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Saturday, November 23, 2013

Maintaining weight and sanity through the holiday season


As published in the Washington Observer-Reporter.

"Aren't you going to try a piece? Is that all you're going to have?"

These are the comments Jennifer Berry of Canonsburg recalls when she thinks of eating pressures around the holidays.

The scene is universal: Tables covered with brightly-colored table cloths and filled with the seasons most tempting foods. Not to mention, Aunt Betty pulling on your heart strings about how little of her famous apple pie you shoveled onto your plate.

Berry, a fitness instructor with a long-time love for group exercise, tries to cut herself a little slack.

"I'm very much a believer in moderation," said Berry. "If you deprive yourself of something, you're going to want it that much more." 

This is a sentiment echoed by Jacqueline Ely, registered dietitian at the Wilfred R. Cameron Wellness Center, though with an extra caveat.

"There's no bad food," said Ely, "just bad portions." 

Ely recognizes that enjoying certain foods is often a part of how we enjoy the holidays, but there are ways to prevent ourselves from over-indulging. 

"I always recommend a 'cheat meal' once per week," said Ely, "So, make your weekly cheat meal Christmas dinner, if that's the one you really want to enjoy."

Knowing that even "healthy foods" have a way of ending up covered in butter or brown sugar around the holidays, Jennifer Berry has a tip of her own: Offer to bring the vegetable. 

"I can make it as healthy as I want," Jennifer said. "Then, I can make half of my plate the vegetable I brought, and half the other foods I want to eat." 

Waistlines run into trouble, though, when a single cheat meal turns into a day or week of grazing and equally as calorie-dense leftovers, which is a great way to incorporate another Ely recommendation: recipe modification. 

"Take the leftover turkey, but don't make turkey, biscuits and gravy when you get home," said Ely. "Try a healthy, hearty turkey soup instead."

Registered clinical exercise physiologist and Wilfred R. Cameron Wellness Center operations manager, Rebecca Feist, isn't nearly as forgiving when it comes to holiday exercise schedules. 

"We try to encourage people to stay where they are," said Feist, "And, in this part of the country, there are still lots of times you can get out of your house and do something, even if it's only two laps around your block." 

In fact, Feist recommends many easy-to-implement modifications to exercise schedules to make the "no mercy" goal more attainable, modifications like interval training. 

Interval training involves periods of lower intensity exercise studded with short periods of high-intensity activity--a technique that greatly increases calorie burn, even if a workout can only last a short period of time. 

"If you normally walk very slowly," said Feist, "you can increase the speed of your walking--whatever that is for you--for 30 seconds every minute, or whatever you can tolerate."

Another tip is to break up a workout throughout the day. 

Waiting for cookies to bake in the oven? Do a 20 minute, at-home workout until the timer dings. Do another 15 minutes while your husband searches for the tree-topper in the basement. 

According to Feist, the calorie burn is the same whether you perform a workout in one lump sum or scattered throughout the day.

Maintaining healthy habits is essential to managing stress over the holidays. Both Ely and Feist warn of the snowball effect stress and a decrease in healthy habits can have, creating a less enjoyable holiday season and seriously threatening one's ability to maintain their weight.

"The alternative is to feel overwhelmed in general," said Ely, "And that is where I see most people fall off the wagon and give into bad eating or a lack of exercise." 

For Jennifer Berry, the hard part isn't exercise; It's food. 

She texts friends for extra bits of encouragement, and has learned to brush off the Aunt Bettys in favor of her own self-discipline. 

"Choosing healthier foods is a mindful choice everyday," said Berry, "And, you can't out-exercise a bad diet."

Ode to Thanksgiving and a Nod Toward Gratitude Journaling


As published in the Washington Observer-Reporter.

My love and excitement for the Macy's Thanksgiving Day Parade, cranberry sauce and my Mom's pumpkin pie catapult me to levels of joy that few other things can inspire. 

It's not just "things" that make me happy; It's the feelings the accompany the things. 

Even when the parade is so-so, it's realization that, in that moment, everything is my definition of perfect. My husband and father look like cookie cutters of one another with sections of the day's newspaper identically in front of their faces. The house air is heavy with the smell of onions, green peppers, celery and butter sweating in my mother's frying pan. And, there's the universal understanding that the day's focus is to enjoy simple, almost childlike details like how high the Macy's balloons got to fly that year.

Thanksgiving, without even trying, teaches me important lessons about being thankful.

If you listen to positive psychology experts--yes, they exist--there are ways to extend this feeling beyond a few days in November.

Gratitude starts with the will to find it. 

It is relatively few days of our lives that we're granted promotions, get engaged or win a contest, but, luckily, these bigger events hardly encompass all that we have to appreciate. 

Mindfulness or presence in the moment is required for us to dig a little deeper. When we are in a constant state of waiting for the end of the the work day, waiting to go to sleep or waiting for the concert this weekend, we are ignoring huge portions of our lives and stacks of blessings within them. So, pay attention. 

You woke up this morning, right? That's a start. Maybe you ate exactly what you wanted for breakfast. That's awesome! 

A great next step, according to reams of research, is to write these little victories down. The practice can be called journaling, gratitude journaling or that-file-I-have-on-my-computer-where-I-write-stuff-I-like. You can even buy beautiful, leather-bound journals that have the word gratitude embossed on the front in gold leaf. Whatever floats your happy little boat. 

Here's the point: In a study conducted by Dr. Robert Emmons (perhaps the world's leader in gratitude psychology) and Dr. Michael MucCullough, participants who wrote down a few things for which they were grateful each day for ten weeks, were more optimistic and felt better about their lives. And, that's just one example.

Maybe journaling won't work for you, but, luckily, it isn't the only option. 

Prayer, meditation and even mentally thanking someone (which is very much akin to the first two, if you ask this girl) can all work to harness our positivity. 

One overriding happiness-helper, however, is to remain engaged with your thankful thoughts. 

Writing, "I am thankful for my toaster oven," isn't valuable unless you are truly in love with that toaster oven. 

Another way to think of it is this: Choose thoughts that resonate with you. Check in occasionally and ask yourself, "Do I believe what I'm writing?"

The road may be bumpy at first. Concentrating on grateful thoughts may feel awkward or unnatural, but fake it 'til you make it. 

Positivity snowballs: The more you have the more you want. Just like pumpkin pie on Thanksgiving Day.

Friday, May 17, 2013

Nice girls: Closing your mouth for kindness


We women struggle. 

We are fortunate not to live in a society that condones female genital mutilation or whose cultural norms leave us defenseless against HIV, but we certainly have a few doozies of our own.

Many women in our country think extraordinarily little of themselves. 

This is neither whiney nor self-indulgent. Or, it isn't anymore. 

Once upon a time--before we received random pieces of mail teaching how to "Eat Yourself Skinny", as I just did, this moment--when there was some semblance of perspective, this sort of thinking might have been wrought with self-pity. But, it has caught on. 

No longer just a means for self-discipline, staring into a mirror simply to point out our own flaws has become a pathological, reflex occurrence. It's even social. 

Who among us hasn't gone to the bathroom with a female friend only to discuss the planet that has erupted on our forehead, "fat pants" or how crappy our hair looks that day? 

We actually bond with other women--women struggling with the same negative thinking as we are--over self-criticism. Like a bad case of pink eye, we're passing this toxic thinking back and forth between some of those we care about most.

And, in fits of self-satisfaction, we condemn the famous and beautiful for their moments of realism. 

Are there things about the Kardashian family that warrant a #SMH. Obviously. Kim Kardashian's pregnancy weight gain is certainly not one of them. 

She is a woman of bodacious hip structure. They were sought after and drooled over before the two pink lines. It is really earth-shattering her weight gain continues to emphasize these assets? Allow me to correct myself: weight gain associated with the creation of another human. 

This negativity snowballs, is passed back and forth and is so subtle we scarcely recognize that we're doing it. But, the cycle has to stop, and it must be a conscious decision. 

Here are a few thoughts for all of us to live a bit happier and more positively about ourselves, each other and our bodies:

1. Make a rule for yourself: "If I'm going to look in the mirror, I am not going to analyze my body."

2. Barring medical necessity, throw away your scale. Numbers cannot be compared between different women of different builds.

3. Compliment, compliment, compliment. Stop a woman at the grocery store whose haircut you've been admiring since aisle three. Say something positive about yourself when you look in the mirror. Someone may be in more desperate need of a compliment than you can imagine, and, look, you made their day! 

4. Gain perspective about pregnancy weight. There are literally legions of women who would give almost anything for the joy of gaining 35 pounds or more, if it allowed them to be a mother. Even more have suffered miscarriages and would do anything for the excitement of being that far along into a pregnancy. Kim Kardashian's weight gain, in its way, is a celebration. 

5. Consider this one a catch-all: In the kindest way possible, SHUT UP. 

Gosh, I know it's tempting. The hens are clucking. It's been a long day. It feels good to gab. How easy is it to sit around and talk crap about how so-and-so's pants have been getting a little tight? 

The discipline it takes to hold that little comment in, is exactly what it takes to put an end to this diseased habit of self-critique. 

Conjure a large dose of empathy to imagine what it would feel like were your friends/co-workers/fellow women talking about you in that manner. 

We're in this together. Let's act like it. 

Monday, April 22, 2013

Everything you never wanted to know about umbilical cords


The umbilical cord: weird, rubbery and attached to the thing (the placenta) dead last on your husband's list of "things I'd most like to see." It is as amazing as it is odd, and is literally the lifeline between mama and baby. 

In keeping with this strangeness, here are a few little-known and quirky facts about the squishy, squiggly vessel.

AVA

Umbilical cords 101: They contain two arteries and one vein, which is easily recalled with the acronym, and popular girls' name, AVA. The one, hefty vein brings oxygen and nutrient-rich blood to the fetus while the two skinnier arteries carry oxygen-poor and waste products back to mom's organs for filtering and re-oxygenating.  

An "elite" 1% of all umbilical cords contain only one of these arteries, which has a few interesting associations. First, 15-20-percent of single-artery umbilical cord babies also have cardiovascular abnormalities. Whether this association is the result of environment--the environment of decreased outflow of oxygen-poor blood, for instance--or as the part of some "genetic bundle" which includes both abnormalities is unclear. In addition, one investigator has shown an association between a single umbilical artery and maternal smoking during pregnancy. 

Yet another nail in ole tobacco's coffin. 

Pick a hand, any hand.

A detail of umbilical cords which can be recognized even by the least scientifically trained of on-lookers is its twisted appearance. The two arteries and one vein aren't paying tribute to candy canes or barbershop twisty things. Instead, these swirls are the result of fetal movement, but do they correlate with handedness? 

According to the folks who actually thought to study this, approximately 85-percent of umbilical cords are left twisted, leaving 15-percent twisted to the right, which is pretty much exactly the proportions of the population who are left and right handed: 85-percent of us are right-handed versus 15-percent who favor their left. 

I see your cord is as big as mine.

Speaking of fetal movement, it is greatly affected by the length of the umbilical cord, which may have something to do with behavior as the child ages. In a study which examined 35,799 umbilical cords, it was found that decreased cord length was correlated with decreased IQ and a greater incidence of motor abnormalities compared with very long cords which were associated with abnormal behavioral control and hyperactivity. 

I know, I know. You've been waiting your entire life to know umbilical cord facts such as these. You're welcome.

Monday, April 15, 2013

This Isn't Your Husband's Prescription

Oh, gender.

It's inspired entire sub-disciplines of anthropology, sociology and psychology; it's made the author of Men Are from Mars, Women Are from Venus one rich human; it's the villain of many a marital spat.

Now, it may change the way certain illnesses are treated.

In a recent study published in a very fancy science journal (Clinical Chemistry and Laboratory Medicine, for you fellow nerds), investigators have identified five clinical areas with considerable evidence for treating men and women differently: cardiovascular disease, cancer, liver diseases, osteoporosis and pharmacology (or drugs.)

Why the misunderstanding? Because women are better multi-taskers, have a mothering instinct and tend to act with more emotional intelligence.

Oh wait, were we talking about medicine? Okay, well it applies there, too.

Medical treatment to this point has not considered applicable social and psychological differences between the sexes, in addition to not properly acknowledging differences in the interpretation of symptoms.

In an additional (and shocking) bit of gender bias, much of the medical research over the past 40 years has focused almost exclusively on male patients.

We get colon cancer later, react differently to chemotherapy, have GI symptoms during a heart attack and enjoy long walks on the beach after surprise candlelight dinners.

Taking notes?


Friday, March 29, 2013

Vitamin D kicks type 2 diabetes' butt in obese children and adolescents

It's just another brick in the endocrine wall toward proof that "vitamin D" has fewer vitamin powers than it does hormonal ones.

Published in the American Journal of Clinical Nutrition is evidence that this super-vitamin can help obese children and adolescents control their blood sugars, potentially warding off Type 2 diabetes.

How? Glad you asked.

Obesity is a two-fold risk for Type 2 diabetes, contributing to both high levels of glucose in blood (which is damaging to tissues over time) and increased insulin resistance (which hinders the body's ability to decrease the sugar circulating in blood.)

After studying 35 pre-diabetic, obese children and adolescents who either took high-dose vitamin D supplements or placebo (sugar pill) for six months, the amount of circulating glucose was significantly decreased--with a decrease in circulating insulin as a result--without any changes in body weight or physical activity…meaning the vitamin D did that work all by itself.

Even the researchers state that this high level of vitamin D isn't for everyone.

The recommended vitamin D supplement for individuals ages 1-70 is 600 IU per day, but the individuals in this study received about double that. Vitamin D--along with its cohorts vitamins A, E and K--are members of the fat-soluble vitamin clan, or the type which can accumulate to toxic levels. While the risk is less for the population in this study given obese individuals can only process vitamin D at about half the normal rate, supplementation of this type is not considered safe for the general population.

While the final word on the significance of this sort of treatment has yet to be seen, checking a vitamin D level on obese children and adolescents might be a great way to broaden the patient picture.

Yay, science!

Thursday, March 28, 2013

Colorectal cancer a family affair


As published in the Washington Observer-Reporter.

For the first 12 years of his life, Hector Riva belonged to a family like any other, until a pattern began to emerge.

The pattern was a genetic one, though this detail would elude the family's doctors for some time since the year was 1957, and the discovery of DNA had just celebrated its fourth anniversary.

The pattern involved colorectal cancer marching down Riva's family tree to the quick tempo of a silent cadence, claiming a few lives along the way.

"I knew a problem with the bowels ran in the family," said Riva a 68-year-old Monongahela resident, "But, I didn't know the cause."

Riva's wife, Carol Riva, attributes that hazy understanding not only to the lack medical technology but also to the culture of the time.

"Our parents told us a little more about the family history as we got older," said Carol, "But, back then, you didn't talk about that stuff."

Even without genetic tests or a perfect understanding of his family history, Hector knew enough to place a colonoscopy--the diagnostic tool of choice for the surveillance of colorectal cancer--on his mental to-do list.

Hector, like many men, was reluctant.

"I said I would wait around until a sign came--some blood (in my stool) or something like that," said Hector, "Which I didn't realize at the time would have been too late."

In addition to blood in the stool, changes in bowel habits, weight loss, persistent abdominal discomfort, weakness and fatigue are all potential symptoms of colorectal cancer.

Hector had decided to wait for a sign, but fate had other plans.

In 1996, when Hector was 52-years-old, he was lucky enough to develop a hernia.

After learning of his family history, the surgeon slated to perform Hector's hernia repair refused to perform the surgery until Hector agreed to a colonoscopy, which involves a scope of the lower digestive tract, beginning with the rectum and advancing through the large intestine, also known as the colon.

The ten pre-cancerous polyps that were removed earned Hector a yearly appointment for a scope of his rectum and colon. Each of the next four years brought the discovery of 14, 75, 0, and then hundreds of polyps, respectively.

Those polyps also brought the family's multi-generation battle with colon troubles to light. They were afflicted with a rare condition called familial adenomatous polyposis, or FAP, characterized by the presence of hundreds-to-thousands of benign polyps (or growths) in the large intestine and an early onset with 95-percent of affected people developing polyps by age 35.

The term "benign" is rather misleading, however. Though not cancerous from the outset, there is a 100-percent chance that the polyps will develop into cancer if the the colon is not surgically removed in those with FAP, a procedure Hector endured in his late-50s.

In the Riva family, however, colon removal is the norm. Hector and his three sons have all had their small intestine connected directly to their rectum in order to live colon, colostomy and, hopefully, colorectal cancer-free.

While the Riva's variant may be rare, colorectal cancer is the second most common type of cancer in Pennsylvania, with 150,000 Americans diagnosed with the disease each year.

The prevalence of colorectal cancer is countered by a fortunate truth of modern medicine: It is also one of the most preventable forms of cancer, where up to 60-percent of all cases can be avoided with proper screening--a piece of information which earns a special amount of advertisement during March, National Colorectal Cancer Awareness Month.

What makes colonoscopy the gold standard for detecting colorectal abnormalities?

Dr. John Hauser, a board-certified gastroenterologist in Monongahela, explains it this way: "Accuracy…assuming it's in the hands of a professional that's trained and does colonoscopy for a living," said Dr. Hauser. "There are some people out there in the community that dabble in it, that don't do it well and don't do it right."

Someone qualified to do colonoscopies, according to Dr. Hauser, is either a board-certified gastroenterologist or colorectal surgeon who has been trained in colonoscopy during their surgical residency. It's someone who can guide a scope all the way to the beginning of the colon at least 95-percent of the time.

For those without a family history of colorectal cancer, screening should begin at age 50, with repeat screenings every 10 years if the previous test was clear.

If there are one or a few "sporadic" cases in the family--meaning, the cases aren't believed to have a genetic cause--screening should begin at age 20-25 or 10 years before the earliest age of onset in the family, whichever comes first.

Scientists have pinpointed a the gene responsible for FAP, and are now able to test the youngest generation of afflicted families with a simple blood test. With its inheritance in a dominant pattern, there is only a 50-percent chance that an individual in an affected family will inherit the gene, but a 100-percent chance they will endure its effects, if inherited.

For FAP families, testing begins at age 10-12 and includes a one-time genetic blood test and yearly colonoscopies, which is just fine with the Rivas.

"If they can be genetically tested and help other people," said Carol, "That's the greatest thing going."