Dear Dr. Roach: In a recent column, you said, ''I don't find simply telling people to eat less and move more to always be an effective therapy.'' What do you suggest to patients wanting to lose weight? C.N.

Dear C.N.: The vast majority of patients I see who are overweight know they are overweight, and have tried unsuccessfully to lose weight. Often, they have tried multiple different types of diets, sometimes having success in the short term but then having gained it back. ''Eat less, move more,'' while correct, doesn't address the issues that are important for many people.

Although some of my colleagues will disagree with me, I look at the issue differently. I recommend that people choose a healthy diet. There are many healthy diets, and people can choose what they like, but I recommend plenty of vegetables, some fruits, and good-quality protein sources such as legumes or nuts and lean meats or fatty fish for those who eat them; processed foods, especially starches and processed meats, should be avoided. Along with these dietary changes, which are modest for many people, I advise increasing exercise, from wherever the person starts (within reason). My rationale is that ''losing weight'' often seems unattainable to people; however, eating better and exercising more feel like they are within one's control. There is no doubt that people will be healthier with a better diet and with more exercise.

It is true that over a long time, most people who make those dietary and exercise changes will lose weight. But the primary goal is to improve health, even if the weight doesn't come down.

Some people, especially those with medical problems due to their weight, need more-intensive intervention, and I am fortunate to have colleagues in weight management, both medical and surgical, for those who need it.

Dear Dr. Roach: I went gluten-free four years ago for ''health'' reasons. I had no irritable bowel issues or celiac disease. After this amount of time, is it OK to reintroduce wheat and gluten? Does going gluten-free when you do not have celiac disease cause you to become more gluten-sensitive because its reintroduction would be like a foreign substance to your system? I fear I may have caused myself to become gluten-sensitive by avoiding it when I didn't have to. Can you please advise? L.

Dear L.: If you had no gluten sensitivity and no celiac disease, then you should have no issues with going back on a diet containing gluten, as far as I have been able to tell from my reading and my understanding of the condition. However, some people with celiac disease have extremely mild symptoms it could be just some abdominal discomfort after eating, or fatigue symptoms felt by nearly everyone from time to time. Nonetheless, making the diagnosis of celiac disease is important, even in people with minimal or no symptoms. People with celiac disease are more likely to develop autoimmune disorders and some cancers, because of possible nutritional deficiencies, and dietary intervention is critical in the case of women who might become pregnant.

If you truly had no symptoms at all before you went gluten-free, and still don't once you restart, I don't think any testing is necessary. However, if you notice symptoms, then a blood antibody test while on a diet containing gluten can establish the diagnosis.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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Choose a better diet and exercise regimen for health - Sarasota Herald-Tribune

If you're constantly judging your diet, exercise regime and lifestyle by labelling things as 'good' and 'bad', you need to stop. Now.

Photo: Lyndi Cohen/ Supplied

This article initially appeared on lyndicohen.com and has been republished here with permission.

All-or-nothing thinking is also known as black-or-white thinking and it's when things are viewed as 'all good' or 'all bad.'

All-or-nothing thinking often means that anything less than 'perfect' is perceived as a failure.

Having these incredibly unattainable standards sets you up to feel like a failure, and you start to tell yourself things like "nothing I ever do is good enough", "if I just weighed less, then..." or "everyone is prettier and thinner than me".

All-or-nothing thinking keeps you stuck, unhealthy and unbalanced. You become unable to eat anything in moderation and are constantly yo-yo-ing from one extreme to another, flipping from restriction to binge eating or inactivity to over-doing at the gym. From feeling motivated and excited to feeling like it's not even worth trying.

But you are not the problem. All-or-nothing thinking is the problem, and it's holding you back.

Why? Well, first of all, you don't need to change yourself. You are enough just the way you are.

You just need to stop thinking it's 'all-or-nothing'.

The first steps to letting go of the all or nothing approach is to realise when you're doing it. Awareness is key. Take this short test to help you work out if you are a black or white thinker:

Is an 'all or nothing' approach to food holding you back from being healthy?

If you can relate to one or more of the following, you probably have an all-or-nothing approach and can benefit from making a mindset shift.

If any of these sound familiar, you need to let go of this approach, and start thinking of your health in holistic terms. These are some of the strategies that helped me...

1. Notice when you're stuck in this thinking pattern

The first step is to become aware of when you're using an 'all-or-nothing' approach. Often, using words like 'always', 'never' or 'nothing' will give you a clue that you're stuck in the cycle.

Try this instead: Count your success! At the end of each day, take two minutes to note the things you did well that day. Just before turning off the lights to sleep, I tell my partner the things I am grateful for about myself that day. This is important for me as my normal default is to run through all my flaws and faults. I don't talk about the things I didn't do well enough, only the things I am proud of doing or grateful to have learned.

2. Give yourself permission to enjoy food throughout the week

If you spend Monday to Friday being incredibly 'good' (or strict), then when it gets to the weekend, you're going to feel like you deserve a treat for your hard work. When you're feeling deprived, one cheat meal will often turn into a cheat weekend.

Try this instead: Give yourself permission to enjoy treats during the week. I personally like to have a couple of squares of chocolate every day. If I'm at a birthday party and there is cake, I'll have it if I feel like it and often I'll share. Say to yourself: "I am allowed it if I want, but do I really feel like it?"

3. Food is neither good or bad, so adjust your language

I get that you've been taught to think that there are 'good foods' or 'bad foods'. There aren't. Enjoying a piece of cake is not bad and salad is not good. Having cake and feeling guilty about it defeats the purpose. All food can be enjoyed in moderation at some time.

Try this instead: Don't refer to food as 'good' or 'bad'. Become aware of your language. You'll notice just how common, socially acceptable it is to label food as good/bad (black/white). Just because everyone else refers to food as good or bad doesn't mean you have to. Your thinking will change when your language does - and your behaviour will change with it.

4. Find the silver lining and practice being an anti-perfectionist

Good enough really is good enough. Something is better than nothing. Any small effort is worthy of being recognised and applauded.

Try this instead: Add the word 'but' to negative statements. For example, "I didn't get to exercise today BUT I did get to bed an hour earlier tonight and my body needs rest" or "I overate at dinner tonight BUT I understand why that happened" or "I ate chocolate today BUT I really enjoyed it" or "I didn't eat enough vegetables today BUT I did have two pieces of fruit". When I'm feeling less than perfect, I'll repeat to myself "I accept myself and accept others". It helps me let go of my need to be perfect and my expectation that everyone else must be perfect, too.

Dancer Amrita Hepi takes you through a stretching routine you can do in the office

Lyndi Cohen is an accredited practising dietitian and the founder of the Keep It Real healthy eating program. For more from Lyndi, head to http://www.lyndicohen.com and keepitreal.lyndicohen.com.

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This expert says you need to let go of your 'all or nothing approach' - Body and Soul

Is the 80/20 rule true when it comes to weight loss?

We know that in order to lose weight, its important to watch what you eat and engage in moderate exercise regularly.

But which is more effective at helping you get the body you want diet or exercise?

According to some personal trainers and nutrition experts, the answer is diet. In fact, they believe that 80 per cent of weight loss is the result of making healthy changes to your diet, while the remaining 20 per cent is due to being physically active.

This 80/20 rule, as its commonly called, is indeed accurate, and one that most nutritionists recommend, says Ardyce Yik, a registered naturopath at the Integrated Medicine Institute in Central, Hong Kong.

The key to weight loss is achieving a negative calorie balance, which means taking in fewer calories than you burn.

Decreasing the number of calories you consume is so much more effective than exercising, because it takes a tremendous amount of physical activity to create a calorie deficit, Yik adds.

But I exercise a lot, more than the average person, at least four times a week, you say.

Unfortunately, that doesnt give you a free pass to indulge in a high-calorie diet.

Studies show that exercise alone has a negligible impact on weight loss, Yik explains.

For example, youd need to burn 3,500 calories to lose just 500g of fat. If you relied on exercise alone to lose weight, you would essentially need to run more than 10km each day to lose one pound a week, without increasing your caloric intake.

This is why the 80/20 rule makes sense its easier to cut calories than it is to burn the same amount of calories through exercise.

However, Yik adds that this is a general rule, and one that may work better for some people more than others, since everyone is different.

Monitor your diet but also commit to exercise if you really want to lose weight.

She says that whats more important is to commit to both a healthy diet and regular, moderate exercise if youre looking to shift extra pounds.

Diet and exercise are equally important for weight loss.

Although cutting calories from your diet is easier and more practical than exercising a lot, bear in mind that when you start eating less, your metabolism starts to slow down and your body will resist weight loss. Exercise can counteract this.

I usually recommend a combination of cardiovascular and strength-training exercises about 30 minutes of moderate cardiovascular exercise, four or five times a week, plus two or three strength-training sessions per week.

As for your diet, you should look to slash about 500 calories a day to lose 500g of fat per week.

I always recommend a healthful and varied diet based on whole, unprocessed foods, says Yik.

Ideally, your meals should consist of lean protein, colourful vegetables, whole grains, nuts and seeds.

If you find that decreasing your caloric intake and exercising regularly isnt helping you achieve your weight loss goals, then you should speak to a nutritionist, dietitian or doctor to investigate and address the underlying causes of your inability to lose weight. South China Morning Post/Sasha Gonzales

Read more here:
The secret to weight loss is 80% diet, 20% exercise is this true? - Star2.com

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A new research project is encouraging people with dementia to take up tai chi.

The project, called The TACIT Trial: Tai ChI for people with demenTia, aims to test whether tai chi is of benefit to people with dementia, and of benefit for their carers.

Dr Samuel Nyman, a NIHR Career Development Fellow at Bournemouth University, is leading the study. He said, For those taking part in the TACIT Trial, they will be helping with an exciting research area; this is the first trial of Tai Chi with people with dementia in the UK. It is also the first trial in the world to include assessments to see how Tai Chi might help with people with dementias balance and help prevent them from falling.

The trial is now recruiting, looking for people with dementia and their carers to sign up to further research, and to reap the health benefits that tai chi can provide.

Dr Nyman continues, Tai Chi is something a few years ago people may not have heard anything about. Tai Chi is particularly suited for people with dementia given it is highly accessible anyone can do it! Because it is very slow, gentle, and repetitive, people of all shapes and sizes and different abilities can do it. Even just by doing the very easy warm-up moves you can benefit from it.

From a pilot study we did in 2016, participants were telling us they felt stronger and more confident to go out of the house on their own or to do gardening, feeling better from having done exercise, and a sense of achievement of having learnt something new.

The aim is for researchers to better understand the benefits that tai chi can bring. Participants will be asked to undertake a 20 week tai chi exercise programme under the watch of Bournemouth Universitys research team, while others, part of a control group, will be asked to continue with their normal NHS treatment. Participants will then be compared to see if tai chi can have positive effects for people with dementia.

Dr Nyman concludes, It is a very slow, gentle, calming form of exercise. By slowing down moving slowly and taking slightly longer breaths it is very relaxing and a real de-stressor. It also helps build up strength and coordination that we lose over the years. The course is very easy to follow with lots of repetition. In fact thats why we called it TACIT; were building on peoples tacit memory things you learn by repetition and then do automatically and people with dementia tend to retain this ability very well despite difficulties with other types of memory.

Classes will be held across the south from Dorset and Southampton to Eastleigh and Portsmouth.

http://www.bournemouth.ac.uk/tai-chi

Link:
Tai Chi for people with dementia - European Pharmaceutical Review

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Diet and Fitness Tips & Articles | Health Info | Walgreens

Exercise is an important part of any diet plan and it doesnt matter so much what exercises are done as long as the dieter is getting their heart rate up and moving.

Furthermore, one doesnt have to join an expensive gym or hire a personal trainer to get results. There are many great exercises that can be done in the privacy of the dieters home with very little or any equipment required.

Weve compiled some good exercise videos that target some core areas and all of these exercises can be done outside the gym.

These Videos are courtesy of Diet.com and they have an extensive exercise video collection available for free on YouTube.com

PINK Method : A DVD and Nutrition plan made just for women.

The Tracy Anderson Method. An exercise based diet that helps you achieve a dancers body.

Beginner Runners Diet Run Your Butt Off! is a beginner runners diet that provides dietary advice and outlines a progressive running program designed for beginners that can help you to lose ten to twelve pounds within twelve weeks.

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Exercise Videos - Expert Diet Plan Reviews

What to include and what to avoid in your menopause diet. Research shows that what women eat can either reduce or exacerbate most menopausal symptoms.

One of the most distressing symptoms of menopause is weight gain. Did you know that six small healthy meals per day can be the secret to maintaining weight control? Only some women can manage this, however, but it is worth trying. If you cant maintain it and have a problem defining small, revert back to three meals per day with smaller portions than those you are used to.

Whilst HRT and natural therapies can help with symptoms of menopause, diet and exercise can go a long way to winning the battle, in fact women who follow a healthy diet and exercise may deal far better with menopause and protect themselves against diseases such as heart disease.

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Here is a quick reminder of the importance of maintaining a healthy Body Mass Index (BMI)

If your BMI is less than 18.4 you are underweight for your height. If your BMI is between 18.5 and 24.9 you are an ideal weight for your height. If your BMI is between 25 and 29.9 you are overweight for your height. If your BMI is between 30 and 39.9 you are obese. If your BMI is over 40 you are very obese.

A BMI of 25 or higher can be associated with an increased risk of heart disease. Losing 10-15 pounds can help to lower blood pressure and reduce your risk of diabetes.

If your BMI is over 30, you need to take immediate action to change your lifestyle in order to lose weight.

Weight distribution is also very important, your waist (just above your naval) should measure below 35 inches.

Research has found that menopausal women who follow a mediterranean diet including whole grain pasta and healthy fats cut their risk of hot flushes and night sweats by about 20%.

Menopausal women who eat diets high in sugar and saturated trans-fats increase their risk by 23%.

Research has shown that trans fats increase bad cholesterol and decrease good cholesterol too much can also have an effect on memory loss and concentration difficulties both of which are well known menopause symptoms.

Your menopause diet needs to contain a variety of foods to ensure that you get all the nutrients (vitamins and minerals) that you need.

FACT If you take in fewer calories than your burn for a long period of time you will lose weight.

Low glycemic carbs whole grain breads, cereals, pasta, all promote energy.

Plant based foods (phytoestrogens) work in the body like a weak form of estrogen and may help to relieve symptoms such as hot flushes and night sweats although research into this remains contradictory soy. linseeds, flaxseed, pumpkin seeds, sesame seeds, celery, rhubarb, green beans.

Consuming four tablespoons of ground flaxseed daily, 2 in the morning and 2 at night may decrease your frequency of hot flushes. Flaxseeds are packed with lignan. Many leading nutritionists think that the combination of fibre, essential fatty acids, protein and lignan help with inflammation and ward off potential heart problems.

Calcium (vital for bone health) found in dairy products, fish with bones, broccoli and legumes.

Iron found in red meat (lean), poultry, fish, eggs, leafy vegetables, nuts and enriched grain produce.

Protein found in meat, dairy products, nuts, beans and lentils. As we age we need enough protein as it plays a vital role in helping your body recover from illness, infections and surgery. Protein helps to constantly build cells so that your body can stay young and maintain a healthy weight

Fibre found in whole grain produce, broccoli, cereals, pasta, rice, fresh fruit and vegetables.

Fruit and vegetables 5 portions per day.

8 glasses of water per day is the recommended requirement for healthy adults.

Omega 3 fatty acids include essential fatty acids that are critical to your health, good food sources include cold-water fish, flaxseed, soy and walnuts.

Flaxseed is a good menopause diet food Low-fat dairy products Soy products such as soy milk and tofu Seeds such as linseeds, flaxseed Oily fish such as salmon, sardines Vegetables Olive oil, canola oil Fruit Wholegrain cereals, pasta and rice Wholegrain bread Nuts Legumes (beans and lentils) Eggs, fish and lean meat Green tea, herbal tea Water

Dr Sarah Brewer is the author of a book entitled Menopause Diet: How to Eat to Beat Hot Flashes. Dr Brewer is one of the few doctors who is also a Registered Nutritionist and a Registered Nutritional Therapist. She explains how certain foods can help with menopause symptoms. All of Dr Brewers advice is evidence-based. You can read my personal review of Menopause Diet: How to Eat to Beat Hot Flashes here.

Processed foods refined carbs such as white bread, rice, pasta and potatoes release glucose into the bloodstream quickly which can lead to high-low mood swings, weight gain, obesity, insulin resistance, fatigue and many other diet related diseases.

Reduce foods high in saturated fat fatty meats, whole milk, ice cream, cheese. (Limit saturated fat to less than 7% of your total daily calories as these raise cholesterol and increase your risk of heart disease).

Reduce foods high in trans fats vegetable oils, baked produce, some margarines, cakes, pizza etc (Fat should provide 25% 35% or less of your total daily calories).

Use sugar and salt in moderation too much sodium is linked to high blood pressure. Salt and processed carbohydrates will make you retain water which will give you that menopause bloating feeling.

Avoid foods containing high levels of nitrates found in smoked produce, salt-cured produce and charbroiled foods. (High levels of nitrates have been linked to cancer)

Alcohol consumption women should limit alcohol to one or fewer drinks per day. As well as increasing hot flushes, alcohol also affects your sleep, mood and weight. Heavy consumption can also lead to osteoporosis as alcohol prevents cells from building new bone. Trigger Foods to Avoid in your Menopause Diet

If you are experiencing hot flushes, avoiding certain trigger foods and beverages may help, such as:-

Spicy foods Caffeine Alcohol Tea Dark chocolate

Try decaffeinated coffee instead and herbal teas.

(If you suffer from Celiac Disease or have a gluten sensitivity you will need to obtain dietary advice from your healthcare professional).

If you are not already eating 6 small meals a day containing healthy foods, now is the time to start. Eating the right diet little and often will help to banish cravings by keeping your blood sugar and hormones levels in check throughout the day.

Dont forget to treat yourself now and again!

You will find more valuable nutritional information and advice here.

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Sources:

Diet, nutrition and the menopause. Retrieved on 16 September 2015 from http://www.womens-health-concern.org/help-and-advice/factsheets/focus-series/diet-nutrition-menopause/ Meltzer Warren, R. MS. RD. 8 Diet Changes Women Must Make After 40. Retrieved on 16 September 2015 from http://www.health.com/health/gallery/0,,20404740,00.html Menopause. Retrieved on 16 September 2015 from http://www.nutrition.org.uk/healthyliving/lifestages/menopause.html

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Menopause Diet, Nutritional Facts

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We understand your priorities youre looking for health and beauty products that are effective, high quality and a great value. At Carol Wright Gifts, thats what we deliver. No matter what type of health and beauty products you need, well make the shopping process easy and convenient. Our Customer Service Representatives are ready to help you find just what you need, via telephone, mail, fax, email or even online live chat. When youre ready to order, use our catalog quick shop or search CarolWrightGifts.com to find products to meet your individual needs. You can also choose to shop from our Virtual Catalog to bring the catalog shopping experience to your computer, page by page. No matter how you shop Carol Wright, your satisfaction is our top priority. If for any reason you are not 100% satisfied with any product you purchase from us, you may return it for a prompt refund.

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Diet & Exercise | CarolWrightGifts.com

Remember the beneficial effects of healthy diet and regular exercise. Women who exercise and follow a healthy diet cope better with menopausal changes and also help protect themselves against other diseases such as heart disease and osteoporosis.

A healthy diet should include 5 portions of fruit/vegetables per day. Try to include unrefined foods as much as possible, rather than refined convenience foods. Take high fat and sugar containing foods in moderation and dont take too much caffeine or alcohol. Being overweight has been shown to worsen flushes and increases the risk of heart disease and diabetes. Losing weight has been shown to reduce the risk of breast cancer (see news item). Try to maintain a healthy Body Mass Index (BMI). Excess caffeine and alcohol not only worsen flushes but also increase the risk of osteoporosis.

Exercise We should all make exercise a priority and build it into our daily routine. Regular exercise not only helps with weight loss but also reduces flushes (SEE AlSO: Menopause News - exercise is good), reduces the risk of heart disease and weight bearing exercise reduces the risk of osteoporosis. Increasing exercise has also been shown to reduce the risk of breast cancer (see news items from 2006 and 2010). Many women join a gym for the first time in their 50s, which works for some but you dont have to - brisk walking is a great form of exercise and is free!

Smoking Women who smoke have an earlier menopause than non-smokers, have worse flushes and often don't respond as well to tablet form of HRT. Its never too late to stop smoking!

Use this time in your life to start living a better healthier life.

Vitamins and minerals

Most women taking a healthy well balanced diet obtain sufficient vitamins and minerals required and do not need to take supplements. However many women nowadays have hectic lifestyles and do not always get everything they need from their diets on a daily basis, this is especially true when women are trying to lose weight, perhaps avoiding some essentials in their diets. Some vegetarians can also be at risk of not obtaining enough nutrients in their diets. Some of our Western World diets are deficient in some minerals not just because we do not eat the right foods, but also because the food growing techniques mean that the food may not be as good quality as it used to be.

VITAMINS

Vitamin A is needed for a healthy immune system but a lack of it is unlikely to affect most healthy menopausal women. However it is one of the Vitamins that can be harmful in excess doses especially in women of childbearing age

Vitamin B group. Most women following a Western diet are unlikely to be deficient in this group of Vitamins as they are added to flour (fortified). Certain B vitamins are more likely to be difficult to obtain from dietary sources, such as Vitamin B5 and Vitamin B6 (pyridoxine). Supplementation of vitamin B6 has been recommended for women who suffer from Premenstrual syndrome. Vitamin B6 may have a role in the prevention of heart disease by lowering harmful homocysteine levels, which are associated with heart disease, stroke, osteoporosis and Alzheimers disease.

Vitamin C. Deficiency of Vitamin C is unlikely in a balanced diet containing fruit and vegetables. It is more likely in smokers and those not eating fresh produce. Some believe that it can fight off colds and flu in high doses. It works as an anti-oxidant.

Vitamin D. Vitamin D is required to maintain bone health. It helps the body absorb calcium and is made in the skin due to sunlight action. Lack of sunlight due to poor climate, people being housebound, or being covered up when outside, often leads to lack of vitamin D, particularly in the elderly. Dietary sources include oily fish, dairy products and margarine and 2 main course portions of oily fish per week are recommended.

Vitamin E may have a protective effect against heart disease and supplementation is recommended. It has been found to reduce the number of non-fatal heart attacks, but not fatal ones. A dose of 400-800 iu is suggested. Some women find that high dose Vitamin E helps with night flushes. It is also known for its beneficial effects on skin and hair.

MINERALS

Calcium. During the menopause, an adequate daily calcium intake is especially important to help protect and maintain bone density as bone loss accelerates. See below for recommended intakes at different stages of life and calcium content in foods. Supplements of Calcium and Vitamin D can be taken if the recommended amount is not achieved but the body copes best with a dietary source of calcium.

Calcium calculator. You can find a daily dietary calcium calculator here and see more information below about dietary calcium.

Phosphorus is a necessary nutrient and typical diets are unlikely to be deficient.

Magnesium supplements of at least 250 mg per day may help prevent bone loss. Lack of it has a possible role inpremenstrual syndromeand ME.

Iron deficiency is relatively common in women still having periods, vegetarians and pregnant women. It is not recommended to take excess supplements of iron unless the deficiency is proven.

Zinc helps with skin repair and damage and also promotes a healthy immune system. The dose should be small to prevent any overdose of the substance. Copper supplements should be taken along with the zinc.

Copper. Small doses of copper can possibly prevent bone loss.

Manganese. A highly processed diet of convenience food could result in low levels of manganese intake. Iron and manganese are best taken together.

Selenium. Supplements of selenium have been associated with a reduction in cancers. Higher amounts of selenium than are available in the diet may be necessary for this protective effect.

Taking a balanced, healthy diet will provide the vitamins and minerals required and is the best way to stay healthy but some women choose to take a supplement, of which many are available.

Why do we need calcium?

calcium is a nutrient that we know has an important role to play in the maintenance of bone health. This Information Sheet contains a selection of calcium rich foods, which, as part of a well balanced diet, may contribute towards an adequate intake.

How much calcium do I need?

The Governments Committee on the Medical Aspects of Food and Nutrition Policy (COMA), now replaced by the Scientific Advisory Committee on Nutrition, sets recommended levels for nutrient intake (Reference Nutrient Intakes) for the UK population. The lower reference nutrient intake (LRNI) for calcium is 400 mg and the RNI is 700 mg for adults. This means that your calcium intake must be over 400 mg and it is recommended that your intake be above 700 mg to be compatible with bone health in the normal population, as based on current evidence. There is inconclusive evidence that more calcium may be needed but further research is necessary.

If you have been diagnosed with osteoporosis, you may need to boost your calcium levels to approximately 1200 mg for adults and consequently may be given a calcium supplement with your treatment. In the trials that have shown bisphosphonates to reduce fractures, the calcium supplementation used was 500 - 1000 mg. Therefore, extra calcium may be taken as part of the diet or as a supplement but the upper limit must not be exceeded.

Can I have too much calcium?

It is recommended that you do not exceed more than 2000 - 2500 mg of calcium a day. Exceeding the upper limit of 2000 - 2500 mg calcium could lead to medical problems including milk alkali syndrome (a high level of calcium in the blood) and may interfere with the absorption of other minerals such as iron.

Does it matter if I do not meet the exact daily amount?

It is important to remember that calcium intake should be looked at over a period of monthly intake rather than daily. A low calcium intake on one day, when most days you achieve more, will not have a detrimental effect on your bone density.

Do I need to supplement my diet with any other nutrients?

Other nutrients and minerals are also important but a well balanced, mixed diet including fresh fruit, vegetables, adequate protein and carbohydrate foods should contain sufficient amounts of the necessary nutrients. Some individuals may feel that they are not obtaining the calcium they need from their diet and there is no way that this can realistically be achieved. In such cases, supplemental calcium may be useful. Your local pharmacist is often an excellent source of information on over the counter products. There is evidence that older people can benefit from supplemental calcium and vitamin D and this is a useful treatment for osteoporosis in this age group.

What else can affect my risk of osteoporosis?

Dietary issues are just one of a variety of important components, which together, can influence an individuals osteoporosis risk. These include exercise levels, hormonal status, corticosteroid use, body stature, strong family history and previous minimal trauma fracture.

General advice to anyone who wishes to minimise the effects of osteoporosis includes taking a well balanced, calcium rich diet, avoiding smoking or excessive alcohol intake and taking regular weight bearing exercise.

Further details on diet and bone health can be obtained in a booklet available from the National Osteoporosis Society, Camerton, Bath BA2 0PJ Telephone number 01761 471771. Website: http://www.nos.org.uk

Food

Quantity

Mg of calcium

Food

Quantity

Mg of calcium

* may be calcium enriched ** different products vary considerably

Please note, the calcium contents (with the exception of milk and bread), have been calculated per 100 g and are therefore not portion size. This has been done to make comparisons between various foods easier.

Ref: Information provided courtesy of The Royal Society of Chemistry, Ministry of Agriculture, Fisheries & Food publication "The Composition of Foods" 1992.

Reproduced with permission from National Osteoporosis Society

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Diet. Exercise. Calcium : Menopause Matters

For years your doctor, your mom and your friend who goes to the gym multiple times a week have probably been telling you to eat better and exercise more. Its all you hear on television, in the newspapers and on talk radio. New doctors and dieticians usher in new diets, new fads, and so youve made some lifestyle changes cutting back on your fat and sweets intake, and doing some cardiovascular exercise a few days a week. Despite all this, you still feel burned out, cant drop those extra pounds, and dont have the energy to greet each day with enthusiasm. What are you missing?

Though the exact mechanisms of how sleep works, how sleep rejuvenates the body and mind is still mysterious, one thing sleep specialists and scientists do know is that adequate sleep is necessary for healthy functioning. Research shows that all mammals need sleep, and that sleep regulates mood and is related to learning and memory functions. Not only will getting your zzzs help you perform on a test, learn a new skill or help you stay on task, but it may also be a critical factor in your health, weight and energy level.

An estimated 18 million Americans have sleep apnea, a sleep-related breathing disorder that leads individuals to repeatedly stop breathing during sleep. Not only does sleep apnea seriously affect ones quality of sleep, but it can also lead to health risks such as stroke, heart attack, congestive heart failure and excessive daytime sleepiness. Sleep apnea is often associated with people who are overweight weight gain leads to compromised respiratory function when an individuals trunk and neck area increase from weight gain. These interacting problems of weight gain and sleep apnea make it difficult to help oneself off the slippery slope of health problems. From a behavioral perspective, those suffering from sleep apnea may be less motivated to diet or exercise daytime sleepiness lowers their energy levels and makes it difficult to commit to an exercise and/or diet program which would improve both their weight and sleep apnea. Unfortunately, losing a significant amount of weight in a healthy manner can be very difficult, so Richard Simon, MD recommends treating sleep apnea first: "Unfortunately, we do not have great treatments for obesity that have long term success rates of much greater than 510%," Simon says. "Thus I prefer to start therapy with [continue positive airway pressure] (70% success rate) and then add exercise (probably less than a 50% success rate). People feel restored when they are effectively treated for sleep apnea and are more willing to start exercising then."

Sleep deprivation may also inhibit ones ability to lose weight even while exercising and eating well! A 1999 study at the University of Chicago showed that restricting sleep to just 4 hours per night for a week brought healthy young adults to the point that some had the glucose and insulin characteristics of diabetics. Such sleep restriction may have been a bit extreme, but it is also not altogether uncommon in our society and is a pattern deemed the "royal route to obesity" by Eve Van Cauter, PhD, who conducted the Chicago study.

Though research shows that exercise is certainly good for ones body and health, properly timing exercise is necessary to maximize the beneficial effects. For example, a good workout can make you more alert, speed up your metabolism and energize you for the day ahead, but exercise right before bedtime can lead to a poor nights sleep. All the jumping jacks in the world wont make up for a night of tossing and turning! Sleep experts recommend exercising at least three hours before bedtime, and the best time is usually late afternoon. Exercising at this time is beneficial because body temperature is related to sleep. Body temperatures rise during exercise and take as long as 6 hours to begin to drop. Because cooler body temperatures are associated with sleep onset, its important to allow the body time to cool off before sleep.

Are you someone who needs a fresh cup of java to coax you out of bed in the morning? Or perhaps you prefer an afternoon jolt from the cola vending machine? Or maybe youre more the candy bar type in any case, youre not alone. In a 24/7 culture, cups of coffee, cans of soda and candy bars are staples of everyday consumers. For some, the day cant begin without a cup of Starbucks and for many students today no study break is complete without a can of Coke. How did caffeine become the drug (and food) of choice?

In fact, lack of sleep creates a vicious cycle the more tired you are, the more caffeine youll consume to stay awake during the day; but the more caffeine you consume, the harder itll be to fall asleep at night. Not only are foods and drinks high in caffeine likely to keep you up at night, but theyre also usually replete with sugar or artificial sugar and not much else. When a healthy snack such as a carrot or granola bar is replaced with a can of Mountain Dew, youre at higher risk for putting on weight and it becomes harder to sustain energy for a longer period of time.

For those individuals who suffer from gastroesophageal reflux (GERD), commonly known as acid reflux, diet and sleep go hand-in-hand. Those individuals with GERD often suffer from nighttime heartburn, and according to NSFs 2001 Sleep in America poll, adults in America who experience nighttime heartburn are more likely to report having symptoms of sleep problems/disorders such as insomnia, sleep apnea, daytime sleepiness and restless legs syndrome than those who dont have nighttime heartburn.

Food is also related to sleep by appetite and metabolism. Research by Dr. Van Cauter shows that people who dont get enough sleep are more likely to have bigger appetites due to the fact that their leptin levels (leptin is an appetite regulating hormone) fall, promoting appetite increase. This link between appetite and sleep provides further evidence that sleep and obesity are linked. To top it off, the psychological manifestations of fatigue, sleep and hunger are similar. Thus, when youre feeling sleepy you might feel like you need to head for the fridge instead of bed.

By now you probably realize that health is complex if one part of the body system suffers, youre likely to see consequences in other areas of your life. Though diet and exercise are critical components of healthy lifestyles, its also important to remember that sleep is inherently linked with how we eat (and how much), how we exercise (and whether or not we lose weight), and how we function on a daily basis. Getting the proper amount of sleep each night is necessary to face the world with your best foot forward. Sleep will help you on the road to good fitness, good eating and good health.

Reviewed by David G. Davila, MD (December 2009).

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Diet, Exercise, and Sleep - National Sleep Foundation