are a poor choice. They may not dissolve completely—and you can’t absorb any nutrients from a pill that doesn’t dissolve. Tablets (and some of the other forms listed above) also may contain binders, fillers, and other additives. These supposedly inert compounds may have all kinds of unknown effects on the body.
My advice: I recommend powders, which are highly absorbable. Just add water and stir. My favorite is the Energy Revitalization System, from Enzymatic Therapy, which I formulated. (So that I can’t be accused of profiting from my recommendation, I donate 100 percent of my royalties from sales to charity.) I recommend one scoop each morning combined with 5 g of ribose (a naturally occurring sugar) to optimize energy.
Don’t like drinks? Try a combination of My Favorite Multiple Take One by Natrol plus two tablets of Jigsaw Sustained Release Magnesium plus two chewable ribose tablets (2 to 3 g each).
Vitamin mistake #5: You take calcium. One-third of people who take supplements take calcium—and I think just about every one of those people is making a mistake. The scientific evidence shows that taking a calcium supplement provides little or no protection against bone fractures, and research now links calcium supplements to increased risk for heart attacks and strokes.
My advice: I strongly recommend that you get your calcium from food, eating one or two servings of dairy a day. Almonds, broccoli, and green leafy vegetables such as kale are also good calcium sources. Unlike supplemental calcium, calcium from food is safe. If you decide to take a calcium supplement for stronger bones, take no more than 100 to 200 mg daily, and always combine it with other bone-supporting nutrients, such as vitamin D, magnesium, and vitamin K. Take these at night to help sleep.
Vitamin mistake #6: You don’t realize that your medication can cause a nutrient deficiency. Some medications block the absorption of specific nutrients. In my clinical experience, the two worst offenders are:
•The diabetes drug metformin, which can cause a B12 deficiency.
What to do: Metformin is an excellent medication, but be sure to take a multivitamin containing at least 200 mcg of B12 daily.
•Proton pump inhibitors such as esomeprazole, which block the production of stomach acid and are prescribed for heartburn, ulcers, and other gastrointestinal problems. Long-term use can cause deficiencies of magnesium and B12.
What to do: Take a multivitamin with 200 mcg of B12 and additional magnesium (200 mg daily), and talk to your doctor about getting off the drug. (A gradual decrease in dosage is safest.) Proton pump inhibitors are toxic when used long-term and addictive, causing rebound acid hypersecretion when stopped. The solution? Improve digestion using plant-based digestive enzymes, deglycyrrhizinated licorice (DGL), marshmallow root, and other stomach-healing supplements. Follow directions on the labels.
›Jacob Teitelbaum, MD, board-certified internist, holistic physician, and nationally known expert in the fields of chronic fatigue syndrome, fibromyalgia, sleep, and pain. Based in Hawaii, he is author of numerous books, including The Fatigue and Fibromyalgia Solution, Pain-Free 1–2-3, and Real Cause, Real Cure, as well as the popular free iPhone and Android application “Cures A–Z.” Vitality101.com.
Ten Hydrophilic Foods That Satisfy Hunger and Help You Lose Weight
What if you could swallow a pill right before dining that would make your stomach swell like a balloon so you would feel artificially full? Well, such a pill is in the works, but there’s a much better solution for you—hydrophilic foods. They attract and absorb water, which makes them swell in size—in a natural process—so you naturally feel satisfied and automatically consume fewer calories. Plus, unlike a weird new diet pill or other diet gimmicks, they are full of nutrients that your body needs. And besides helping you lose or maintain weight, hydrophilic foods—because they contain digestible soluble fiber—also help control blood sugar and cholesterol.
And it’s all real food. What more could you want?
THE TOP TEN HYDROPHILIC FOODS
•Chia seeds. Chia seeds are the perfect example of a hydrophilic food. They start out as tiny, crunchy, nutty-tasting seeds (just a little bigger than poppy seeds), but each seed can absorb up to twelve times its weight in water, so they form a gel that’s filling and extremely nutrient-rich—each seed is supercharged with omega-3s and packed with antioxidants, fiber, iron, magnesium, calcium, and potassium! So sprinkle a tablespoon into your smoothie for breakfast, add some to soups and porridges, or use them in place of breadcrumbs to bind meatballs. You can even make a simple and nutritious pudding by combining two tablespoons of chia seeds per cup of almond milk or other liquid, sweetening to taste, and refrigerating overnight—no cooking needed.
•Okra. OK, okra might be a turnoff for some people because it gets sappy—or downright slimy—when cooked, but that texture speaks volumes about its soluble fiber, which, along with a host of vitamins and minerals, turns okra into a dietary powerhouse. Add sliced okra to soups and stews, where the consistency doesn’t stand out so much and, in fact, the okra acts as a natural thickener. Also consider cooking okra at high heat (in a wok, for example), or slicing it lengthwise and grilling it—both cooking styles will reduce the vegetable’s slipperiness. To use it raw, slice and toss into salads, or dress with oil and vinegar all on its own. It’s tasty, with a good crunch, and its slight sappiness enhances the texture of the dressing.
•Oatmeal. Oatmeal is a hydrophilic food you might already be filling up on since it’s well-known for its cholesterol-controlling abilities. Just picture the way raw oats absorb water while they cook, and you’ll understand why they make my top-ten list of hydrophilic foods. Don’t like oatmeal? Maybe it’s because the only kind you know is rolled oats—the kind that look flattened and may have even been partially cooked before you buy them. Rolled oats can cook up mushy and without much natural flavor. Try steel-cut oats. They cook up into a hearty, pleasantly toothsome, and nutty-tasting dish.
•Pears. Pears are naturally full of pectin, a type of soluble fiber found in the walls of plant cells. If you’ve ever made jam, you’ve probably added pectin powder to thicken it. In addition to helping you feel full, pectin acts as a detoxifier, a gastrointestinal tract regulator, and an immune system stimulant. Grab a pear for a juicy snack, or try these delicious ways to use them—add thin slices to sandwiches, toss into salads, or cut them in half, core them, and either grill or roast them. To grill, simply place them, cut side down, on a lightly oiled stovetop grill until they are seared. To roast, place them, cut side down, in a baking pan, warm up a half cup of apple juice and a tablespoon or two of honey, pour the apple juice over the pears, and bake at 400°F for thirty minutes.
•Barley. Like oats, barley absorbs a substantial amount of water as it cooks—and like oats, it also expands further in your stomach, providing heart-healthy nutrition and natural fullness. Americans aren’t very familiar with barley and don’t use it very much in their kitchens, which is ironic, since it was one of the original foods grown by the Pilgrims and may have been eaten at the first Thanksgiving. Beyond the standard beef-barley stew (which, by the way, can be a very healthful meal), it’s actually very easy to use and enjoy barley. Just follow cooking instructions on the package, and then use barley as the base in your favorite wholegrain salad recipe (instead of wheat berries, for example) or instead of small pastas in soups (it lends an earthier tone than pasta), or sauté it with some butter and sliced mushrooms, salt, and pepper. You can even cook barley like risotto—barley’s soluble fiber creates the right kind of creaminess for risotto-like dishes.
•Brussels sprouts. Serving for serving, Brussels sprouts are among the vegetables highest in soluble fiber. For a taste revelation, try tossing fresh Brussels sprouts with olive oil and salt, then roasting in the oven at 400°F for thirty to forty minutes or until they are softened and caramelized, or shred them raw and use in slaw. You can also make an easy, delicious boiled Brussels sprouts dish. Cut the sprouts in half, then boil them with a variety of herbs such as garlic, basil, thyme, and rosemary in one-part wine vinegar and one-part water until they are tender. Drain, then dress with balsamic vinegar and olive oil, salt, pepper, and more herbs to taste. Let cool and serve at room temperature.
•Kidney beans. Like all beans, kidney beans soak up water as they cook and keep doing it after you eat them. I especially favor kidney beans because their red color indicates a high level of disease-fighting antioxidants—the darker red, the better. Of course, they are a great addition to chilies, salads, and soups such as minestrone. You might also like to partly mash a cup and a half of cooked kidney beans and mix them with olive oil, a dash of balsamic vinegar, salt, garlic, and other spices to taste for a delicious bean spread served with crostini or Italian bread.
•Chickpeas. Also called garbanzo beans, these might be the single easiest and most versatile food on this top-ten list. You know you can toss them onto any salad, but you don’t even need the salad. You can simply open a can of chickpeas, drain, add any salad dressing, and start eating—and if you like this idea, don’t miss trying them in Caesar dressing with Parmesan cheese sprinkled on top. If you have a little more time, purée chickpeas with garlic, cumin, tahini, olive oil, and lemon juice for a healthy, homemade hummus. For a portable snack, toss chickpeas with a bit of olive oil and your favorite spice blend, then roast until irresistibly crunchy. Or make pasta e fagiole—the Italian version of rice and beans—by adding cooked chickpeas and small pasta to a saucy sauté of diced onions, carrots, celery or fennel, zucchini, and stewed tomatoes and their juice.
•Oranges. That an orange easily fits in a purse or jacket pocket makes it one of my favorite snacks. Besides the famous vitamin C content, oranges are packed with soluble fiber. To get the most nutritional (and weight-loss) benefit, don’t peel off all the pith—the white substance beneath the peel. It’s got loads of pectin and almost as much vitamin C as the juicy fruit it covers.
•Agar. Unless you are really into baking or fancy cooking, agar (also called agar-agar) is the hydrophilic food you’re least likely to have in your pantry, but you might want to consider stocking it. It’s a gelling agent made from seaweed that has a whopping 80 percent soluble fiber with no fat and virtually no calories, carbs, or sugar. If you want a homemade sweet, agar is the perfect ingredient for making custards, puddings, and fruit gels. And it couldn’t be easier to use—just substitute it for gelatin in recipes.
Bon appétit to your health and waistline!
›Keren Gilbert, MS, RD, nutritionist and the founder and president of Decision Nutrition, a nutrition consulting firm in Great Neck, New York, and author of The HD Diet: Achieve Lifelong Weight Loss with Chia Seeds and Other Water-Absorbent Foods.
Suicide by Sugar
The phrase “addictive white powder” probably makes you think of illegal drugs. Add sugar to that addictive group. Americans consume vast quantities—and suffer withdrawal symptoms when they don’t get it. In fact, animal studies indicate that sugar is more addictive than cocaine.
Excess sugar has been linked to obesity, cancer, diabetes, and dementia.
SUGAR, SUGAR, EVERYWHERE
In the United States, the average person consumes about 142 pounds of sugar each year, the equivalent of forty-eight teaspoons a day. Of that amount, seventy-four pounds are added sugar—about twenty-three teaspoons every day. Added sugars are defined as those sugars added to foods and beverages during processing or home preparation as opposed to sugars that occur naturally.
People who want to cut back on sweeteners usually start with the sugar bowl. They spoon less sugar on their breakfast cereal, for example, or use a sugar substitute in their coffee.
This doesn’t help very much. The vast majority of added sugar in the diet comes from packaged foods, including foods that we think are healthful.
For example, eight ounces of one brand of sweetened apple yogurt contains 44 g of sugar, according to the nutrition facts label. Four grams equals one teaspoon, so that’s eleven teaspoons of sugar. (You cannot tell from the label how much sugar is from the yogurt, how much is from the apples, and how much is added sugar.)
Most of the added sugar that we consume comes from regular soft drinks (there are about ten teaspoons of sugar in twelve ounces of nondiet soda), candy, pies, cookies, cakes, fruit drinks, and milk-based desserts and products (ice cream, sweetened yogurt).
If you look carefully at ingredients labels, which list ingredients in order of quantity, you will see that the first two or three ingredients are often forms of sugar, but many have innocuous-sounding names, such as barley malt, galactose, and agave nectar. Other forms of sugar include honey, maple syrup, corn syrup, corn sweetener, dextrine, rice syrup, glucose, sucrose, and dextrose.
DANGEROUS IMBALANCE
The difference between sickness and health lies in the body’s ability to maintain homeostasis, the proper balance and performance of all of the internal functions. Excess sugar disturbs this balance by impairing immunity, disrupting the production and release of hormones, and creating an acidic internal environment.
It’s not healthy to maintain a highly acidic state. The body tries to offset this by making itself more alkaline. It does this, in part, by removing calcium and other minerals from the bones.
Result: People who eat too much sugar experience disruptions in insulin and other hormones. They have an elevated risk for osteoporosis due to calcium depletion. They also tend to have elevated levels of cholesterol and triglycerides (blood fats), which increase the risk for heart disease.
BREAK THE CYCLE
Sugar, like drugs and alcohol, is addictive because it briefly elevates levels of serotonin, a neurotransmitter that produces positive feelings. When a sugar addict doesn’t eat sugar, serotonin declines to low levels. This makes the person feel worse than before. He/she then eats more sugar to try to feel better, and the vicious cycle goes on.
For the best chance of breaking a sugar addiction, you need to ease out of it. This is usually more effective than going cold turkey. Once you’ve given up sugar entirely and the addiction is past, you’ll be able to enjoy small amounts of sugar if you choose, although some people find that they lose their taste for it. Here’s how to break the habit:
•Divide sugar from all sources in half. Do this for one week.
Examples: If you’ve been drinking two soft drinks a day, cut back to one. Eat half as much dessert. Eat a breakfast cereal that has only half as much sugar as your usual brand, or mix a low-sugar brand in with your higher-sugar brand.
•Limit yourself to one sweet bite. The second week, allow yourself to have only one taste of only one very sweet food daily. This might be ice cream, sweetened cereal, or a breakfast muffin. That small hit of sugar will prevent serotonin from dropping too low, too fast.
After about two weeks with little or no sugar, your internal chemistry, including levels of serotonin and other neurotransmitters, will stabilize at a healthier level.
•Eat fresh fruits and vegetables. These foods help restore the body’s natural acid-alkaline balance. This will help reduce sugar cravings and promote better digestion. Be sure to substitute fresh fruits for juices. Whole fruit is better, because the fiber slows the absorption of sugars into the bloodstream. The fiber is also filling, which is why few people will sit down and eat four oranges, the number you would need to squeeze to get one eight-ounce glass of juice.
Helpful: All fruits are healthful, but melons and berries have less sugar than other fruits.
›Nancy Appleton, PhD, a clinical nutritionist in San Diego. She is author, with G. N. Jacobs, of Suicide by Sugar: A Startling Look at Our #1 National Addiction.
Kick the Sugar Habit: Four-Week Plan
The average American consumes forty-eight teaspoons of added sugar per day. That’s right—forty-eight teaspoons a day.
We all know that sugar can lead to weight gain, but that’s just the beginning. People who eat a lot of sugar have nearly double the risk for heart disease as those who eat less, according to data from the Harvard Nurses’ Health Study. They’re more likely to develop insulin resistance and diabetes. They also tend to look older, because sugar triggers the production of advanced glycation end products (AGEs), chemical compounds that accelerate skin aging.
If you want to avoid these problems, it’s not enough to merely cut back on sugar. In my experience, patients need to eliminate it from their diets—at least at the beginning—just like addicts have to eliminate drugs from their lives. In fact, a study showed that sugar cravings are actually more intense than the cravings for cocaine.
You don’t have to give up sugar indefinitely. Once the cravings are gone, you can enjoy sweet foods again—although you probably will be happy consuming far less than before. After a sugar-free “washing out” period, you’ll be more sensitive to sweet tastes. You won’t want as much.
Bonus: Some people who have completed the four-week diet and stayed on the maintenance program for four or five months lost thirty-five pounds or more.
FIRST STEP: THREE-DAY SUGAR FIX
For sugar lovers, three days without sweet stuff can seem like forever. But it’s an essential part of the sugar detox diet, because when you go three days without any sugar, your palate readjusts. When you eat an apple after the three-day period, you’ll think it’s the sweetest thing you’ve ever tasted. You’ll even notice the natural sweetness in a glass of whole or 2 percent milk (which contains about three teaspoons of naturally occurring sugar).
You may experience withdrawal symptoms during the first three days. These can include fatigue, headache, fogginess, and irritability, but soon, you’ll feel better than you have in years.
Caution: If you have any type of blood sugar problem, including hypoglycemia, insulin resistance, or diabetes, you must consult your physician before starting any type of diet, including the sugar detox diet. In addition, if you are on insulin or an oral medication to control blood sugar, it is likely that your dosage will need to be adjusted if you lower your daily sugar intake.
During the three days, follow these guidelines:
•No foods or drinks with added sugar. No candy, cookies, cake, doughnuts, etc.—not even a teaspoon of sugar in your morning coffee.
•No artificial sweeteners of any kind, including diet soft drinks. Artificial sweeteners contribute to the sweetness overload that diminishes our ability to taste sugar.
•No starches. This includes pasta, cereal, crackers, bread, potatoes, and rice.
•No fruit, except a little lemon or lime for cooking or to flavor a glass of water or tea. I hesitate to discourage people from eating fruit, because it’s such a healthy food, but it provides too much sugar when you’re detoxing.
•No dairy. No milk, cream, yogurt, or cheese. You can have a little (one to two teaspoons) butter for cooking.
•Plenty of protein, including lean red meat, chicken, fish, tofu, and eggs.
•Most vegetables, such as asparagus, broccoli, cauliflower, celery, peppers, kale, lettuce, and more—but no corn, potatoes, sweet potatoes, winter squash, beets, or other starchy vegetables.
•Nuts—two one-ounce servings a day. Almonds, walnuts, cashews, and other nuts are high in protein and fat, both of which will help you feel full. Nuts also will keep your hands (and mouth) busy when you’re craving a sugary snack.
•Lots of water, but no alcohol. It’s a carbohydrate that contains more sugar than you might think. You can drink alcohol later (see below).
NEXT STEP: A FOUR-WEEK PLAN
This is the fun part. During the three-day sugar fix, you focused on not eating certain foods. Now you’ll spend a month adding tasty but nutritious foods back into your diet. You’ll continue to avoid overly sweet foods—and you’ll use no added sugar—but you can begin eating whole grains, dairy, and fresh fruits.
Week 1: Wine and cheese. You’ll continue to eat healthy foods, but you now can add one apple a day and one daily serving of dairy, in addition to having a splash of milk or cream in your coffee or tea if you like. A serving of dairy could consist of one ounce of cheese, five ounces of plain yogurt, or one-half cup of cottage cheese. You also can have one serving a day of high-fiber crackers, such as Finn Crisp Hi-Fibre or Triscuit Whole Grain crackers.
You also can start drinking red wine if you wish—up to three four-ounce servings during the first week. Other alcoholic beverages such as white wine, beer, and liquor should be avoided. Red wine is allowed because it is high in resveratrol and other antioxidants.
Week 2: More dairy, plus fruit. This is when you really start adding natural sugar back into your diet. You can have two servings of dairy daily if you wish and one serving of fruit in addition to an apple a day. You can have one-half cup of blackberries, blueberries, cantaloupe, raspberries, or strawberries each day. Or you can have a grapefruit half. You’ll be surprised how sweet fruit really is. You also are allowed one small sweet potato or yam (one-half cup cubed) daily.
Weeks 3 and 4: Whole grains and more. The third and fourth weeks are very satisfying, because you can start eating grains again. But make sure it’s whole grain. Carbohydrates such as white bread, white pasta, and white rice are stripped of their fiber during processing, so they are easily broken down into sugar. Whole grains are high in fiber and nutrients and won’t give the sugar kick that you would get from processed grains.
Examples: A daily serving of barley, buckwheat, oatmeal (not instant), quinoa, wholegrain pasta, whole-wheat bread, or brown rice.
You might find yourself craving something that’s deliciously sweet. Indulge yourself with a small daily serving (one ounce) of dark chocolate.
Deadly Diet Drinks
Drinking two or more diet sodas or diet fruit drinks a day resulted in a 30 percent greater risk for heart attack or stroke than rarely or never consuming these diet drinks, an eight-year observational study of nearly sixty thousand women (average age sixty-two) has found.
Theory: Diet sodas and diet fruit drinks (as well as the nondiet versions) have been linked to weight gain and metabolic syndrome, which raise risk for heart disease.
›Ankur Vyas, MD, cardiovascular diseases fellow, University of Iowa Health Care, Iowa City.
›Patricia Farris, MD, FAAD, clinical associate professor at Tulane University, New Orleans, and member of the media-expert team for the American Academy of Dermatology. She is coauthor, with Brooke Alpert, MS, RD, CDN, of The Sugar Detox: Lose the Sugar, Lose the Weight, Look and Feel Great.
Get Rid of Stubborn Belly Fat That Increases Diabetes Risk
Don’t count on the latest diet to shrink an expanding waistline. Belly fat is stubborn. Unlike fat in the thighs, buttocks, and hips, which visibly diminishes when you cut calories, belly fat tends to stick around. Even strenuous exercise might not make a dent.
The persistence of a belly bulge isn’t merely cosmetic. Beneath the subcutaneous fat that you can pinch with your fingers, fat deep in the abdomen is metabolically different from normal fat. Known as visceral fat, it secretes inflammatory substances that increase the risk for type 2 diabetes, as well as risk for heart attack and some cancers. Even if you’re not overweight, a larger-than-average waistline increases health risks.
Surprisingly, even thin people can have a high percentage of visceral fat. It might not be visible, but the risks are the same.
Weight-loss diets can certainly help you drop pounds, and some of that weight will come from the deep abdominal area. But unless you take a broader approach than the standard diet and exercise advice, it’s very difficult to maintain visceral fat reductions over the long haul. Here are better approaches to shrink your belly:
•Don’t stress over losing weight. Everyone knows about stress eating. After a fight with your spouse or a hard day at work, food can be a welcome distraction. What people don’t realize is that the struggle to lose weight may itself be highly stressful and that it can cause your belly fat to stick around.
How this happens: Cortisol, one of the main stress-related hormones, increases appetite and makes you less mindful of what you eat. It causes the body to store more fat, particularly visceral fat. People who worry a lot about their weight actually may find themselves eating more.
Take action to reduce stress by practicing yoga (see page 319), meditation, or tai chi (see page 183) for even just a few minutes a day. One study found that there was little or no obesity among more than two hundred women over age forty-five who had practiced yoga for many years. The key is regular practice—it’s better to do ten minutes of yoga a day than a ninety-minute class once a week.
Also helpful: Belly breathing. Sit up straight in a chair or lie down on your back, close your eyes, and tune into your breathing. Breathe in and out through your nose slowly and deeply but without straining. You’ll feel your belly gently moving out as you inhale and then in as you exhale.
This type of breathing is an effective form of stress control. Try it for one to five minutes once or twice a day or anytime you’re feeling stressed.
•Cultivate mindfulness in your everyday life. According to yoga and Ayurvedic medicine (a system of healing that originated in India), an overly busy mind can play as big a role in weight gain as diet or exercise. We all need to step back from the chaos of life and give our nervous system a chance to unwind. Take it one step at a time. Do less multitasking. Try to move a little more slowly and deliberately. Spend less time on the internet and watching television—especially when you’re eating. Although these activities may seem relaxing, they can stimulate the mind and the nervous system and lead to overeating.
Bonus: When you eat mindfully, you’ll enjoy your food more and need less to feel satisfied.
•Exercise, but don’t go crazy. Exercise, particularly aerobic exercise, can obviously be good for weight loss. But for many people, the intensity at which they exercise becomes yet another source of stress.
Example: One of my medical colleagues described a “type A” patient who was an exercise fanatic. Despite her strenuous fitness program, she had a stubborn ten pounds that she couldn’t get rid of. He suggested that she might have more luck if she’d simply relax a bit. She ignored his advice—until she broke a leg and had to take a break. The ten pounds melted away.
My advice: Get plenty of exercise, but enjoy it. Don’t let it be stressful—make it a soothing part of your day. Go for a bike ride, swim in a lake, or take a hike in nature. Exercise that is relaxing may burn just as many calories as a do-or-die gym workout but without the stress-related rise in cortisol.
Tip: If you’ve practiced belly breathing (see above), try to bring that kind of breath focus to your exercise. It’s even possible to slowly train yourself to breathe through your nose while you exercise, potentially lowering cortisol levels and the rebound hunger that is so common after a workout.
•Eat more fresh, unprocessed food. What really matters for health and healthy weight is the quality of your food. Many diets that have been shown to be effective—such as the low-fat vegetarian Ornish program, the Mediterranean diet, and some high-protein plans—disagree with one another, but they all emphasize old-fashioned unprocessed food.
My advice: Worry less about micronutrients such as specific vitamins, minerals, and types of fat or your protein/carbohydrate balance, and instead focus on eating more fresh vegetables, legumes, whole grains, fruit, nuts, and seeds. If you eat animal foods, choose free-range and pasture-raised meat and dairy products, organic if possible.
•Cut back on refined sugar. If you follow the advice above and avoid processed foods, you’ll naturally consume less sugar, refined grains (such as white bread), and other simple carbohydrates. This will help prevent insulin surges that can lead to more visceral fat.
As always, balance is important. I don’t advise anyone to give up all sources of sugar or all carbohydrates. After all, a plum is loaded with the sugar fructose—and fruits are good for you! It’s the added sugar in junk and fast food that’s the problem. Just be aware that any processed food—including many snacks that are marketed as healthier alternatives—will make it harder to control your weight.
›Timothy McCall, MD, an internist and medical editor of Yoga Journal. He is author of Yoga As Medicine: The Yogic Prescription for Health and Healing, in which he reports on the connection between stress and weight gain. DrMcCall.com.
Five Tricks to Make Yourself Exercise
Seven out of ten Americans can’t make exercise a habit, despite their best intentions and obvious health risks—especially diabetes. But you can learn to motivate yourself to make exercise a regular part of your life. Elite athletes as well as everyday people who have made a successful commitment to lifelong fitness use these insider tips. Here are their secrets:
•Make your first experience positive. The more fun and satisfaction you have while exercising, the more you’ll want to pursue it and work even harder to develop your skills. Even if your first experience was negative, it’s never too late to start fresh. Choose a sport you enjoy, and work to improve your skill level.
The key is finding a strong beginner-level coach who enjoys working with novices. For instance, the YMCA offers beginner swim lessons, and instructors are armed with strategies for teaching in a fun, nonintimidating way.
If your friends have a favorite dance class, play racquetball, or practice karate, ask them for a referral to an approachable teacher. City recreation departments also often host beginner-level classes for a variety of indoor and outdoor activities. You might also try a private lesson. The confidence you gain will motivate you to try it out in a group setting next.
•Focus on fun, not fitness. Forcing yourself to hit the gym four times a week sounds like a chore, and you’ll likely stop going before you have the chance to begin building your fitness level. But lawn bowling, dancing, Frisbee throwing, hiking, even table tennis—those all sound fun, and you’ll still be getting physical activity that helps promote weight control; reduced risk for heart disease, diabetes, and cancer; stronger bones; and improved mood. As you start to have more fun, you’ll want to become more involved, and your fitness level will improve over time.
No strategy is more crucial than this: Get hooked on the fun, and you’ll get hooked on the activity for life.
•Find your competitive streak. We all have one, and you can tap into it, no matter what activity you choose. Jogging outside? Make it a game by spotting landmarks in the near distance, like trees or homes, and push yourself to pass them in a certain number of seconds. Swimming laps? Try to match the pace of the slightly faster swimmer in the next lane. Or keep track of the time it takes to swim ten laps, and try to beat your time. Even riding the recumbent bicycle at the gym can be turned into a competition by moving your workout to the spin studio, where you can privately compete against other class members for pace or intensity.
•Practice the art of the con. If you’ve ever overheard a pair of weight lifters in the gym, you’ll recognize this tip. The spotter encourages the lifter, “One more, just one more!” and then after the lifter completes one more lift, the spotter again urges, “Now one more!” Make this tip work for you by learning how to self-con. Let’s say you’re too tired to work out. Tell yourself, I’ll just drive to the gym and park. If I’m still tired, I can leave.This is often enough to kick-start your workout. And while swimming laps, tell yourself you’ll just do five, then two more, then just three more.
•Cultivate a mind-set of continuous improvement. Tennis great Jimmy Connors once shared what keeps athletes motivated—“Getting better.” Lifelong exercisers have a yearning to improve that acts as both a motivator and a goal.
•Help yourself get better by educating yourself about your sport. To do this, read books by or about professional athletes, read articles about them in magazines, newspapers, and online, and even book a private lesson to have your running gait/golf swing/basketball shot analyzed.
Also, offer yourself rewards for hitting certain benchmarks. Treat yourself to a massage after your first three months of walking your dog nightly for thirty minutes, or book a trip to a luxury ski lodge to celebrate your first year of skiing. You earned it!
›Robert Hopper, PhD, a Santa Barbara–based exercise physiologist and author of Stick with Exercise for a Lifetime: How to Enjoy Every Minute of It!
Test (and Fix!) Your Fitness for a Long, Healthy Life
We all know that exercise is good for us, but some ways of exercising are particularly effective, and they don’t require time-consuming maneuvers or expensive equipment.
Are you out of breath after walking up a flight of stairs? Do you feel discomfort or pain when looking over your shoulder as you back up a car? Is it becoming difficult to reach the top shelves of closets? Or after having sat through a movie, do you feel pain or stiffness when you stand up? Any yes answer means that exercise would be especially beneficial for you.
TO INCREASE FLEXIBILITY
Test: Put one arm over your shoulder, and reach behind your back. Then bring your other arm up behind your back, and try to touch the fingers of the hand that went over your shoulder.
Goal: To increase the flexibility of your arms, especially your shoulders.
Exercise: The test is also an exercise. Perform it several times a day, holding the stretch for thirty seconds, then reversing your arms. Soon, your fingers will easily touch. At that point, it’s OK to reduce the frequency until you reach a level where you can consistently touch fingers.
Exercise for lower back and hamstring muscles: Sit toward the front of a chair with one leg stretched out straight with toes pulled toward you and the other leg bent to a right angle at the hip and knee. With one hand on top of the other, reach your hands toward the toes of the straight leg.
Important: If you have osteoporosis or have had an upper-back fracture, do not do this exercise.
FOR BETTER POSTURE
Test: Stand with your back as flush as possible against a wall and both heels touching it. When you’re in that position, does your head easily touch the wall? If it doesn’t, you could use some work on posture, which can be vital to overall physical health.
Goal: To improve posture as quickly as possible.
Exercise: Once or twice daily, sit in a supportive chair, chin tucked in toward your chest. Breathe in as you bend your elbows at your sides and close your fingers in a relaxed fist. Gently press your elbows back into the chair. Stay in that position for ten seconds as you continue to breathe deeply. Do not move. Breathe in again as you release the position slowly. Begin with three repetitions, and build to ten or twenty.
Once your head effortlessly touches a wall when you stand against it, you’ll know that your posture has improved. At that point, reduce the number of times you perform the exercise.
By experimenting with the frequency of the exercise, you can determine how many times you need to do it in order to maintain good posture. Keep in mind, however, that as you age, the number of times required will nearly always increase slightly from year to year.
FOR MORE STRENGTH
Test: In thirty seconds, how many times can you stand up from and sit down in a chair with your arms crossed on your chest?
Goal: Women between the ages of sixty and sixty-four should be able to stand and sit twelve to seventeen times in thirty seconds. Men of that age should be able to perform the task fifteen to twenty times. The benchmark drops slightly as your age increases.
Exercise: Perform the test two or three times a day until you can easily stand and sit within the benchmark range. Then do the exercise once every other day to keep in shape.
Also helpful: Unless you have problems with your hips and knees, walk up and down a flight of stairs two or three more times a day than you normally would.
To strengthen the arms, weighted dumbbells may be used. You should seek the guidance of a physical therapist before you start any weight training so that you perform the motions correctly and also use the correct amount of weight. An alternative to using weights is using elastic bands that can be cut into appropriate lengths for both arm and leg exercises. (See my book Age-Defying Fitness for many exercises with weights and elastic bands.)
Advantages of elastic bands: Unlike weights, there’s no danger in dropping an elastic band when you exercise. Also, you can easily take an elastic strip with you when you travel. TheraBand strips, about six inches wide, are available from many retailers that sell exercise equipment and from distributors.
How to do it: Run the elastic band under the seat of an armless chair from side to side. Sit in the chair, and hold one end of the band in each hand. Then raise your arms high over your head, stretching the band as you do so and also breathing out. Cut the TheraBand strip to a length that lets you perform a set of eight to twelve stretches before tiring. Perform one or two sets of these exercises three times a week.
FOR BETTER BALANCE
Test: Cross your arms on your chest, then see how long you can stand on one leg. Then test the other leg.
Goal: To remain standing for at least thirty seconds. If you can’t, your balance needs improving.
Exercise: Hold on to the counter with one hand and stand on your toes. Then bend one knee back so that you’re standing on your toes with one leg. After doing it only a few times, you may not need to hold on to the counter with your hand. Also try to rise up and down on your toes five to ten times while standing on one leg.
TO INCREASE ENDURANCE
Test: Assuming that you do not have any heart or lung problems, try to march in place for two minutes, bringing your knees about halfway up to the level of your hips. Count only the number of times you bring your right knee up.
Goal: In two minutes, women ages sixty to sixty-four should be able to bring up the right knee between 75 and 107 times. For men of that age, the benchmark is between 87 and 115 times.
Exercise: March in place several times a week, slowly increasing the number of steps you take in each two-minute period. Traditional exercises, such as walking, running, and bicycling, are also effective in building up endurance. Or use a treadmill or stationary bike. Whatever your choice of endurance exercise, you should gradually build up to thirty to forty-five minutes each session anywhere from three to seven days a week.
GETTING STARTED
Note: If you’re new to exercise, consult a physical therapist who will guide you through an appropriate exercise program. If you have heart, blood pressure, or lung problems, also consult your physician before starting the program. To find a physical therapist, contact the American Physical Therapy Association or your state’s physical therapy association.
›Marilyn Moffat, PhD, PT, a professor of physical therapy at New York University in New York City and a former president of the American Physical Therapy Association. She is coauthor of Age-Defying Fitness.
If You’re Starting to Exercise, Expect to Be Miserable
We all know that exercise is perhaps the single most beneficial action we can take to protect our health. So why are two of every three American adults still sedentary—meaning they get little or no exercise?
LIVE THREE YEARS LONGER!
Most people who want to start exercising do so because it’s good for them. But to stay motivated, you should know exactly why you want to start exercising.
For example, compared with people who exercise regularly, sedentary people are three times more likely to develop metabolic syndrome—a constellation of risk factors including high blood pressure (hypertension), elevated LDL “bad” cholesterol, high blood sugar, and obesity. Regular physical activity also has been found to reduce risk for cognitive decline.
And if that doesn’t keep you motivated, consider this: People who regularly exercise briskly live an average of three years longer than those who are sedentary. “Briskly” means exercising at an intensity that makes you perspire and breathe a little heavily while still being able to carry on a conversation. This is known as the talk test.
HOW MUCH EXERCISE?
It’s a common misconception that you must exercise daily to achieve significant health benefits.
In a study of ten thousand men and three thousand women conducted at the Cooper Aerobics Center’s clinic, we found that walking just two miles in less than thirty minutes three days a week is all that’s needed to achieve a moderate level of fitness, which lowers risk for all causes of death and disease.
For a less demanding workout that confers the same benefits, you could walk two miles in thirty-five minutes four days a week, or walk two miles in forty minutes five days a week. If you prefer other forms of exercise, such as biking or swimming, use these frequency guidelines, plus the talk test (described above) to achieve a moderate fitness level. By increasing the frequency and/or intensity, you’ll achieve even greater health benefits.
HIT THE SIX-WEEK MARK
If you have not exercised regularly in the last six months and/or are overweight (for women, having a waist size of thirty-five inches or more; for men, forty inches or more), the basic exercise requirement described above may be too much. You may want to start by walking only to the end of the block for a few days, then gradually increase the distance. Aim for an increase of up to 10 percent weekly—for example, from ten minutes per week to eleven minutes the next week and so on.
Helpful: Expect the first few weeks to be miserable—you’ll feel some muscle soreness for a while. Accept it—but make the commitment to keep going.
Important: If your muscle pain doesn’t go away within several weeks, see your doctor to rule out an underlying condition, such as arthritis.
We’ve found at the Cooper Aerobics Center that few people quit after they’ve performed a program of physical activity for six weeks. Once people reach the four to six-month mark, adherence to an exercise program approaches 100 percent for the long term.
DETERMINE YOUR BASELINE
If you’ve been sedentary, be sure to get a comprehensive medical checkup before starting an exercise program. This is particularly important for men age forty and older and women age fifty and older—cardiovascular disease risk rises at these ages.
People of any age with underlying health problems or a family history of diabetes, hypertension, high cholesterol, or heart disease also should get a checkup before starting to exercise.
Ask your doctor—or a fitness trainer—to give you baseline measurements for strength, flexibility, and aerobic capacity, which will enable you to track future changes.
Checking these measurements (along with such markers as blood pressure, cholesterol, and blood sugar) again in about three months will give you tangible evidence of your progress and can motivate you to keep exercising.
›Tyler C. Cooper, MD, MPH, a preventive medicine specialist at the Dallas-based Cooper Aerobics Center (CooperAerobics.com) and founder of Cooper Ventures, which helps people incorporate healthy living into every aspect of their lives. He is coauthor, with his father, Kenneth H. Cooper, MD, MPH, founder and chairman of Cooper Aerobics Center, of Start Strong, Finish Strong.
You Can Exercise Less and Be Just as Healthy
Do you struggle to fit the recommended amount of exercise into your busy schedule? Well, what if we told you that the amount of exercise needed to reap health benefits might be less than you think? Maybe you could free up some of your workout time for other activities that are important to you and beneficial to your health—like playing with your kids or grandkids, volunteering for a favorite charity, or cooking healthful meals.
THE LATEST IN EXERCISE RESEARCH
A recent study published in the Journal of the American College of Cardiology found that people lived longest when they ran, on average, for thirty minutes or more, five days a week. Surprisingly, that research also showed that people who jogged at an easy pace for as little as five to ten minutes a day had virtually the same survival benefits as those who pushed themselves harder or longer.
Also surprising: A study recently done at Oregon State University found that one and two-minute bouts of activity that add up to thirty minutes or more per day, such as pacing while talking on the telephone, doing housework, or doing sit-ups during TV commercials, may reduce blood pressure and cholesterol and improve health as effectively as a structured exercise program.
HOW TO EXERCISE SMARTER, NOT HARDER
Here are four strategies to help you exercise more efficiently:
•Recognize that some exercise is always better than none. Even though exercise guidelines from the Centers for Disease Control and Prevention (CDC) call for at least 150 minutes of moderate exercise each week, you’ll do well even at lower levels.
A study in The Lancet found that people who walked for just fifteen minutes a day had a 14 percent reduction in death over an average of eight years. Good daily exercises include not only walking but working in the yard, swimming, riding a bike, etc.
If you’re among the multitudes of Americans who have been sedentary in recent years, you’ll actually gain the most. Simply making the transition from horrible fitness to below average can reduce your overall risk for premature death by 20 to 40 percent.
•Go for a run instead of a walk. The intensity, or associated energy cost, of running is greater than walking. Therefore, running (or walking up a grade or incline) is better for the heart than walking—and it’s easier to work into a busy day, because you can get equal benefits in less time.
For cardiovascular health, a 5-minute run (5.5 mph to 8 mph) is equal to a 15-minute walk (2 mph to 3.5 mph), and a 25-minute run equals a 105-minute walk.
A 2014 study of runners found that their risk of dying from heart disease was 45 percent lower than nonrunners over a fifteen-year follow-up. In fact, running can add, on average, three extra years to your life.
Caution: If you take running seriously, you should still limit your daily workouts to sixty minutes or less, no more than five days a week. (See below for the dangers of overdoing it.) People with heart symptoms or severely compromised heart function should avoid running. If you have joint problems, check with your doctor.
•Ease into running. Don’t launch into a running program until you’re used to exercise. Make it progressive. Start by walking slowly, say, at about 2 mph. Gradually increase it to 3 mph, then to 3.5 mph, etc. After two or three months, if you are symptom-free during fast walking, you can start to run (slowly at first).
•Aim for the “upper-middle.” I do not recommend high-intensity workouts for most adults. Strive to exercise at a level you would rate between “fairly light” and “somewhat hard.”
How to tell: Check your breathing. It will be slightly labored when you’re at a good level of exertion. Nevertheless, you should still be able to carry on a conversation.
Important: Get your doctor’s OK before starting vigorous exercise, and don’t ignore potential warning symptoms. It’s normal to be somewhat winded or to have a little leg discomfort. However, you should never feel dizzy, experience chest pain, or have extreme shortness of breath. If you have any of these symptoms, stop exercise immediately, and see your doctor before resuming activity.
TOO MUCH OF A GOOD THING?
Most people who run for more than an hour a day, five days a week, are in very good shape. Would they be healthier if they doubled the distance or pushed themselves even harder? Not necessarily. Risks linked to distance running include:
•Acute right-heart overload. Researchers at William Beaumont Hospital who looked at distance runners before and immediately after marathon running found that they often had transient decreases in the pumping ability of the right ventricle and elevations of the same enzymes (such as troponin) that increase during a heart attack.
•Atrial fibrillation. People who exercise intensely for more than five hours a week may be more likely to develop atrial fibrillation, a heart-rhythm disturbance that can trigger a stroke.
•Coronary plaque. Despite their favorable coronary risk factor profiles, distance runners can have increased amounts of coronary artery calcium and plaque as compared with their less active counterparts.
Watch out: Many hardcore runners love marathons, triathlons, and other competitive events. Be careful. The emotional rush from competition increases levels of epinephrine and other stress hormones. These hormones, combined with hard exertion, can transiently increase heart risks.
Of course, all this doesn’t mean that you shouldn’t enjoy a daily run or a few long ones—just don’t overdo it!
›Barry A. Franklin, PhD, director of cardiac rehabilitation at William Beaumont Hospital in Royal Oak, Michigan. He is also coauthor, with Joseph C. Piscatella, of 109 Things You Can Do to Prevent, Halt & Reverse Heart Disease.
Strength Training for Beginners—No Gym Needed
Strength training not only builds muscles, it also improves bone density, speeds up metabolism, promotes balance, and even boosts brain power. You’ll also gain mobility, says Cedric X. Bryant, PhD, chief science officer at the American Council on Exercise, who designed the workout below. Translation: this routine will help make everyday movements—such as getting in and out of a car, reaching overhead, bending, and climbing stairs—much easier for you.
And not to worry—you won’t be straining under heavy barbells. All the exercises below use just your own body weight or a simple elastic tube for resistance.
Recommended: Opt for a light-resistance tube with handles, available at sporting goods stores and online.
What to do: Get your doctor’s OK first, as you should before beginning any new exercise routine. Perform eight to fifteen reps of each of the following moves two to three times per week on nonconsecutive days—muscles need a day between workouts to repair and strengthen, Dr. Bryant notes. Always move in a slow, controlled fashion, without jerking or using momentum. When you can easily do fifteen reps of a particular exercise, advance to the “To progress” variation.
NO-EQUIPMENT-NEEDED EXERCISES
•Wall squat—for legs and buttocks.
Start: Stand with head and back against a wall, arms at sides, legs straight, feet hip-width apart and about eighteen inches from wall.
Move: Keeping head and torso upright and your back firmly pressed against the wall, bend knees and slide down the wall about four to eight inches. Knees should be aligned above ankles—do not allow knees to extend past toes. Hold for several seconds. Then, using thigh and buttock muscles, straighten legs and slide back up wall to the start position. Repeat.
To progress: Bend knees more, ideally to a 90° angle so thighs are parallel to floor, as if sitting in a chair.
•Wall push-up—for chest, shoulders, and triceps.
Start: Stand facing a wall, feet hip-width apart and about eighteen inches from wall. Place hands on wall at shoulder height, slightly wider than shoulder-width apart.
Move: Tighten abdominal muscles to brace your midsection, keeping spine and legs straight throughout. Slowly bend elbows, bringing face as close to wall as you can. Hold for one second, then straighten arms and return to the start position. Repeat.
To progress: Start with feet farther from wall, and bring face closer to wall during push-up.
•Supine reverse march—for abdominals, lower back, and hips.
Start: Lie face up, knees bent, feet flat on floor, arms out to sides in a T position, palms up, abs contracted.
Move: Slowly lift left foot off floor, keeping leg bent. Bring knee up and somewhat closer to torso. When left thigh is vertical to floor, stop moving and hold for five to ten seconds. Then slowly lower leg and return foot to floor. Repeat. Switch legs.
To progress: As knee moves upward, raise both arms toward ceiling. Lower arms as leg lowers.
MOVES WITH TUBES
•Seated row—for back, abs, and biceps.
Start: Sit on floor, torso upright, legs out in front of you, knees slightly bent, feet together. Place center of elastic resistance tube across soles of feet and hold tube handles in hands, arms extended in front of you, elbows straight.
Move: Bending elbows, slowly pull handles of tube toward chest (do not lean backward, arch back, shrug shoulders, or bend wrists). Hold for several seconds, then slowly straighten arms and return to the start position. Repeat.
To progress: To increase resistance, rather than placing center of tube across soles of feet, anchor it firmly around an immovable object one to three feet in front of you.
•Lateral raise—for shoulders.
Start: Stand with feet hip-width apart, anchoring center of elastic resistance tube under both feet. Hold tube handles in hands, arms down at sides.
Move: Keeping elbows very slightly bent and wrists straight, slowly lift arms out to sides so palms face floor and hands reach shoulder height (or as high as you can get them). Lower arms to the start position. Repeat.
To progress: To increase resistance, widen your stance on the tubing.
›Cedric X. Bryant, PhD, the chief science officer for the American Council on Exercise. He has written more than 250 articles and columns in fitness magazines and exercise science journals and is author or coauthor of more than thirty books, including Strength Training for Women. AceFitness.org, twitter.com/DrCedricBryant.
Take the Stairs!
Until recently, fitness gurus have advised people to take the stairs mainly as a substitute for do-nothing elevator rides.
Now: Stair-climbing is becoming increasingly popular as a workout that’s readily accessible (stairs are everywhere), often climate-controlled (indoor stairs), and free.
It burns more calories than walking, strengthens every muscle in the legs, and is good for your bones as well as your cardiovascular system. It may even extend your life span.
Compelling research: A study found that participants who averaged eight flights of stairs a day had a death rate over a sixteen-year period that was about one-third lower than those who didn’t exercise and more than 20 percent lower than that of people who merely walked.
A CONCENTRATED CLIMB
Walking is mainly a horizontal movement, with an assist from forward momentum. Stair-climbing is a vertical exercise. Your body weight is lifted straight up, against gravity. Climbing stairs also involves more muscles—in the calves, buttocks, and the fronts and backs of the thighs—than walking. Even the arms get a workout. Canadian researchers found that it required double the exertion of walking on level ground and 50 percent more than walking up an incline.
As a weight-loss tool, stair-climbing is hard to beat. An hour of climbing (for a 160-pound person) will burn about 650 calories. That compares with 400 calories an hour for a fifteen-minute-mile power walk and 204 calories for a leisurely stroll.
IT’S EASY TO START
Inconvenience is one of the biggest barriers to exercise. It sometimes feels like a hassle to change into workout clothes and drive to a health club or even exercise at home. But you can always find a set of stairs—in your neighborhood, at work, at the mall, or at home.
You don’t need fancy workout gear to climb stairs (uncarpeted stairs are preferred). Because it doesn’t involve side to side movements, you don’t necessarily need to invest in specialized shoes. You can do it in any pair of athletic shoes or even work shoes, as long as they don’t have high heels.
HOW TO CLIMB
When getting started, begin with a single flight of stairs. When that feels easy, take additional flights or increase the intensity by going a little faster. Work up to five minutes, then slowly increase that to ten, fifteen and twenty minutes, if possible, three times a week. Here are some other tips:
•Keep your upper body straight. There’s a natural tendency to lean forward when you climb stairs, particularly because a forward-leaning position feels easier. Remind yourself to stand straight when you’re climbing and descending. It will give your legs a better workout, strengthen your abdominal and other core muscles, and help improve your balance.
•Swing your arms. You don’t need an exaggerated swing, but keep your arms moving—it helps with balance and provides exercise for your arms and shoulders. You’ll often see stair-climbers with their hands or arms on the rails. It’s OK to use the rails if you need the support, but it reduces the intensity of the exercise. It also causes the stooped posture that you want to avoid.
•One step at a time. Unless you’re a competitive stair-climber, you’ll probably do best by taking just one step at a time. Ascending stairs is a concentric exercise that increases muscle power; it’s also the part of the workout that gives most of the cardiovascular benefit. Coming down the stairs is an eccentric (also called negative) movement that puts more stress on the muscles and increases strength.
Important: Descend the stairs slowly, and keep jolts to a minimum. It sounds counterintuitive, but the descents cause more muscle soreness than the climbs.
You can take two steps at a time on the ascent if your balance is good and you’re bored with single-step plodding. The faster pace will increase the intensity of your workout, particularly when you give your arms a more exaggerated swing. To minimize jolt and maximize safety, however, stick to single steps on the descent.
TO END YOUR WORKOUT
The “Figure 4 Stretch” is a great way to conclude a stair-climbing workout. It stretches the calves, hamstrings, gluteals, low back, and upper back.
What to do: While sitting on the floor with your right leg straight, bend your left leg so that your left foot touches your right thigh, making a 4. Slowly reach your right hand toward your right foot. Then grasp your foot, ankle, or lower leg, and hold for twenty seconds. Repeat on the other side.
Caution: Stair-climbing should be avoided if you have serious arthritis or other joint problems. It’s less jarring than jogging, but it’s still a weight-bearing exercise that can stress the joints. People with joint issues might do better with supported exercises, such as cycling, rowing, or swimming.
Before taking up stair-climbing as a form of exercise, check with your doctor if you’re middle-aged or older, have arthritis or a history of heart or lung disease, or if you’ve been mainly sedentary and aren’t confident of your muscle strength—or your sense of balance.
STAIR-STEPPING WITHOUT A STAIRCASE
If you want to climb stairs without using a staircase, consider buying a commercial stepper, such as those from StairMaster. Some have components that work the arms as well as the legs. Stair-steppers, however, don’t provide the benefit of actual stair-climbing, which uses more muscles because of the descent. These machines can be costly (at least $2,500 for a new one but much less for a used one on Craigslist or eBay). They typically hold up for years of hard use.
Caution: I don’t recommend mini-steppers that sell for as little as fifty dollars. They have hydraulics, bands, or other systems that cause the steps to go up and down, but the equipment usually breaks quickly.
›Wayne L. Westcott, PhD, a professor of exercise science at Quincy College in Quincy, Massachusetts, and a strength-training consultant for the American Council on Exercise and the American Senior Fitness Association. He is also coauthor of several books, including Strength Training Past 50.
Seven Mistakes That Can Sabotage Your Walking Workout
We all know that walking is very good for us. Studies have shown that walking promotes heart health, strengthens bones, spurs weight loss, boosts mood, and even cuts risk for diabetes, cancer, and Alzheimer’s.
But what most people don’t realize is that they could significantly improve the health benefits of their walks by tweaking their walking techniques and using the right equipment.
Here are common walking mistakes—and what you should be doing instead.
Mistake #1: Tilting forward. Some walkers tilt their upper bodies forward, as though they’re walking into the wind. They think that this position increases speed. It does not—and it greatly increases pressure on the lower back while straining the shins.
Better: Walk with your head high and still, shoulders relaxed, and chest slightly out. In this position, you can rotate your eyes downward to survey the path and look ahead to view the scenery around you.
Mistake #2: Swinging the arms inefficiently. Many walkers waste energy by swinging their arms side to side or pumping their arms up and down. These exaggerated movements add little to cardiovascular fitness and make walking less efficient, because arm energy is directed upward or sideways rather than straight ahead.
Better: For maximum efficiency, pump your arms straight ahead on a horizontal plane, like you’re reeling in a string through your midsection. This motion improves balance, posture, and walking speed.
Mistake #3: Using hand and/or ankle weights. While some people like to walk with weights to boost the intensity of a walking workout, the risk for injury far outweighs the benefits of using weights. The repetitive stress of swinging weights can cause microtears in the soft tissues of the arms and legs.
Better: To increase exertion, walk uphill or on an inclined treadmill.
Another good option: Try Nordic walking for a total-body workout. With this type of walking, you use specially designed walking poles (one in each hand) to help propel your body forward.
Compared with regular walking, Nordic walking can increase your energy expenditure by 20 percent, according to a study from the Cooper Institute. It works the abdominal, arm, and back muscles and reduces stress on the feet, ankles, knees, and hips while improving endurance.
Mistake #4: Not doing a warm-up. You’re inviting muscle soreness and potential injury if you hit your top speed at the start.
Better: Be sure to warm up. Start slowly, accelerating over the first five to ten minutes, and end slowly, decelerating over the last five minutes. A slow start allows your muscles to warm up and become flexible, while enabling your cardiorespiratory system to get used to higher workloads. A proper cooldown helps eliminate the buildup of lactic acid, which can lead to muscle soreness.
Mistake #5: Doing the same walk every day. It’s best to alter your routine for maximum health benefits and to maintain motivation.
Better: Do shorter, faster-paced walks some days (cardiovascular conditioning) and longer, moderate-paced walks on other days (calorie burning). Also try walks on steeper terrains and walks that alternate faster intervals with slower intervals.
Mistake #6: Not keeping a walking log or journal. Every day, indicate how far and fast you walked and any other observations you wish to record in a notebook or on your computer. Keeping a journal helps foster a sense of accomplishment and self-esteem and is the single most effective method for ensuring that you’ll stick to a walking program.
Mistake #7: Choosing cushy shoes. A study in the American Journal of Sports Medicine found that, on average, expensive, high-tech footwear caused twice the injuries as shoes costing half as much.
Some high-priced, cushiony shoes can make you feel as if you’re walking on a foam mattress, but they have an inherent wobble that can cause your foot to move side to side, leading to potential foot, ankle, knee, and hip injuries.
What to do: In addition to walking regularly, start a core-muscle strengthening regimen and a stretching program to tone your hip and leg muscles.
›Robert Sweetgall, president of Creative Walking, a McCall, Idaho, company that designs walking and fitness programs for schools, corporations, and other clients. He is the only person to have walked through all fifty states in 365 days, and he has walked/run across the United States seven times. Sweetgall is coauthor, with Barry Franklin, PhD, of One Heart, Two Feet: Enhancing Heart Health One Step at a Time. CreativeWalking.com.
Win the Inner Game of Stress
Stress creates unproductive panic, inhibits creative thought, contributes to chronic illness, and is just plain exhausting. But no matter what’s going on in our lives, we can tap into our inner resources to keep stress from doing its damage.
Different strategies work for different people. Below are some of the most effective ones.
THE INNER GAME
We all are playing an inner game whether we recognize it or not. That means that while we are all involved in outer games (overcoming obstacles in the outside world to reach our goals), we are at the same time faced with inner obstacles, such as fear, self-doubt, frustration, pain, and distractions. These inner obstacles prevent us from expressing our full range of capabilities and enjoying our time to the utmost.
The secret lies in knowing that you have choices about how you look at external events, how you define them, how you attribute meaning to them, and how you react to them mentally and emotionally. The key is to recognize that every person has the internal wisdom to bypass the frustrations and fears that pull them into the negative cycle of stress.
BECOME YOUR OWN CEO
Feeling powerless and victimized is among the most common sources of stress. You’re likely to feel more in control if you consider yourself the CEO of your life. To do so:
•Write a mission statement. What is the primary mission of your life?
Examples: To create prosperity for myself and my family, to pay attention to my inner life as well as my achievements, to help others in my work or personal life.
•Identify your main product or service. What do you provide to others? These could be specific to a particular business or profession.
Example: As a doctor, my services would include being up-to-date in my knowledge, knowing the best specialists to refer a patient to, seeing patients quickly.
•List your company’s resources. Include both internal resources—positive personal traits, such as your compassion, intelligence, and humor—and external resources—your financial assets, friends, and possessions. Ask yourself whether you are getting as much from each of these resources as you could.
LOST CONTROL?
Consider whether you have given up too much control of your corporation. What would it cost to buy back some of your shares?
Example: Did you sell too many shares of yourself for your big home? If massive mortgage payments fill you with stress—or force you to remain in a job that fills you with stress—perhaps you should move into a smaller home and take back those shares.
This CEO thought process serves as a reminder that we are not helpless. Your life is yours, and you get to decide everything. It is always your choice, even if you decide to comply with the wishes of someone else. Once you become aware of the limits that you place on your choices, your freedom will evolve, and your stress will ease.
REGAINING CONTROL
Trying to control things that are outside our control is enormously stressful—yet many of us unwittingly do this. When you feel stressed, consider:
What don’t I control here?
What am I trying to control here?
What could I control here that I’m not currently controlling?
Confronting these questions can help us focus on things that we can accomplish and reduce our stress over things that we cannot.
Example: When a man who is stressed over his wife’s poor health asks himself these questions, he realizes that her health is not something that he can control, so he should stop trying to. What he can control is his attitude toward life. By remaining upbeat, he can help his wife remain upbeat.
THE MAGIC PEN
Select a stress-causing situation in your life, then write down your usual inner dialog on this subject. Once you have written everything that comes to mind, take out a new piece of paper, and imagine that your pen has been magically endowed with one of your positive inner resources. This resource might be your clarity, compassion, candor, serenity, or patience—any trait that you consider a personal strength. Try to empty your mind of all thought, then let your magic pen write a message to you about this stressful subject. Don’t censor the pen—let it write everything.
Example: A man feels guilty about his grown son, who can’t find direction in life. If he endowed his pen with his compassion, the pen might write that he did his best to raise his son and that his son is doing his best to live his life.
›John Horton, MD, a physician specializing in preventive medicine and stress, Westlake Village, California. He is coauthor, with sports psychologist W. Timothy Gallwey and stress expert Edd Hanzelik, MD, of The Inner Game of Stress: Outsmart Life’s Challenges and Fulfill Your Potential.
Yoga Can Change Your Life!
Not that long ago, yoga was viewed primarily as an activity for “youngish” health nuts who wanted to round out their exercise regimens.
Now: Older adults—meaning people in their sixties, seventies, eighties, and beyond—are among the most enthusiastic practitioners of this ancient healing system of exercise and controlled breathing.
YOGA GOES MAINSTREAM
Virtually everyone can benefit from yoga. Unfortunately, many people are reluctant to try it because they assume that it’s too unconventional and requires extreme flexibility. Neither belief is true.
What’s more, its varied health benefits are largely what’s making the practice so popular now with older adults. More than one thousand scientific studies have shown that yoga can improve conditions ranging from arthritis, asthma, insomnia, and depression to heart disease, diabetes, and cancer.
You look better too: Yoga is quite useful in helping to prevent rounding (or hunching) of the back, which occurs so often in older adults. This condition can lead to back pain and breathing problems as the rib cage presses against the lungs.
My experience: After teaching yoga to thousands of students, I’m continually amazed at how many tell me that it has literally changed their lives by helping them feel so much better physically and mentally.
GETTING STARTED
If you want to see whether you could benefit from yoga, ask your doctor about trying the following poses, which address common physical complaints. These poses are a good first step before taking a yoga class.* Yoga is best performed in loose, comfortable clothing and in your bare feet, so your feet won’t slip. Try these poses:
•Knees to chest pose. For low back pain and painful, tight hips.
What to do: Lie on your back (on carpet or a yoga mat, available at sports-equipment stores for about twenty-five dollars). With your arms, hug both knees in to your chest. Keep your knees together and your elbows pointing out to each side of your body. Slowly rock from elbow to elbow to massage your back and shoulders. Take deep, abdominal breaths while holding your thighs close to your chest, and hold for six complete inhales and exhales.
•Mecca pose. This pose also relieves back pain.
What to do: Begin by kneeling on the floor with your knees together. For added comfort, place a small towel behind your knees. Sit back on your feet, and lean forward from your waist so that your chest and stomach rest atop your thighs. Reach your arms out in front of you, resting your forehead to the floor while stretching your tailbone to your heels. Hold for six complete inhales and exhales.
•Leg rotation. For sciatica, a cause of back, pelvic, and leg pain.
What to do: Lie on your back with both legs extended. Slowly bring your right knee to your chest and inhale. Rest your right ankle on the front of your left thigh, and exhale as you slowly slide it down along your left knee, shin, and ankle to toes. This helps “screw” the top of your right thighbone into the hip socket, easing lower back and leg pain. Repeat on other side. Do three times on each side.
To conclude your session: While in a sitting position, press your palms together. Bring your thumbs into your breastbone. Tuck your elbows in and down, and press your breastbone to your thumbs, lifting and opening your chest. Hold for six breaths.
Important: Even when you’re not doing yoga, don’t forget your breath. Slow, thoughtful, deep breathing is most effective, but don’t perform it too quickly. I find the technique to be most effective when you hold the inhalation and exhalation for a certain number of counts.
What to do: Lie on your back, resting your hands on your belly so that your middle fingers touch across your navel. Inhale through your nose for a count of six, pushing your navel out so that your fingertips separate. Pause, then exhale for a count of nine, pulling your navel back in. Perform these steps two more times (more may make you dizzy). Do this in the morning and at night (deep breathing improves mental focus and can be energizing in the morning and calming at night).
›Mary Louise Stefanic, a certified yoga and qigong instructor with a focus on therapeutic yoga. Ms. Stefanic is a staff member at the Loyola Center for Fitness and Loyola University Health System, both in Maywood, Illinois. She has been teaching yoga since 1969.
Dangers of Sleep Apnea
Doctors have long known that obstructive sleep apnea (repeated interruptions in breathing during sleep) can harm the overall health of men and women who suffer from the condition.
Now: Recent research shows that sleep apnea is even more dangerous than experts had previously realized, increasing the sufferer’s risk for heart attack, stroke, diabetes, and fatal car crashes.
NO ROOM TO BREATHE
Sleep apnea occurs about twice as often in men as in women, but it is overlooked more often in women. An estimated 70 percent of people with sleep apnea are overweight. Fat deposited around the neck (men with sleep apnea often wear a size seventeen or larger collar, while women with the disorder often have a neck circumference of sixteen inches or more) compresses the upper airway, reducing air flow and causing the passage to narrow or close. Your brain senses this inability to breathe and briefly awakens you so that you can reopen the airway.
The exact cause of obstructive sleep apnea in people of normal weight is unknown, but it may involve various anatomical characteristics, such as having a narrow throat and upper airway.
Red flag #1: About half of all people who snore loudly have sleep apnea. One telling sign is a gasping, choking kind of snore, during which the sleeper seems to stop breathing. (If you live alone and don’t know whether you snore, ask your doctor about recording yourself while you are sleeping to check for snoring and other signs of sleep apnea.)
Red flag #2: Daytime sleepiness is the other most common symptom. Less common symptoms include headache, sore throat and/or dry mouth in the morning, sexual dysfunction, and memory problems.
DANGERS OF SLEEP APNEA
New scientific evidence shows that sleep apnea increases risk for the following:
•Cardiovascular disease. Sleep apnea’s repeated episodes of interrupted breathing—and the accompanying drop in oxygen levels—takes a toll on the heart and arteries.
Recent finding: Heart attack risk in sleep apnea sufferers is 30 percent higher than normal over a four-to five-year period, and stroke risk is twice as high in people with sleep apnea.
•Diabetes. Sleep apnea (regardless of the sufferer’s weight) is linked to increased insulin resistance—a potentially dangerous condition in which the body is resistant to the effects of insulin.
Recent finding: A Yale study of 593 patients found that over a six-year period, people diagnosed with sleep apnea were more than two and a half times more likely to develop diabetes than those without the sleep disorder.
•Accidents. Sleep apnea dramatically increases the risk for a deadly mishap due to sleepiness and impaired alertness.
Recent finding: A study of sixteen hundred people, presented at an American Thoracic Society meeting, found that the eight hundred sleep apnea sufferers were twice as likely to have a car crash over a three-year period. Surprisingly, those who were unaware of being sleepy were just as likely to crash as those who were aware of being sleepy.
DO YOU HAVE SLEEP APNEA?
If you think you may have sleep apnea, see a specialist at an accredited sleep center, where a thorough medical history will be taken and you may be asked to undergo a sleep study. This involves spending the night in a sleep laboratory where your breathing, oxygen level, movements, and brain wave activity are measured while you sleep.
BEST TREATMENT OPTIONS
The treatment typically prescribed first for sleep apnea is continuous positive airway pressure (CPAP). A stream of air is pumped onto the back of the throat during sleep to keep the airway open. The air is supplied through a mask, most often worn over the nose, which is connected by tubing to a small box that contains a fan.
In recent years, a larger variety of masks have become available, and fan units have become smaller and nearly silent. A number of adjustments may be needed, which may require trying several different devices and more than one visit to a sleep lab.
Other treatments for sleep apnea are usually prescribed to make CPAP more effective, or for people with milder degrees of the disorder who have tried CPAP but were unable or unwilling to use it.
These treatments include:
•Mouthpieces. Generally fitted by a dentist and worn at night, these oral appliances adjust the lower jaw and tongue to help keep the airway open.
•Surgery. This may be recommended for people who have an anatomical abnormality that narrows the airway and for whom CPAP doesn’t work. The most common operation for sleep apnea is uvulopalatopharyngoplasty (UPPP), in which excess tissue is removed from the back of the throat. It works about 50 percent of the time.
HELPING YOURSELF
Several measures can make sleep apnea treatment more effective and, in some cases, eliminate the condition altogether. Try these suggestions:
•Lose weight, if you are overweight. For every 10 percent of body weight lost, the number of apnea episodes drops by 25 percent.
•Change your sleep position. Sleeping on your side—rather than on your back—typically means fewer apnea episodes. Sleeping on your stomach is even better. Some obese people who have sleep apnea do best if they sleep while sitting up.
•Avoid alcohol. It relaxes the muscles around the airway, aggravating sleep apnea.
•Use medication carefully. Sleep medications can worsen sleep apnea by making it harder for your body to rouse itself when breathing stops. If you have sleep apnea, make sure a doctor oversees your use of sleep medications (including over-the-counter drugs).
›Ralph Downey III, PhD, D, ABSM, adjunct associate clinical professor of medicine and past chief, sleep medicine, Loma Linda University Medical Center, Loma Linda University Children’s Hospital.
Sleep Soundly: Safe, Natural Insomnia Solutions
A good night’s sleep. There’s nothing more restorative—or elusive—for the 64 percent of Americans who report regularly having trouble sleeping. Poor-quality sleep may even be secretly sabotaging your blood sugar. A disconcertingly high percentage of the sleepless (nearly 20 percent) solve the problem by taking sleeping pills. But sleeping pills can be dangerously addictive, physically and/or emotionally—and swallowing a pill when you want to go to sleep doesn’t address the root cause of the problem. What, exactly, is keeping you up at night?
SLOW DOWN
According to Rubin Naiman, PhD, a psychologist and clinical assistant professor of medicine at the University of Arizona’s Center for Integrative Medicine, most of our sleep problems have to do not with our bodies, per se, but with our habits. The modern American lifestyle—replete with highly refined foods and caffeine-laden beverages, excessive exposure to artificial light in the evening, and “adrenaline-producing” nighttime activities, such as working until bedtime, watching TV, or surfing the Web—leaves us overstimulated in the evening just when our bodies are designed to slow down and, importantly, to literally cool down as well.
Studies show that a cooler core body temperature—and warmer hands and feet—make you sleepy. “Cooling the body allows the mind and the heart to get quiet,” says Dr. Naiman. He believes that this cooling process contributes to the release of melatonin, the hormone that helps to regulate the body’s circadian rhythm of sleeping and waking.
DEEP GREEN SLEEP
Dr. Naiman has developed an integrative approach to sleep that defines healthy sleep as an interaction between a person and his/her sleep environment. He calls this approach Deep Green Sleep. “My goal was to explore all of the subtleties in a person’s life that may be disrupting sleep. This takes into account your physiology, emotions, personal experiences, sleeping and waking patterns, and your attitudes about sleep and the sleeping environment.” This approach is unique because it values “the subjective and personal experience of sleep,” he says—in contrast with conventional sleep treatment, which tends to rely on “computer printouts of sleep studies—otherwise known as ‘treating the chart.’”
It’s important to realize that lifestyle habits and attitudes are hard to change, so Dr. Naiman cautions that it often can take weeks, even months, to achieve his Deep Green Sleep. The good news is that the results are lasting and may even enhance your waking life.
Here are his suggestions on how you can ease into the night:
•Live a healthful waking life. “The secret of a good night’s sleep is a good day’s waking,” says Dr. Naiman. This includes getting regular exercise (but not within three hours of bedtime) and eating a balanced, nutritious diet.
•Cool down in the evening. It’s important to help your mind and body cool down, starting several hours before bedtime, by doing the following:
›Avoid foods and drinks that sharply spike energy, such as highly refined carbohydrates and anything with caffeine, at least eight hours before bedtime.
›Limit alcohol in the evening—it interferes with sleep by suppressing melatonin. It also interferes with dreaming and disrupts circadian rhythms.
›Avoid nighttime screen-based activities within an hour of bedtime. You may think that watching TV or surfing the Web are relaxing things to do, but in reality, these activities are highly stimulating. They engage your brain and expose you to relatively bright light with a strong blue wavelength that “mimics daylight and suppresses melatonin,” says Dr. Naiman.
•Create a sound sleeping environment. It is also important that where you sleep be stimulation-free and conducive to rest.
IN YOUR BEDROOM
•Be sure that you have a comfortable mattress, pillow, and bedding. It’s amazing how many people fail to address this basic need—often because their mattress has become worn out slowly, over time, and they haven’t noticed.
•Remove anything unessential from your bedside table that may tempt you to stay awake, such as the TV remote control or stimulating books.
•When you are ready to call it a night, turn everything off—radio, TV, and, of course, the light.
•Keep the room cool—68°F or lower.
•Let go of waking. Each day, allow your mind and body to surrender to sleep by engaging in quieting and relaxing activities starting about an hour before bedtime, such as:
›Gentle yoga
›Meditation
›Rhythmic breathing
›Reading poetry or other nonstimulating material
›Journaling
›Taking a hot bath
•Sex seems to help most people relax and can facilitate sleep, in part because climaxing triggers a powerful relaxation response, Dr. Naiman says.
•Consider supplementing with melatonin. If sleep is still elusive after trying these Deep Green Sleep tips, Dr. Naiman often suggests a melatonin supplement. Dr. Naiman believes that this is better than sleeping pills since melatonin is “the body’s own natural chemical messenger of night.” “Melatonin does not directly cause sleep but triggers a cascade of events that result in natural sleep and dreams,” he says, adding that it is nonaddictive, inexpensive, and generally safe. Not all doctors agree, however, so it is important to check with your doctor first.
›Rubin Naiman, PhD, psychologist specializing in sleep and dream medicine and clinical assistant professor of medicine at the University of Arizona’s Center for Integrative Medicine. He is author of the book Healing Night and coauthor with Dr. Andrew Weil of the audiobook Healthy Sleep.
Good Oral Health Lowers Risk for Diabetes and More
Until recently, most people who took good care of their teeth and gums did so to ensure appealing smiles and to perhaps avoid dentures. Now, a significant body of research shows that oral health may play a key role in preventing a wide range of serious health conditions, including heart disease, diabetes, some types of cancer, and perhaps even dementia.
Healthy teeth and gums may also improve longevity. Swedish scientists recently tracked 3,273 adults for sixteen years and found that those with chronic gum infections were significantly more likely to die before age fifty, on average, than were people without gum disease.
What’s the connection? Periodontal disease (called gingivitis in mild stages and periodontitis when it becomes more severe) is caused mainly by bacteria that accumulate on the teeth and gums. As the body attempts to battle the bacteria, inflammatory molecules are released (as demonstrated by redness and swelling of the gums). Over time, this complex biological response affects the entire body, causing systemic inflammation that promotes the development of many serious diseases. Scientific evidence links poor oral health to the following conditions:
•Diabetes. State University of New York at Buffalo studies and other research show that people with diabetes have an associated risk for periodontitis that is two to three times greater than that of people without diabetes. Conversely, diabetics with periodontal disease generally have poorer control of their blood sugar than diabetics without periodontal disease—a factor that contributes to their having twice the risk of dying of a heart attack and three times the risk of dying of kidney failure.
•Heart disease. At least twenty scientific studies have shown links between chronic periodontal disease and an increased risk for heart disease. Most recently, Boston University researchers found that periodontal disease in men younger than age sixty was associated with a twofold increase in angina (chest pain), or nonfatal or fatal heart attack, when compared with men whose teeth and gums are healthy.
•Cancer. Chronic gum disease may raise your risk for tongue cancer. State University of New York at Buffalo researchers recently compared men with and without tongue cancer and found that those with cancer had a 65 percent greater loss of alveolar bone (which supports the teeth)—a common measure of periodontitis. Meanwhile, a Harvard School of Public Health study shows that periodontal disease is associated with a 63 percent higher risk for pancreatic cancer.
•Rheumatoid arthritis. In people with rheumatoid arthritis, the condition is linked to an 82 percent increased risk for periodontal disease, compared with people who do not have rheumatoid arthritis.
Good news: Treating the periodontitis appears to ease rheumatoid arthritis symptoms. In a recent study, nearly 59 percent of patients with rheumatoid arthritis and chronic periodontal disease who had their gums treated experienced less severe arthritis symptoms—possibly because eliminating the periodontitis reduced their systemic inflammation.
•Dementia. When Swedish researchers recently reviewed dental and cognitive records for 638 women, they found that tooth loss (a sign of severe gum disease) was linked to a 30 to 40 percent increased risk for dementia over a thirty-two-year period, with the highest dementia rates suffered by women who had the fewest teeth at middle age. More research is needed to confirm and explain this link.
STEPS TO IMPROVE YOUR ORAL HEALTH
Even though the rate of gum disease significantly increases with age, it’s not inevitable. To promote oral health, brush (twice daily with a soft-bristled brush, using gentle, short strokes starting at a forty-five-degree angle to the gums) and floss (once daily, using gentle rubbing motions—do not snap against the gums). In addition:
•See your dentist at least twice yearly. Ask at every exam, “Do I have gum disease?” This will serve as a gentle reminder to dentists that you want to be carefully screened for the condition. Most mild to moderate infections can be treated with a nonsurgical procedure that removes plaque and tartar from tooth pockets and smooths the root surfaces. For more severe periodontal disease, your dentist may refer you to a periodontist (a dentist who specializes in the treatment of gum disease).
Note: Patients with gum disease often need to see a dentist three to four times a year to prevent recurrence of gum disease after the initial treatment.
Good news: Modern techniques to regenerate bone and soft tissue can reverse much of the damage and halt progression of periodontitis, particularly in patients who have lost no more than 30 percent of the bone to which the teeth are attached.
•Boost your calcium intake. Research conducted at the State University of New York at Buffalo has shown that postmenopausal women with osteoporosis typically have more alveolar bone loss and weaker attachments between their teeth and bone, putting them at substantially higher risk for periodontal disease. Other studies have linked low dietary calcium with heightened periodontal risk in both men and women.
Self-defense: Postmenopausal women and men over age sixty-five should consume 1,000 to 1,200 mg of calcium daily to preserve teeth and bones. Aim for two to three daily servings of dairy products (providing a total of 600 mg of calcium), plus a 600 mg calcium supplement with added vitamin D for maximum absorption.
Helpful: Yogurt may offer an edge over other calcium sources. In a recent Japanese study involving 942 adults, ages forty to seventy-nine, those who ate at least 55 g (about two ounces) of yogurt daily were 40 percent less likely to suffer from severe periodontal disease—perhaps because the “friendly” bacteria and calcium in yogurt make a powerful combination against the infection-causing bacteria of dental disease.
•Control your weight. Obesity is also associated with periodontitis, probably because fat cells release chemicals that may contribute to inflammatory conditions anywhere in the body, including the gums.
•Don’t ignore dry mouth. Aging and many medications, including some antidepressants, antihistamines, high blood pressure drugs, and steroids, can decrease saliva flow, allowing plaque to build up on teeth and gums. If you’re taking a drug that leaves your mouth dry, talk to your doctor about possible alternatives. Prescription artificial saliva products—for example, Caphosol or Numoisyn—also can provide some temporary moistening, as can chewing sugarless gum.
•Relax. Recent studies reveal a strong link between periodontal disease and stress, depression, anxiety, and loneliness. Researchers are focusing on the stress hormone cortisol as a possible culprit—high levels of cortisol may exacerbate the gum and jawbone destruction caused by oral infections.
•Sleep. Japanese researchers recently studied 219 factory workers for four years and found that those who slept seven to eight hours nightly suffered significantly less periodontal disease progression than those who slept six hours or less. The scientists speculated that lack of sleep lowers the body’s ability to fend off infections. However, more research is needed to confirm the results of this small study.
›Robert J. Genco, DDS, PhD, distinguished professor in the department of oral biology, School of Dental Medicine, and in the department of microbiology, School of Medicine and Biomedical Sciences at the State University of New York at Buffalo.
Don’t Make These Common Mistakes When Brushing and Flossing
If you’re like most Americans, you brush your teeth every day—and may even use floss. But as surprising as it may seem, most people don’t do either of these daily rituals correctly and fail to take other small, but highly effective, steps to protect their oral health.
Doing everything you can to care for your teeth and gums is important because, as you probably know, poor oral health has been linked to heart disease and other chronic diseases, such as diabetes and respiratory infections.
Here are some common mistakes to avoid.
Mistake #1: Assuming that electric toothbrushes are better than manual ones. It’s true that electric and ultrasonic toothbrushes produce more strokes per minute than manual toothbrushes. However, the shape and size of the handle of the typical electric or ultrasonic toothbrush can make it more difficult to access all the teeth, particularly the backs of the last teeth.
My advice: Use both types of toothbrushes. Each time you brush, begin with an electric brush to maximize the strokes per minute, and finish up with a manual one for thirty seconds or so to access teeth you may not have fully reached. Be sure to use a soft-bristle manual brush.
Mistake #2: Not brushing long enough. Most dentists recommend brushing for two minutes in the morning and again in the evening. However, if you have tiny spaces between your teeth or an advanced gum condition, such as periodontitis, you may need to brush for four or even six minutes to adequately clean your teeth.
And don’t forget to brush your gums. Regular, gentle brushing can help toughen the gums and keeps the gum tissue more tightly attached to the tooth.
My advice: Brush a minute or so longer than usual (most people don’t brush long enough). Then ask your dental hygienist during your next visit if you need to adjust the amount of time you brush.
Mistake #3: Not flossing correctly. Most dentists recommend flossing once daily. But people who have areas in their mouths in which food routinely gets trapped should floss after each meal, as well as after they brush. Flossing after brushing allows you to remove food particles that may have been pushed into any spaces between your teeth with your toothbrush.
My advice: For convenience, keep containers of floss everywhere—in your coat pocket, glove compartment, bag, desk, and near your seat when you watch TV.
Also important: Opt for white floss (waxed or unwaxed is fine). Colored floss makes it hard to see bleeding from the gums, a sign of gum disease.
Mistake #4: Not considering a dental irrigator. Dental irrigators, such as those by Waterpik, Oral-B, and Philips, rinse away leftover food particles that brushing and flossing leave behind. Not everyone needs a dental irrigator, but those who have pockets (spaces between the gum and the teeth) of more than 4 mm (as measured by your hygienist) should use one.
My advice: Make irrigating the third step of your daily oral-care routine. As with brushing and flossing, it’s important to be gentle. Start with a low setting on the machine, and gradually work up to harder pulsations over a period of days. Ask your hygienist how long you should irrigate each day.
Mistake #5: Thinking mouthwash can replace flossing. Mouthwash is easier to use than floss but does not heal gum disease—it should be used only as a supplement to brushing, flossing, and irrigating.
Mouthwash is generally thought of as a breath freshener and bacteria fighter, but some brands that contain added minerals claim to also build enamel. Enamel is composed of minerals, but the mouthwash’s “remineralization” occurs only at the surface level.
My advice: If you don’t have gum disease, mouthwash is optional. If you do, use mouthwash (either with alcohol or alcohol-free) with an irrigator after each brushing.
Mistake #6: Forgetting to scrape your tongue. Bacteria become trapped and breed on the tongue’s rough surface, which can lead to bad breath and cavities.
My advice: Scrape your tongue whenever you see a grayish or whitish coating. A healthy tongue is pinkish. Many commercial tongue-scraping tools are available, but you can use a dry toothbrush or even the edge of a spoon.
Important: Each person’s specific oral care needs are different, but most people can complete these steps in about three to five minutes each time they brush. If you feel you don’t have that much time, ask your hygienist for advice on what areas of your mouth need the most attention and which tools he/she recommends you use most often.
›Tom McGuire, DDS, a holistic dentist consultant in Sebastopol, California. He is author of several books, including Healthy Teeth–Healthy Body: How to Improve Your Oral and Overall Health. DentalWellness4U.com.
*Be sure to check supplement dosage amounts with your doctor, especially if you have diabetes or another chronic condition.
*To find a yoga class near you, check your local community center and/or consult the International Association of Yoga Therapists (www.iayt.org).