And the Winner is...

So, what piece of exercise equipment do I recommend the most for my patients? The hands down winner is an exercise bike. Treadmills are great if you've got room (see yesterday's post). However, I always recommend cross-training to avoid injuries, and walking somewhere outdoors should be an option for everyone. Elliptical machines provide a different muscle stress than walking, but I have found that the less expensive ones don't get used too much because of instability or jerky movements, and the top of the line ellipticals are a major investment.
Exercise bikes allow for cross training, take up relatively less room, and tend to have better quality at a lower price point (compared with treadmills and ellipticals.) Also, for me, reading is truly an option on the bike. I find I cannot focus clearly enough to read on the other types of machines. I recommend the "recumbent" bikes- one with the big cushy chair that supports your rear end and your back, but still allows you to sit upright (not the ones on the floor where your legs are straight out.)
No matter what you buy, though, TRY IT OUT before you invest! Machines fit everyone differently, and you can't tell from a picture on the internet if your leg or arm is going to hit the water bottle holder.
BOTTOM LINE: If you've got tons of money and space, take your pick and buy more than one type of home exercise machine, but if you're limited, buy the BIKE!

Location, location, location!

Location- it's not just for real estate, but also for EXERCISE! If you are going to invest in a piece of home exercise equipment (which I highly recommend), please place it where it will get used. Treadmills and exercise bikes quickly become expensive clothes hangers if they are not set up in a user-friendly spot. What's ideal? In front of a television- wherever that works in your home. Listening to music or reading a book (on a bike) are great options, but having the ability to watch a show really seems to make the exercise time fly by. Please do consult with your spouse- he/she may not want your lovely new elliptical machine in the center of your living room! However, if your living room is the only room with a tv, I'd try to compromise.
In my fifteen years of practice, every time someone tells me they own a machine but don't use it, there are only a few reasons.

One- it's out in the garage (and in Texas, this means it's WAY too hot most of the year.)
Two- it got moved to a spot where it's impossible or awkward to see the tv.
Three- it's in the bedroom and it bothers my spouse (because he/she is sleeping) or it's buried under clothes and towels.
BOTTOM LINE: Treadmills, exercise bikes and elliptical machines are wonderful, healthy additions to your home...IF they are placed in the right location to optimize use!

Guilt-free "Do-Over"!

Happy Friday! Can you believe that it's already the last Friday in January? Where did the first month of 2010 go? Monday brings with it the start of Valentine's season, so here is my first Valentine to you: a free "do-over"!
If you started the year with wonderful intentions of healthier eating, movement, and lifestyle, but feel you've already fallen off the wagon, don't give up! Cut yourself some slack, and instead of lining up the excuses, do something today to make a positive change. Enjoy a fruit smoothie, walk your dog, jump back on the Wii fit- whatever sounds uplifting to you, and make a fresh start on Monday (or better yet, today!) Every day, truly, provides the opportunity to improve your health. Sometimes we get so sunk into the guilty or failure mindset that we need "permission" to set the reset button, so here it is!
BOTTOM LINE: Give yourself a big hug and celebrate your successful strides for "MORE" in 2010, and/or grant yourself a guilt-free new start today!

Q&A about GERD

Since I brought up caffeine yesterday, let me follow with a related common question I hear in the office. "What can you give me for my heartburn?" or, sadly, since the dawn of commercials telling us what we "need", "I think I need the purple pill for my GERD (Gastro-Esophageal Reflux Disease)"! And what do I say? My response is "Let me teach you what YOU can do to improve your heartburn."
There are certainly a plethora of medicines we can use to treat reflux, from over the counter antacids to expensive proton pump inhibitors, and they all work very well. However, why not address the CAUSE of the problem? Heartburn comes from stomach acid sloshing back upwards into the esophagus rather than flowing downstream. This happens when the sphincter- the band of tissue that surrounds the connection between the esophagus and the stomach- relaxes. What causes it to relax?
You already know the answer if you picture what people do after overeating, and they want to relieve their distended stomach. Tobacco, alcohol, caffeine and peppermints all relax that sphincter, letting our stomachs feel less distended, but allowing acid reflux in the process. Remember this when the waiter sets your mints down as he refills your coffee with desert.
BOTTOM LINE: If you're having heartburn on a regular basis, limit the causes of reflux- smoking, alcohol, caffeine and mints- BEFORE you head to the doctor for a quick fix.

Time to decaffeinate?

How much caffeine is too much? Most of my patients would laugh and tell you I think any caffeine is too much, because I have asked so many of them to give it up (and, for the record, had very positive feedback from those who have!) In reality, though, here is my standard answer. Do you have headaches, insomnia, heartburn or fatigue? If you have any of those, I would advise you to completely decaffeinate, because caffeine aggravates all these problems. Yes, I understand that you drink your coffee because you are tired and need the "pick-me-up", but all that you are doing is perpetuating the cycle. The more caffeine, the worse quality of sleep, and the more tired you get.
So how do you wean? Many people get intense headaches if they abruptly quit caffeine. (Here's a hint- if you do get caffeine withdrawal headaches, this should be a clue you're consuming "too much" for you!) Start mixing your coffee with roughly a third decaf, then several days later go to half decaf/half regular, and then several days after that drop down to 1/3 caffeinated. By day 10, you should be fully decaffeinated without getting a headache. I have found that after a couple weeks of NO caffeine, most people begin to have more energy.
BOTTOM LINE: If you have no trouble falling asleep, wake up rested and energetic, and never have heartburn- enjoy your Starbucks guilt-free! BUT...if you have any of those issues, it's time to DE-caffeinate!

Cover the clock!

What is the most useful information you've ever received from a doctor? Well, I saw yet another patient today who told me this was the best advice I had given them, so I thought I should share it here. COVER THE CLOCK!
If you are having trouble sleeping, whether it's difficulty falling asleep or problems with waking up every morning at 3:17am (and isn't it amazing how accurate our internal clocks can be when they get stuck on a frustrating awakening time?), one simple piece of advice is to cover your clock. Cover it- turn it around- whatever it takes so you simply cannot see the time. You'll be amazed how well this works! You may still wake up, but without seeing the time, you don't start that whole cycle of "oh my gosh, it's 3:17am, and here I am awake again, and I'll never be able to function today, and I'm so tired, and look, now it's 3:19am..."
Of course, if you're like me, you'll need to double and triple check that your alarm is set before you turn the clock away from you (or cover it), but that's okay. It will likely take you several nights to break your cycle of awakening, but if you don't "cheat" and sneak a peak at the time, you'll be sleeping better before you know it.
BOTTOM LINE: COVER THE CLOCK to improve your sleep!

Yummy Allergen-free cookies!

Okay, since I put in a pitch for Girl Scout Cookies, and that left out a chunk of our society that cannot eat them, here is my balancing plug. Gluten-free cookies have become fairly plentiful. In both the major grocery stores where I shop, there is now a gluten-free section that includes breads, pastas, and yes, COOKIES! Certainly, I find a greater selection in Whole Foods or Central market, but HEB and Randalls are steadily catching up.
For the past couple months, I have been trying to follow a gluten-free, casein-free, soy-free diet (long story, but not for weight issues.) I absolutely LOVE baking, and needless to say, skipping wheat flour and dairy limits my standard recipes!
Cheers to Leslie Hammond, author of "Enjoy Life's Cookies for Everyone!" This cookbook is designed to avoid the eight major food allergens: gluten, wheat, dairy, egg, soy, tree nut and peanuts. No small task! As you flip through the book, beautiful pictures have you drooling and dying to make these delicious treats. Leslie does a nice job, too, of letting you know how to stock your pantry (and where to buy these ingredients.)
I am a tough critic on cookbooks, and I will confess the first cookie I made looked spectacular, tasted very good, but was hard as a rock. (I will say, though, I'm going to try it again because it has such potential ;0) The second cookie, however, the "Chompin' Choco Chip Banana Bars" were so good that they disappeared immediately, despite my protests to the rest of the family that these were MY cookies!
BOTTOM LINE: Check out "Enjoy Life's Cookies for Everyone" to make homemade allergen-free treats!

An App for Everything- PERIOD.

Gotta love our modern technology, right? Ladies, this one's for you. Every time you go to the doctor, the medical assistant asks you "what is the first day of your last period"? And who can remember? From the doctor's standpoint, I'll tell you that more often than not, the date entered into our form is followed with a question mark, if a date is put in at all. And, for the record, this is actually useful information for us- we're not just being nosy. Beyond simply implying whether or not you might be pregnant, timing of periods can give us clues to your hormonal cycles and may suggest causes for symptoms (such as pelvic pain during ovulation).
In the course of seeing a patient this week, I had occasion to ask if her periods were regular. She whipped out her iphone, and said, "Did you know I've got an app for that?" After we both cracked up, she showed me her "P. Tracker", complete with cute flower icons. It was so helpful! I've seen everything from day planners, to laptops, to stray pieces of paper stuffed in purses with dates scribbled upon them, and while all of these can be helpful, my hat is off to the "P. Tracker" for it's ease/convenience.
BOTTOM LINE: Who knew there'd be an app for periods? Check it out at http://app-store.appspot.com/?url=viewSoftware%3Fid%3D289084315%26mt%3D8

Support Girl Scouts- Buy some cookies today!

Okay, how can I recommend cookies when I'm supposed to be all about health? Simple! I have never said that desserts were "bad". I am way less about what you can NOT eat, and more about, well, MORE fruits, veggies, and exercise! Unless you have specific medical issues (such as gluten intolerance), cookies can be included in a healthy diet. (If you have celiac disease, we'll talk about yummy cookies for you another day- the Girl Scouts do not yet have a gluten-free cookie, though I hope they are working on developing one.)
Today marks the official start of Girl Scout Cookie season. I am a troop leader for a wonderful group of Junior Scouts, and we, along with the rest of American Girl Scouts, will be out selling cookies. Our troop does not set any cookie-selling records- to be honest, we joke we do "cookies-light". However, our girls look forward to our annual week or two of cookie sales, enjoying customers' tales of their daughters selling cookies and taking pride in the number of boxes of cookies we receive as donations for our men and women in the military. Of course, back in MY day, we had to go door to door, walking our neighborhoods and taking orders long before we handed out cookies...but I digress!
Scouting is still a wonderful opportunity for girls of all ages to build "confidence, character and courage" as they learn new skills and have fun.
BOTTOM LINE: Enjoy a girl scout cookie or buy a box as a donation for your favorite charity, and THANKS for supporting GIRL SCOUTS!

Break the "Eat, Repent, Repeat" Cycle!

Tired of that eat, repent, repeat cycle? Dr. Michelle May's new book, Eat what you love, Love what you eat! is your ticket out. BUY THIS BOOK when you are really ready for change. This book is not a new diet to follow, and is not a quick read- but it is worth every minute you invest. Dr. May, a fellow family physician, has done an amazing job of helping readers be able to figure out the WHY behind their weight issues. She is a recovered yo=yo dieter herself, so she clearly understands the complexities of weight management.
I began recommending her book fresh off the presses, and I already have several success stories to share! The best news to me, however, is that my patients have universally agreed that this is the first book where the author "got inside (my) head". Dr. May teaches you to really "eat mindfully", enjoying and savoring flavors, smells, and the company at meals, rather than mindlessly tossing back food on the run.
BOTTOM LINE: If you have struggled with being overweight, buy and read Eat What You Love, Love What You Eat and figure out how to "eat mindfully and live vibrantly"!

SMOOTHIES RULE!

Since we're in a new decade, it's time to share my favorite after-school snack (or after-work, or before dinner, or for breakfast...)
I Loooooove smoothies. My basic recipe is this:
Add a banana (over-ripe is okay) to the blender. Toss in a handful of frozen berries (I prefer strawberries). Put in enough vanilla yogurt to cover the fruit (roughly a cup). Blend. That's it! For variety, change up the frozen fruit. Our daughter's girl scout troop did every variety I could find in a grocery store one day- from blueberries & raspberries, to peaches and mangos. A few girls liked "just banana" and many liked banana and chocolate syrup (go figure!)
Here's the most important tip: to CLEAN the blender, fill half way with water, add one drop of liquid dish soap, put back on the blender and mix for 10-30 seconds. This cleans virtually everything (except sometimes blueberries, which leave more residue.)
BOTTOM LINE: Try a smoothie and sit back and ENJOY!

Healthy Snacks!

Okay, it's week #2 of 2010...how are those resolutions going? Did you do the one word resolution (see December's blog) or write a whole list? It's funny how often by this second week that we've already drifted into old habits. So, what's my thought for today? Try some new healthy snacks! (Yes, it's still about food...)
I am a BIG fan of HUMMUS- regardless how you pronounce it. It takes less than 5 minutes to make, and it's creamy texture never fails to fill my craving for dip. Use carrots as the dipper, and you've got an amazingly nutritious snack!
Click here for my current favorite quick recipe:
http://mideastfood.about.com/od/appetizerssnacks/r/hummusbitahini.htm

BOTTOM LINE: Think outside your bag of chips and try some new healthy snacks!

MORE "Fun"

Is exercise always fun? Hmm…. I exercise first thing in the morning, because the reality is that life seems to intervene whenever I think I’m going to carve out a half-hour later in the day. Do I wake up with a song in my heart and smile on my lips, leaping out of bed with joy? Heck no! I moan and whine to myself, grumbling as I get dressed and leash the dog. The truth is, though, that by the time I reach the top of the large hill around the corner, I’m usually in good spirits, and I certainly feel more energetic and positive by the time I jump in the shower.
BOTTOM LINE: Not everyone who exercises daily LOVES it (at least on the front end), but it is one of the best gifts you can give yourself.

MORE Exercise Buddies

Okay, we’re nearing the end of the first week of the year. How are you doing? Have you started focusing on MORE healthy foods and activities? Make sure you enlist some friends in your increased activity plan. It’s far easier to hit the snooze button instead of exercising if the only one it affects is you. If, however, your neighbor is meeting you outside to go for a walk, I’ll bet you’re going to get up and go!
Consider having multiple exercise buddies, so you have several “obligations” throughout the week to keep you moving. Perhaps you have one friend who likes to go to an aerobics class, another who walks in the evenings, and your faithful dog who is ready for walk when your alarm goes off each morning. Think about signing up for some kind of lessons such as martial arts, dancing, kayaking or yoga. I’m not saying you need to be so scheduled that you have a different activity mandated every day of the week, but having multiple choices keeps your increased activity fresh and doesn’t have to feel like chore.
BOTTOM LINE: Exercise buddies will make it easier to have MORE aerobic activity.

When is a Pound Really GONE?

While we are talking about pounds, let’s make sure everyone has realistic understanding about what it takes to lose weight. No matter how you slice it, weight loss happens when you burn more calories than you take in, right? Duh- we all know that. But how many calories do you have to burn per day to lose a pound per week? One pound is 3600 calories (kcal), so rounding down and dividing by seven days in a week, the answer is that you need reduce your daily calories by 500 kcal.
Now, if you’ve paid attention to the number of calories burned when you hop on a machine at the gym, you may think it’s impossible to burn 500 kcal per day- and you’re probably right! The good news is that there simply needs to be a 500 kcal deficit, so by eliminating one higher calorie habit such as that afternoon pick-me-up soda or frappachino, you may only need to “exercise off” one or two hundred calories. Look at the calories and serving size of your favorite foods and drinks. You might be shocked to see that your morning muffin counts as three servings and totals 600 kcal if you eat the whole muffin (and who eats a third of a muffin??)
BOTTOM LINE: Realize that losing a pound per week is excellent weight loss- it didn’t come on over night, and it wont come off that way, either!

An Ounce of Prevention...

Equals pounds coming off ! Planning ahead is crucial for a successful change in your diet. Mind you, I’m using the word “diet” to refer to what you eat, not a specific regimented plan. If you’re going to focus on MORE fruits and vegetables, what happens when it’s halfway through the morning or afternoon at work and you’re ready for a snack? Well, if you’ve brought some sliced apples or baby carrots with you, you’ve got a healthy choice. If you’re heading to the vending machine or coffee shop, I’ll bet you’re less likely to succeed.
On your next trip to the grocery store, load up on produce. Purchase single portion servings, or create your own so that in the morning rush, you only have to grab and go.
BOTTOM LINE: Organize your snacks ahead of time so it is easy to make a healthy choice!

And MORE "More, More, More"!

Okay, why stop at MORE fruits and vegetables? Let’s continue a healthy 2010 by adding in MORE exercise, too! The key here is to set realistic goals. If you are very overweight and get short of breath unloading groceries, deciding to start exercising by running 3 miles per day (like you did when you were on the high school track team) is unlikely to succeed. Start low, go slow. For example, get a pedometer and WEAR it. (I emphasize wearing it because of the large number of patients who tell me they bought a pedometer, or exercise bike, or joined a gym, but never USED it.) Whatever your baseline number of steps per day is, add 300 steps per day until you reach a goal of 10,000 steps per day. The positive feedback of reaching your goal each day is going to keep you motivated.
If you are already walking a couple miles per day, but want to take your aerobic fitness to the next level, the same principle applies. Consider signing up for a 5K or 10K race, or perhaps a sprint distance triathlon. When you know what you “must” be able to do by a certain date, it’s easier to set up a training regimen with short term weekly goals.
BOTTOM LINE: Focus on MORE aerobic activity by creating realistic short -term goals that will set you up for continued success!

With a Rebel Yell...More, More, MORE!

Happy New Year! With apologies to Billy Idol, let me suggest a new framework for the most popular New Year’s Resolution - dieting. Instead of focusing on restricting calories, fats, carbs, or protein, why not focus on eating MORE fruits and veggies? We all know that a carrot is better for our bodies than a hot fudge sundae if we are trying to lose weight. But what happens when we tell ourselves “NO dessert” or “NO nachos and margaritas” or “NO ‘whatever’?” Well, I don’t know about you, but for me, the second I say “NO”, I immediate crave that item! And if I don’t crave it, at a minimum I will feel pathetic and deprived.
This year, set yourself up for success. Start with the simple goal of eating a minimum of five servings of fruits and vegetables per day. A serving is simply what will fit in your open, cupped hand, so a salad with a cup of lettuce, a handful of shredded carrots and a bunch of cherry tomatoes might be three servings. Add in a smoothie (typically made with a banana and some other fruit) and you’re already up to five servings for the day!
BOTTOM LINE: Push yourself to add more healthy foods to your diet, rather than restricting the less healthy choices. Before long, you’ll be filling up on fruits and vegetables and feeling fit!