Tag Archives: nutrition

Recommendations to Help Prevent High Blood Pressure

February 14, 2017 Teresa Stockton - Blog, General Information

Hypertension is abnormally high blood pressure. High blood pressure puts extra strain on the heart, lungs, brain, and kidneys. It carries with it an increased risk of death and disability from coronary artery disease (CAD), stroke, heart failure, and kidney disease.

High blood pressure is very common but can’t be seen or felt. Many people with high blood pressure don’t know they have it. The best way to know if you have high blood pressure is to keep track of your numbers. You can get your blood pressure checked at your doctor’s office, at home, or at your local pharmacy. It’s important to get your blood pressure checked regularly.

Defining High Blood Pressure
High blood pressure is defined by 2 numbers (systolic and diastolic). The systolic or top number measures the pressure in your blood vessels when your heart beats. The diastolic or bottom number measures the pressure in your blood vessels when your heart rests between beats.

The normal blood pressure varies with age, usually increasing as we get older. In general, systolic blood pressure (SBP) less than 120 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg are considered normal and prehypertension is a SBP120-139 mm Hg or DPB 80-89 mm Hg. Abnormal levels include:
• Stage 1 hypertension—SBP 140-159 mm Hg or DPB 90-99 mm Hg
• Stage 2 hypertension—SBP more than 160 mm Hg or DBP more than 100 mm Hg

In people with diabetes or kidney disease, the targets numbers are lower. Check with your doctor to see what your target range should be.

Common Risk Factors
There is no single cause for high blood pressure, but there are several factors that can increase your risk.

Some risk factors for high blood pressure include:
• Age: middle-aged or elderly—onset generally happens at 20-50 years, but likelihood increases with age
• Race: African American
• Gender: Male

Medical factors, such as:
• Diabetes
• Obesity
• Metabolic syndrome—A condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern.
• A family history of high blood pressure
• Sleep apnea
• Prehypertension

Lifestyle factors, such as:
• Smoking
• Being physically inactive
• Taking birth control pills
• Having diet high in red meat, salt, and saturated and trans fats
• High alcohol intake

Risk factors don’t mean you will get high blood pressure, but that you have an increased chance of developing it. Fortunately, there are also factors that can help you prevent high blood pressure or lower your blood pressure if you already have elevated blood pressure.

Lifestyle Guidelines to Prevent or Reduce High Blood Pressure
The National Heart, Lung, and Blood Institute’s recommendations to help prevent or lower high blood pressure include:
• Losing weight if you are overweight
• Increasing levels of physical activity—Aim for 30 minutes per day on most days of the week.
• Eating a diet rich in fruits, vegetables, and low-fat dairy products
• Eating a diet that is low in saturated and total fat
• Limiting consumption of sodium (salt) to less than 2,300 milligrams per day
• Drinking alcohol only in moderation—This means 1 drink or less per day for women and 2 drinks per day or less for men.

Another approach endorsed by National Heart, Lung, and Blood Institute is use of the DASH diet. This is a special low-salt diet which has been shown effective in both preventing and treating high blood pressure.

High blood pressure is a major player in heart disease and stroke. Protect yourself and know your numbers. The next time you take a trip to the pharmacy, check your blood pressure. If you do it on a regular basis and follow the lifestyle guidelines, you may be able to avoid future problems.

by Michael Jubinville, MPH

RESOURCES:
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

American Heart Association
http://www.heart.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Heart & Stroke Association
http://www.heartandstroke.ca

REFERENCES:
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.

How can high blood pressure be prevented? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/prevention. Updated September 10, 2015. Accessed August 2, 2016.

Hypertension. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 12, 2016. Accessed August 2, 2016.

Hypertension treatment in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 11, 2016. Accessed August 2, 2016.

Preventing high blood pressure: Healthy living habits. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/bloodpressure/what_you_can_do.htm. Updated July 7, 2014. Accessed August 2, 2016.

Understanding your risk for high blood pressure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp#.V6CgG02FPIU. Updated June 29, 2016. Accessed August 2, 2016.

Whelton PK, He J, Appel LJ, et al. Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA. 2002;288(15):1882-1888.

Last reviewed July 2016 by Michael Woods, MD Last Updated: 8/2/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

A Healthy Start in 2017

January 5, 2017 Teresa Stockton - Blog, General Information

It’s time to get a healthy start in 2017! We provided some general health and wellness tips to get you on your way to an amazing year! We call it the Pearls of Longevity!

PROTEIN
Eat 25 grams of protein each meal especially breakfast to prevent being hungry from carb cravings and crashes, help maintain and build muscle, and improve your immune system.

DID YOU KNOW?
For every 100 calories of protein you eat, it takes 25 calories to digest meaning you really only ate 75 calories! This is a 25% discount! For carbs and fat, you get less than a 10% discount.

EXERCISE
Exercise at least 30 minutes a day to burn calories and decrease stress. Lift weights or use body weight strengthening exercises to increase lean muscle and boost your metabolism.

DID YOU KNOW?
Exercise relieves symptoms of depression as well or even better than medication. Losing 10 lbs. decreases your risk of knee arthritis by 50%, while losing 10% of your body weight decreases joint pain by 50%!

ANTI INFLAMMATORY & ANTIOXIDANT-RICH FOODS
Fill half your plate at every meal to ensure you eat enough of these power foods.

DID YOU KNOW?
Eating lots of fruits, vegetables, nuts, olive oil, beans, salmon, spices, and even dark chocolate helps reduce inflammation and stress, decreases joint and muscle pain, and reduces your risk heart disease, hypertension, diabetes, cancer and stroke.

RELAXATION & STRESS REDUCTION
Practice inhaling slowly through your nose until you feel your belly button move out and then slowly exhale through your mouth feeling your belly button move in. Practice at least 5 minutes a day while driving, at your computer, while watching TV or when in bed. Smile, laugh and hug someone once a day.

DID YOU KNOW?
Deep breathing reduces stress, muscle pain, and blood pressure, while improving memory, concentration and performance. Happiness and affection are considered by many experts to be the fountain of youth as it lowers stress and releases hormones that help fight aging.

LIQUIDS
Drink 2 cups of water or tea when you wake up and drink 1-2 cups in between meals. Coffee does not count as it can lead to dehydration.

DID YOU KNOW?
Water reduces hunger, improves metabolism, brings nutrients, and hydrates your muscles and connective tissue. This can reduce inflammation and scar tissue which can lead to decreased muscle and joint pain.

SLEEP
Sleep at least 7-8 hours per night consistently going to bed and waking up the same time even on weekends.

DID YOU KNOW?
Sleep releases growth hormone which helps keep you young, increase lean muscle and decrease body fat!

A healthy start can lead to great endings. Best of luck to you and yours and Happy New Year!

December 2016 Events

November 22, 2016 Teresa Stockton - Blog, Events

Check out our Physical Therapy Monthly Events Calendar! Focusing on events from PTandMe.com participating physical and occupational therapy clinics. Read more to find out what’s happening in your community in December 2016!

GEORGIA PHYSICAL THERAPY EVENTS

ROME, GA
DATE: November 23rd – December 16th 2016
Advance Rehabilitation Canned Food Drive
CLINIC: Advance Rehabilitation – Rome
Help Feed the Hungry This Holiday Season.
Advance Rehabilitation is accepting food donations at all locations through December 16th
Pantry Program Needed Items are:
• Canned Vegetables (low sodium or no added salt)
• Canned Fruit (in its own juice or 100% juice)
• Canned Tomato Products (low sodium or no added salt)
• Canned Tuna/Chicken (low sodium)
• Boxed Potatoes
• Boxed/Bagged Stuffing
• Whole Grains
• Brown Rice
All South Georgia locations are accepting donations along with Columbus, GA.
For more information about Advance Rehabilitation, visit them online at http://www.advancerehab.com.

MICHIGAN PHYSICAL THERAPY EVENTS

GRAND RAPIDS, MI
DATE: December 6th 2016, 5:30PM – 6:30PM
CPR Downtown Yoga Classes Begin!
CLINIC: The Center for Physical Rehabilitation – Downtown Grand Rapids
Join the Academy at CPR’s Downtown location for an “All Levels Yoga Class”. Whether you are new to the mat, or an experienced student, this class is designed for everyone to work at their own ability and comfort level. New students will be exposed to basic poses and body positioning, while more experienced student will be challenging their body through variations in poses they have mastered.
For more information about The Center for Physical Rehabilitation, visit them online at http://www.pt-cpr.com.

SALINE, MI
DATE: December 10th 2016, 10:00AM – 1:30PM
Saline Area Chamber of Commerce Treasure Trail to Santa
CLINIC: Physical Therapy In Motion – Saline
The event is the Saline Area Chamber of Commerce Treasure Trail to Santa at the Saline Shopping Center. Children will go on a treasure trail starting at Physical Therapy in Motion, stopping at all of the businesses for a treat, and end at Busch’s to see Santa. Carriage rides, photo booth, and a petting farm will be available. For more information about Physical Therapy In Motion, visit them online at http://www.physicaltherapyinmotion.com/.

NEW JERSEY PHYSICAL THERAPY EVENTS

NEW MILFORD, NJ
DATE: November 23rd – December 23rd 2016
Spread the Warmth Blanket & Jacket Drive
CLINIC: Madison Spine & Physical Therapy – New Milford
Please support the Madison Spine & Physical Therapy charity campaign by donating today! On December 23rd They will drive into NYC with the Donations & Hand Them Out to Those Who Could Use a Little Warmth!
Items needed are:
• JACKETS
• BLANKETS
• BOOTS
• GLOVES
• HATS
• SCARVES
YOU DONATE, MADISON SPINE DELIVERS! Let’s all come together and make a difference! All locations are accepting donations now. For more information about Madison Spine & Physical Therapy, visit them online at http://madisonspinept.com/physicaltherapy.

TENNESSEE PHYSICAL THERAPY EVENTS

PULASKI, TN
DATE: December 8th 2016, 11:30AM – 1:00PM
Sudden Violence: Surviving an Active Shooter
CLINIC: STAR Physical Therapy, LP – Pulaski
Giles County Workforce Employer Outreach Committee invites you to join us for an informative lunch and learn. Lunch Provided by STAR Physical Therapy.
Speaker: Barry Crotzer, Agent – TN Homeland Security
Located at: First National Bank Building, 206 South 1st Street, Pulaski, TN
Please RSVP by Tuesday, December 6th online: https://goo.gl/forms/0ckSzRdplrMv89m13
We look forward to seeing you there!
For more information about STAR Physical Therapy, LP, visit them online at http://www.starpt.com.

MURFREESBORO, TN
DATE: December 14th 2016, 12:00PM – 1:30PM
Sudden Violence: Surviving an Active Shooter
CLINIC: STAR Physical Therapy, LP – Murfreesboro
The WEOC is an ongoing effort by the TN Department of Labor & Workforce Development to reach out to Tennessee employers and provide valuable information to foster economic development and to promote our services. Lunch Sponsored by STAR Physical Therapy.
Speaker: Barry Crotzer, Agent – TN Homeland Security
Located at: Rutherford County Chamber of Commerce, 3050 Medical Center Parkway, Murfreesboro, Tennessee 37129.
Please RSVP by Tuesday, December 12th online: https://goo.gl/forms/qWqCr8LJoPdSk6Ex1
We look forward to seeing you there!
For more information about STAR Physical Therapy, LP, visit them online at http://www.starpt.com.

Type 2 Diabetes (Diabetes Mellitus Type 2; Insulin-Resistant Diabetes; Diabetes, Type 2)

November 10, 2016 Teresa Stockton - Blog, General Information

Definition
Glucose is a type of sugar. It comes from food, and is also created in the liver. Glucose travels through the body in the blood. It moves from the blood to cells with the help of a hormone called insulin. Once glucose is in those cells, it can be used for energy.

Diabetes is a condition that makes it difficult for the body to use glucose. This causes a buildup of glucose in the blood. It also means the body is not getting enough energy. Type 2 diabetes is one type of diabetes, and it is the most common.

Medication, lifestyle changes, and monitoring can help control blood glucose levels.

Causes
Type 2 diabetes is often caused by a combination of factors. One factor is that your body begins to make less insulin. A second factor is that your body becomes resistant to insulin. This means there is insulin in your body, but your body cannot use it effectively. Insulin resistance is often related to excess body fat.

Risk Factors
Type 2 diabetes is more common in people who are aged 45 years and older. It is also common in younger people who are obese and belong to at-risk ethnic groups. Other factors that increase your chance for type 2 diabetes include:
• Prediabetes — impaired glucose tolerance and impaired fasting glucose
• Metabolic syndrome — a condition marked by elevated cholesterol, blood glucose, blood pressure, and central obesity
• Excess weight or obesity, especially central obesity
• Lack of exercise
• Poor diet — high intake of processed meats, fats, sugar-sweetened foods and beverages, and calories
• Family history of type 2 diabetes
• High blood pressure
• History of cardiovascular disease
• Depression
• History of gestational diabetes, or having a baby that weighs over 9 pounds at birth
• Endocrine disorders, such as Cushing’s syndrome, hyperthyroidism, acromegaly, polycystic ovary syndrome, pheochromocytoma, or glucagonoma
• Conditions associated with insulin resistance, such as acanthosis nigricans
• Certain medications, such as glucocorticoids or thiazides
• Certain ethnic groups, such as African American, Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander

Symptoms
You may have diabetes for years before you have symptoms. Symptoms caused by high blood sugar or include:
• Increased urination
• Extreme thirst
• Hunger
• Fatigue
• Blurry vision
• Irritability
• Frequent or recurring infections
• Poor wound healing
• Numbness or tingling in the hands or feet
• Problems with gums
• Itching
• Problems having an erection

Diagnosis
The doctor will ask about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.

Diagnosis is based on the results of blood testing. American Diabetes Association (ADA) recommends diagnosis be made if you have one of the following:
• Symptoms of diabetes and a random blood test with a blood sugar level greater than or equal to 200 mg/dL (11.1 mmol/L)
• Fasting blood sugar test is done after you have not eaten for 8 or more hours—showing blood sugar levels greater than or equal to 126 mg/dL (7 mmol/L) on two different days
• Glucose tolerance test measures blood sugar 2 hours after you eat glucose—showing glucose levels greater than or equal to 200 mg/dL (11.1 mmol/L)
• HbA1c level of 6.5% or higher—indicates poor blood sugar control over the past 2-4 months

* mg/dL = milligrams per deciliter of blood; mmol/L = millimole per liter of blood

Treatment
Treatment aims to:
• Maintain blood sugar at levels as close to normal as possible
• Prevent or delay complications
• Control other conditions that you may have, like high blood pressure and high cholesterol

Diet
Food and drinks have a direct effect on your blood glucose level. Eating healthy meals can help you control your blood glucose. It will also help your overall health. Some basic tips include:
• Follow a balanced meal plan. It should include carbohydrates, proteins, and fats.
• Be aware of appropriate serving size. Measure your food to help understand ideal serving size.
• Do not skip meals. Plan your meals and snacks through the day. Having meals throughout the day can help avoid major changes in glucose levels.
• Eat plenty of vegetables and fiber.
• Limit the amount of fat (especially saturated and trans fats) in your foods.
• Eat moderate amounts of protein and low-fat dairy products.
• Carefully limit foods containing high concentrated sugar.
• Keep a record of your food intake. Share the record with your dietitian or doctor. This will help to create an effective meal plan.

Weight Loss
If you are overweight, weight loss will help your body use insulin better. Talk to your doctor about a healthy weight goal. You and your doctor or dietitian can make a safe meal plan for you.

These options may help you lose weight:
• Use a portion control plate
• Use a prepared meal plan
• Eat a Mediterranean-style diet

Exercise
Physical activity can:
• Make the body more sensitive to insulin
• Help you reach and maintain a healthy weight
• Lower the levels of fat in your blood

Aerobic exercise is any activity that increases your heart rate. Resistance training helps build muscle strength. Both types of exercise help to improve long-term glucose control. Regular exercise can also help reduce your risk of heart disease.

Talk to your doctor about an activity plan. Ask about any precautions you may need to take.

Medication
Certain medications will help to manage blood glucose levels.

Medication taken by mouth may include:
• Biguanides reduce the amount of glucose made by the body
• Sulfonylureas encourage the pancreas to make more insulin
• Insulin sensitizers to help the body use insulin better
• Starch blockers to decrease the amount of glucose absorbed into the blood
• Sodium-glucose co-transporter 2 (SGLT-2) inhibitors to increase glucose excretion in urine
• Bile acid binders

Some medications needs to be given by injection, such as:
• Incretin-mimetics stimulate the pancreas to produce insulin and decrease appetite, which can assist with weight loss
• Amylin analogs replace a protein of the pancreas that is low in people with type 2 diabetes

Insulin
Insulin may be needed if:
• The body does not make enough of its own insulin
• Blood glucose levels cannot be controlled with lifestyle changes and medications

Insulin is given through injections. There is one short-acting inhaled insulin which may be available for select persons.

Blood Glucose Testing
You can check the level of glucose in your blood with a blood glucose meter. Checking your blood glucose levels during the day can help you stay on track. It will also help your doctor determine if your treatment is working. Keeping track of blood sugar levels is especially important if you take insulin.

Regular testing may not be needed if your diabetes is under control and you don’t take insulin. Talk with your doctor before stopping blood sugar monitoring.

An HbA1c test may also be done at your doctor’s office. This is a measure of blood glucose control over a long period of time. Doctors advise that most people keep their HbA1c levels below 7%. Your exact goal may be different. Keeping HbA1c in your goal range can help lower the chance of complications.

Counseling
Depression can undermine your recovery and put you at risk for other complications. Feelings of sadness, hopelessness, and loss of interest in your favorite activities that stay with you for at least 2 weeks should prompt you to call your doctor. Depression is treatable. Your doctor may refer you to counseling to help you better manage your depression and diabetes.

Decreasing Risk of Complications
Over a long period of time, high blood glucose levels can damage vital organs. The kidneys, eyes, and nerves are most affected. Diabetes can also increase your risk of heart disease.

Maintaining goal blood glucose levels is the first step to lowering your risk of these complications. Other steps:
• Take good care of your feet. Be on the lookout for any sores or irritated areas. Keep your feet dry and clean.
• Have your eyes checked once a year.
• Don’t smoke. If you do, look for programs or products that can help you quit.
• Keep track of your moods and be alert for persistent depressive symptoms.
• Plan medical visits as recommended.

Prevention
To help reduce your chance of type 2 diabetes:
• Participate in regular physical activity
• Maintain a healthy weight
• Drink alcohol only in moderation (2 drinks per day for a man, and 1 drink per day for a woman)
• Eat a well-balanced diet:
– Get enough fiber
– Avoid fatty foods
– Limit sugar intake
– Eat more green, leafy vegetables
– Eat whole fruits, especially apples, grapes, and blueberries

by Debra Wood, RN

RESOURCES:
American Diabetes Association
http://www.diabetes.org

National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov

CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:

American Association of Clinical Endocrinologists, American College of Endocrinology. Medical guidelines for the management of diabetes mellitus. The AACe system of intensive diabetes self-management. 2002 update. Endocrine Practice. 2002;8(suppl 1):S40-S82.

American Diabetes Association Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33:S62-S69.

Boren SA, Gunlock TL, Schaefer J, Albright A. Reducing risks in diabetes self-management: a systematic review of the literature. Diabetes Educ. 2007;33:1053-1077.

Causes of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/causes-diabetes/Pages/index.aspx. Updated June 2014. Accessed September 3, 2015.

Diabetes. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/diabetes/home/index.html. Updated August 18, 2015. Accessed September 3, 2015.

Diabetes mellitus type 2 in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults. Updated August 29, 2016. Accessed September 29, 2016.

Diabetes mellitus type 2 in children and adolescents. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901364/Diabetes-mellitus-type-2-in-children-and-adolescents. Updated June 9, 2016. Accessed September 29, 2016.

Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28(suppl 1):S37-42.

Dietary considerations for patients with type 2 diabetes. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T270045/Dietary-considerations-for-patients-with-type-2-diabetes. Updated January 19, 2016. Accessed September 29, 2016.

Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;248:383-393.

Harsch IA. Inhaled insulins: their potential in the treatment of diabetes mellitus. Treat Endocrinol. 2005;4:131-138.

Lee DC, Sui X, Church TS, Lee IM, Blair SN. Associations of cardiorespiratory fitness and obesity with risks of impaired fasting glucose and type 2 diabetes in men. Diabetes Care. 2009;32:257-262.

Marre M. Reducing cardiovascular risk in diabetes. J Hypertens. 2007;(supp 11)S19-22.

Physical activity/exercise and diabetes. Diabetes Care. 2004;27(suppl 1):S58-62.

Rosenbloom AL, Silverstein JH, Amemiya S, et al. ISPAD Clinical Practice Consensus Guideline 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes. 2008;9:512-526.

Rosenzweig JL, Ferrannini E, Grundy SM, et al. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:3671-3689.

Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE and VA diabetes trials: a position statement of the American Diabetes association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Circulation. 2009;119:351-7.

Standards of medical care in diabetes—2009. Diabetes Care. 2009;32:S13-61.

Statement by an AACE/ACE Consensus Panel on Type 2 Diabetes Mellitus: An Algorithm for Glycemic Control. Endocr Pract. 2009;15:540-559.

Traina AN, Kane MP. Primer on pramlintide, an amylin analog. Diabetes Educ. 2011;37(3):426-431.

Type 2. American Diabetes Association website. Available at: http://www.diabetes.org/diabetes-basics/type-2/?loc=HomePage-type2-tdt. Accessed September 3, 2015.

UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet. 1998;352:954-965.

US Preventive Services Task Force: Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:846-854.

11/29/2006 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-1679.

9/19/2006 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Syst Rev. 2006;CD002968.

6/1/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356(24):2457-2471.

7/13/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Farmer A, Wade A, Goyder E, et al. Impact of self-monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007;335(7611):132.

12/13/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Milman U, Blum S, Shapira C, et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2-2 genotype. A prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol. 2008;28(2):341-347.

2/28/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336(7642):491-495.

2/28/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168:141-146.

6/18/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-2572.

2/24/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Liese AD, Weis KE, Schulz M, Tooze JA. Food intake patterns associated with incident type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009;32:263-268.

5/11/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Loimaala A, Groundstroem K, Rinne M, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103:972-977.

8/19/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Li TY, Brennan AM, Wedick NM, Mantzoros C, Rifai N, Hu FB. Regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with type 2 diabetes. J Nutr. 2009;139:1333-1338.

10/12/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Crandall JP, Polsky S, Howard AA, et al. Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr. 2009;90:595-601.

11/20/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Lund SS, Tarnow L, Frandsen M, et al. Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial. BMJ. 2009;339:b4324.

12/21/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):414-420.

2/15/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1:S11-61).

2/15/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1:S62-69).

7/2/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Micha R, Wallace SK, Mozaffarian D. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010;121(21):2271-2283.

10/5/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;341:c4229.

1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Pan A, Lucas M, Sun Q, et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. 2010;170(21):1884-1891.

5/6/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Muraki I, Imamura F, Manson J, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013;347:f5001.

4/14/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Xi B, Li S, et al. Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2014;9(3):e93471.

7/21/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Afshin A, Micha R, et al. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100(1):278-288.

9/11/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Tovote KA, Fleer J, Snippe E, et al. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care. 2014;37(9):2427-2434.

9/16/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Zhou D, Yu H, He F, et al. Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2014;100(1):270-277.

Last reviewed January 2016 by Kim Carmichael, MD

November 2016 Events

October 20, 2016 Teresa Stockton - Blog, Events

GEORGIA PHYSICAL THERAPY EVENTS

GREENSBORO, GA
DATE: November 9th 2016, 12:00PM – 2:00PM
8th Annual Thanksgiving Dinner
CLINIC: Advance Rehabilitation Physical Therapy – Greenboro
Advance Rehab is celebrating its 8th annual Thanksgiving dinner in Greensboro, Georgia with a turkey and all the fixings!
For more information about Advance Rehabilitation Physical Therapy, visit them online at http://www.advancerehab.com.

Exercise and Bone Health

September 1, 2016 Teresa Stockton - Aging, Blog, Sports and Fitness

Bone is living tissue that is constantly undergoing a process called remodeling. In remodeling, cells called osteoclasts are breaking down old bone, as cells called osteoblasts are replacing it with new tissue. Many factors can affect the remodeling process and leave you with bones that are less dense and more fragile.

Some factors that interfere with bone health and remodeling are:
• Increased age
• Low vitamin D—The body makes vitamin D in response to sunlight. You can also get vitamin D by eating certain kinds of food or by taking a supplement.
• A diet low in calcium
• Smoking
• Lack of exercise—especially weight bearing and resistance exercise

Why Exercise Is Good for Bone Health
Regular weight-bearing and resistance exercise helps build muscle, as well as maintain and increase bone strength. Exercise causes the muscle to contract against the bone. This action stresses or stimulates the bone, and the bone becomes stronger and denser. The 3 main types of exercise are (some activities can be more than 1 type):

Aerobic (Cardiovascular) Exercises to Improve Bone Health
In aerobic exercise, you continually move large muscles in the legs, shoulders, and buttocks. This action causes you to breathe more deeply, and your heart to work harder pumping blood, thereby strengthening your heart and lungs. Examples include:
• Walking
• Jogging
• Running
• Aerobic dance
• Bicycling
• Swimming

Weight-Bearing Exercises to Improve Bone Health
In weight-bearing exercises, your bones and muscles work against gravity, and your feet and legs bear the weight. Your bones adapt to the weight and pull of the muscle during weight-bearing exercise. Examples of weight-bearing exercises include:
• Jogging
• Walking
• Stair climbing
• Dancing
• Soccer

Resistance Exercises to Improve Bone Health (Strength Training)
Resistance exercises use muscle strength to improve muscle mass and strengthen bone. Examples include:
• Weight lifting, using:
• Free weights
• Weight machines
• Elastic tubing

• Calisthenics such as push-ups and chin-ups

Tips for Beginning:
Aerobic or Weight-bearing Exercises to Improve Bone Health
• Warm up for 5 minutes before activity. This can consist of dynamic stretches that involve movement and a light walk.
• Start the activity slowly for the first 5 minutes.
• Slowly increase your intensity so that your heart rate increases. A person doing moderate-intensity aerobic activity can talk. A person doing vigorous-intensity activity cannot say more than a few words without stopping to take a breath.
• Gradually increase your workout until you are working out at least 150 minutes a week at moderate–intensity or 75 minutes a week at vigorous intensity.

Resistance Exercises to Improve Bone Health
• Begin each exercise with light weights and minimal repetitions.
• Slowly (over weeks) increase weight, never adding more than 10% in a given workout.
• Do these exercises 2-3 times a week. Allow for 1 day between each workout for your bones and muscles to rest and repair themselves.
• Gradually increase the number of repetitions to 2-3 sets of 8-10 repetitions with a rest period of 30-60 seconds between sets.
• Although stiffness the day after exercise is normal, if you are in pain, you did too much. Decrease the intensity or the duration of your exercise.

Before starting any type of exercise program, check with your doctor about any possible medical problems you may have that could limit your ability to exercise.

by Mary Calvagna, MS

RESOURCES:
National Osteoporosis Foundation
http://www.nof.org

The President’s Council on Physical Fitness, Sports, and Nutrition
http://www.fitness.gov

CANADIAN RESOURCES:
Canadian Orthopaedic Foundation
http://www.canorth.org

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:
2008 Physical Activity Guidelines for Americans. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/default.aspx#toc. Published October 2008. Accessed January 21, 2016.

Bone remodeling. University of Washington website. Available at: http://courses.washington.edu/bonephys/physremod.html. Updated March 30, 2007. Accessed January 21, 2016.

How much physical activity do adults need? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html. Updated June 4, 2015. Accessed January 21, 2016.

Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 13, 2015. Accessed January 21, 2016.

Skeleton keys. Smithsonian Museum of Natural History website. Available at: http://anthropology.si.edu/writteninbone/young_old.html. Accessed January 21, 2016.

Last reviewed January 2016 by Michael Woods, MD

What Does It Really Mean to Have Prediabetes?

June 9, 2016 Teresa Stockton - Blog, General Information

Type 2 diabetes usually occurs as a result of genetics and lifestyle. It is marked by abnormally high levels of blood sugar, known as glucose. Glucose is the primary source of energy for our cells that the body makes from food we ingest. The onset of type 2 diabetes is triggered when the body is no longer able to properly use insulin, the hormone that helps cells take in glucose from the blood. When glucose stays in the blood stream instead of moving into the cells, nerves and blood vessels can be damaged. This increases the risk of cardiovascular disease, stroke, blindness, kidney disease, and circulation problems.

What Is Prediabetes?
Prediabetes is a condition that precedes the onset of type 2 diabetes. It is characterized by blood glucose levels that are elevated, though not high enough to be classified as diabetes. Doctors usually refer to prediabetes as impaired glucose tolerance or impaired fasting glucose. The American Diabetes Association (ADA) recommends screening for all adults 45 years old and older. Also, if you are younger than 45 and are overweight or obese and have risk factors for diabetes, you should be screened. Risk factors include:
• Family history of diabetes
• Having hypertension, high cholesterol, or high triglycerides
• Sedentary lifestyle
• History of gestational diabetes or giving birth to a baby weighing more than 9 pounds (4 kilograms)
• History of cardiovascular disease
• Having a condition associated with insulin resistance, such as polycystic ovary syndrome or metabolic syndrome

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

How Do You Know If You Have Prediabetes?
During a routine office visit, your doctor can order tests, such as:
• Fasting plasma glucose test—For this test, you fast overnight and have your blood glucose measured in the morning before eating. Results in the range of 100-125 mg/dL (5.6-6.9 mmol/L) may indicate prediabetes.
• Oral glucose tolerance test (OGTT)—Again, you fast overnight and have your blood glucose measured after the fast. Then, you consume a sugary drink and have your blood glucose measured two hours later. Results in the range of 140-199 mg/dL (7.8-11 mmol/L) indicate prediabetes.
• Hemoglobin A1c (HbA1c)—This is an indicator of your average blood sugar levels over the previous three months. Results in the range of 5.7%-6.4% indicate prediabetes.

What Can You Do If You Have Prediabetes?
If you are diagnosed with prediabetes, it is important to take action to manage your condition. If you are overweight, your doctor may recommend that you lose weight. Reducing your body weight, even by 5%-10% can help improve your health. In general, changing your diet and being physically active and exercising at least 30 minutes a day will help you stay on track. Participating in a behavioral modification program may further help you achieve your weight loss goals.

Because many of the lifestyle-related risk factors associated with diabetes are also risk factors for other health issues, making lifestyle changes to reduce your risk of diabetes may have a positive effect on your overall health.

Some people can take medication to manage their blood glucose levels, though lifestyle modification should be the first approach to manage prediabetes. Medications that may be used include metformin, pioglitazone, and acarbose.

How Can You Prevent Prediabetes?
The same strategies that are used to lower your risk of type 2 diabetes can be applied to prediabetes, as well. The American Diabetes Association (ADA) recommends these strategies:
• Lose excess weight.
• Exercise for at least 150 minutes per week.
• Reduce your intake of calories and fat.
• Try to eat more fiber and whole grains.

If you do have prediabetes, you can take steps that may slow or avoid the progression to type 2 diabetes. It will take a lot of effort on your part, but the potential benefits—being healthy and living longer—are worth it.

by Julie J. Martin, MS

RESOURCES:
American Diabetes Association
http://www.diabetes.org

National Diabetes Education Program
http://www.ndep.nih.gov

CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:
Am I at risk for type 2 diabetes? Taking steps to lower the risk of getting diabetes. National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/risk.pdf. Published June 2012. Accessed April 26, 2016.

American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Diseases. The prevention or delay of type 2 diabetes. Diabetes Care 2002;25:1-8.

Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. NEJM. 2002;346:393-403.

Diabetes mellitus type 2 prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 22, 2016. Accessed April 26, 2016.

Diagnosing diabetes and learning about prediabetes. American Diabetes Association website. Available at: http://www.diabetes.org/are-you-at-risk/prediabetes. Updated December 9, 2014. Accessed April 26, 2016.

Kanaya AM, Narayan KM. Prevention of type 2 diabetes: Data from recent trials. Primary Care. 2003;30:511-526.

Narayan K, Imperatore G. Targeting people with prediabetes. British Medical Journal. 2002;325:403-404.

Nathan DM. Diabetes Care. 2007;30:753.

Prediabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 22, 2016. Accessed April 26, 2016.

Tuomilehto J, Lindstorm J. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2004;344:1343-1350.

10/21/2008 DynaMed’s Systematic Literature Surveillance: http://www.ebscohost.com/dynamed: Greaves CJ, Middlebrooke A, O’Loughlin L, et al. Motivational interviewing for modifying diabetes risk: a randomised controlled trial. Br J Gen Pract. 2008;58:535-540.

10/12/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Crandall JP, Polsky S, Howard AA, et al. Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr. 2009;90:595-601.

2/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1:S11-S61).

2/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1:S62-S69).

Last reviewed April 2016 by Michael Woods, MD Last Updated: 6/3/014

Long Work Hours May Increase Risk of Stroke

April 14, 2016 Teresa Stockton - Blog, Neurological Rehab

Stroke is a brain injury caused by an interruption in blood flow. It is a leading cause of death in the US, and can also cause disability, decreased quality of life and increased healthcare expenses. There are many lifestyle factors that affect you risk of stroke including diet, exercise, smoking and stress. Other lifestyle habits like long periods of standing or long work hours are also being reviewed for their impact on stroke risk.

Earlier research has suggested that long working hours may be linked to stroke, but the evidence is limited. Researchers wanted to determine if there was a possible connection between long work hours and the risk of stroke. The study, published in Lancet, found that employees who work long hours have a higher risk of stroke than those who do not.

About the Study
The systematic review of observational studies included 528,908 men and women from Europe, the U.S. and Australia who were free from history of stroke at the beginning of the study. The participants volunteered their work hours and were tracked for the development of stroke. During an average 7.2 year follow up there were 1,722 stroke-related events.

Compared to those who worked standard hours (35-40 hours/week), participants who worked 49-54 and more than 55 hours a week had an increased risk of stroke.

The effects remained apparent even when other stroke factors like age, sex and health history were accounted for.

How Does This Affect You?
A systematic review pools a large number of trials to create a larger pool of data. The larger the pool of data, the more reliable outcomes are. However, the review is only as reliable as the trials that are included. The included studies were all observational studies which means a direct cause and effect link could not be established and the studies can only show a potential link between factors.

There is a reasonable link between extra work hours and stroke since longer hours are often associated with extra stress and less relaxation time. If you have long work hours, you may want to talk to your doctor about your personal risk factors for stroke and follow other stroke prevention methods such as:
• Exercising regularly
• Maintaining a healthy weight
• Eating more fruits, vegetables and whole grains and limiting dietary salt and fat
• If you smoke, talking to your doctor about way to quit
• Increasing your consumption of fish
• Drinking alcohol in moderation
• Managing chronic medical conditions, such as high blood pressure, high cholesterol and diabetes

Rehabilitation doesn’t reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke.

What is a Stroke?
A stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.

• A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

What are the Effects of Stroke?
The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can’t reach the region that controls a particular body function, that part of the body won’t work as it should. Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation helps you return to independent living.

Rehabilitation doesn’t reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke.

What Will I Do in Rehabilitation?
What you do in rehabilitation depends on what you need to become independent. You may work to improve your independence in many areas. These include:
• Self-care skills such as feeding, grooming, bathing, toileting and dressing
• Mobility skills such as transferring, walking or self-propelling a wheelchair
• Communication skills in speech and language
• Cognitive skills such as memory or problem solving
• Social skills for interacting with other people

by Cynthia M. Johnson, MA

RESOURCES:

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

American Stroke Association
http://www.strokeassociation.org

Kivimäki M, Jokela M, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015 Oct 31;386(10005):1739-1746. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960295-1/fulltext. Accessed January 19, 2016.

Risk factors for stroke or transient ischemic attack. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 28, 2015. Accessed January 19, 2016.

Last reviewed January 2016 by Michael Woods, MD

Eating Healthfully on a Tight Budget

March 3, 2016 Teresa Stockton - Blog, General Information

When you are on a tight budget, shopping for food can be challenging. It is a common misconception that cutting back on food expenses means sacrificing good nutrition. However, you can be healthier and wealthier by getting wiser about planning meals and shopping. Here are some guidelines that can help:

Let the Plate Be Your Guide
Many people plan their meals around meat, and leave grains, vegetables, and fruit for side dishes. However, according to Choose My Plate, the bulk of your diet should be made up of vegetables and fruit. And at least half of your grains should be whole grains such as whole wheat breads, pasta, and brown rice. Meats and dairy products should be treated as side dishes and eaten less frequently. This is not only more economical but more healthful. Here are a few examples of meals made mostly with whole grains, fruits, and vegetables:
• Chili—beans, vegetables, and meat, served with a salad
• Stir-fry—vegetables with a small amount of meat served over rice or pasta and a salad
• Stews or soup—beans, vegetables, pasta, rice, meat or chicken, served with salad
• Taco—beans or meat with lots of lettuce, tomato, onions, and a corn tortilla

Make It From Scratch
Many of the prepackaged, boxed, canned, and frozen foods you buy from the store are high in fat, calories, sodium, sugar, and cost, compared with foods prepared at home. They may also be lower in vitamins and minerals. You pay for the fancy packaging and convenience of these items, but you get much less for your money. For example, you can make many more bags of popcorn from a bag of unpopped corn compared to buying a bag of already-popped popcorn. The pre-made popcorn is much more expensive and has more fat and sodium than what you can make at home. Of course, making food from scratch may take a little more time, but it can be well worth it in terms of cost and nutrition.

Have a Game Plan for Shopping
Have a game plan for shopping that includes what you are going to buy and where you are going to buy it. Here are some tips on developing a shopping plan:
• Plan meals and snacks several days in advance. Then write a shopping list—and stick to it!
• Compare prices among grocery stores. Shop at national chains and discount food outlets. Do not shop at convenience stores.
• Go to stores that sell generic foods, store brand foods, and foods in bulk.
• Use coupons with caution. They are often for foods that are more expensive. Do not buy junk food or something you normally would not buy, just because you have a coupon.
• Never shop on an empty stomach.
• Look for sales on items that are on your list.

When shopping, it’s also important to look for foods that are fresh. Check the dates on perishable items like meat, cheese, and yogurt. If you aren’t able to consume the item before the date, then you shouldn’t purchase it.

Check the Unit Prices of Items
The unit price calculates the cost of a product per unit. For example, a unit could be by the ounce, pound, or number of items in a package. Unit prices are usually marked on the shelf below the product. For example, let’s say you are looking for canned beets and there are three different brands to choose from. If you look at the unit price below each one, you can find the brand that is cheapest, especially if you buy the largest can. However, it only makes sense to buy the largest can if you are sure you will use it all.

Read Food Labels
It is easier to make the most nutritious choice when you know how to read the nutrition facts label. These labels contain the nutritional information and are found on most packaged foods. Use the nutrition facts label to focus on the facts that are most important to you, such as the fat, sugar, or sodium content. Nutritional labels make it easier for you to compare similar products.

Buy in Bulk… When It Makes Sense
Save time and money by buying in bulk. You can buy in bulk through supermarkets, buying clubs, food cooperatives, farmer’s markets, and warehouses. When you buy in bulk, you can purchase a product in multiple or large units that can be stored, or from an open container in the store, such as a bin of rice where you can scoop out as much as you want. Before buying in bulk, keep the following tips in mind:
• Buy only products that your family will like and use often enough so that they will be used before spoiling or becoming outdated. Otherwise, you will waste food and money.
• Not all bulk items are bargains. Make sure the item is really a good buy and saves you money. Check the unit price; do not just look at the size of the package.
• When you buy in bulk, you buy more than you can use before your next shopping trip. Be sure you have enough money to do this.
• You should know what type of storage is needed for the product and have enough space to store it.
• Beware that buying in bulk can lead families to overeat or eat too quickly. If this happens, you could run out of food or money before the end of the month. Make sure you can store food so that it will not get eaten too quickly.
• Freeze prepared items in small containers rather than one large container so you only need to thaw the servings you need.
• Know proper storage times for different foods. For example:
• Ground meats: 3-4 months in the freezer
• Hot dogs: 1-2 months in the freezer
• Eggs: 3-5 weeks in the refrigerator
• Opened lunch meats: 3-5 days in the refrigerator
• Bacon: 7 days in the refrigerator
• Fresh chicken or turkey parts: 9 months in the freezer

Eat at Home
Eating out can be expensive and the food is often high in fat, salt, and sugar. A spaghetti dinner at a restaurant could cost $10 or more, but only a few dollars if you prepared it at home. At a restaurant, your extra costs go toward profits and tips. Consider having a potluck. When you entertain guests at home, ask them to bring a dish.

Be Prepared
If you are going to be out running errands or shopping with your family, bring some healthy snacks and drinks with you. That way, if hunger hits, you will not be tempted to stop at a fast food restaurant or buy snacks from a vending machine—something that can hurt your wallet and your waistline. Whether you make snacks at home or buy them from the grocery store, it is less expensive than buying them in the mall.

by Amy Scholten, MPH

RESOURCES:
American Dietetic Association
http://www.eatright.org

Choose My Plate—US Department of Agriculture
http://www.choosemyplate.gov

CANADIAN RESOURCES:
Canada’s Food Guide
http://www.hc-sc.gc.ca

Dietitians of Canada
http://www.dietitians.ca

REFERENCES:
Charts: food safety at a glance. FoodSafety.gov website. Available at: http://www.foodsafety.gov/keep/charts/index.html. Accessed January 27, 2016.

Eating better on a budget. Choose My Plate, US Department of Agriculture website. Available at: http://www.choosemyplate.gov/ten-tips-eating-better-on-a-budget. Updated September 1, 2015. Accessed January 27, 2016.

Lino M. Nutrition doesn’t have to be expensive. Choose My Plate, US Department of Agriculture website. Available at: http://www.choosemyplate.gov/sites/default/files/printablematerials/USDABlog-NutritionDoesntHaveToBeExpensive.pdf. Published August 25, 2011. Accessed January 27, 2016.

Last reviewed January 2016 by Michael Woods, MD Last Updated: 3/13/2014

Post Workout Nutrition Tips for an Intense Workout

January 19, 2016 Teresa Stockton - Blog, Sports and Fitness

After an intense workout you need to replenish your body with the nutrients and vitamins that were lost while exercising. We have compiled a post workout nutrition guide to help you make good choices as you refuel your body.

PROTEIN, CARBOHYDRATE AND WATER:
Intake within 30-60 minutes post workout for optimal nutrient uptake (muscles and energy system get the most out of the nutrients).

PROTEIN TO CARBOHYDRATE RATIO OF 3:1 (chocolate milk is perfect: 8g Carbs/ 24g Protein)
TAKING IN PROTEIN WITH CARBOHYDRATES
• Slows nutrient uptake into the bloodstream (keeping blood sugar from spiking up, minimizing production of insulin which in turn slows fat storage)
• Maintains a steady burning metabolism
• Helps to more effectively restore muscle glycogen (energy)
• Begins to heal muscle tissue quicker.

BASIC POST WORKOUT MEALS INCLUDE:
• Wheat Bagel with Almond Butter
• Tuna on Wheat Crackers
• Cereal with Skim Milk
• Greek Yogurt with Fruit
• Stir Fry
• Turkey/Chicken Sandwich
• Protein Bar
• Hummus with Whole Grain Pita
• Sports drink with Protein Shake
• Water, Water, Water!!!!

There are many more choices, and creativity is always an option. The important part is to choose a lean meat or protein source (chicken, turkey, fish, lean beef, tofu, beans, nuts), healthy carbohydrate source (whole grain, fruits, vegetables, nuts) and a small amount of healthy fat (Unsaturated: Avocadoes, almonds, walnuts, olive oil). Mixing and matching these is the best approach. This guarantees the widest range of vitamins and minerals in your meal.