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Diet

Exercise is important in reducing the risk of fractures. Stock photo

By David Dunaief, MD

Osteoporosis is a complex disease. For one thing, it progresses with no symptoms, until the more severe stage of fractures that cause potential disability and increase mortality. For another, the only symptoms are from the treatment with medications, better known as side effects. Third, lifestyle modifications and supplements, while important, require adherence to a regimen.

I am not a big advocate of medication, as I am sure you have gathered from my previous articles; however, medication does have its place. There are studies that show benefit from the two main classes for osteoporosis, bisphosphonates such as alendronate (Fosamax, though it is now generic) and the newer class that involves monoclonal antibodies such as denosumab (Prolia). And, of course, I am a big advocate of lifestyle modifications including diet, exercise, smoking cessation and even some supplements. The side effects of these modifications are better health outcomes for chronic diseases and disorders in general. What I can’t advocate for, as a physician sworn to help people, is the new emerging cohort that I refer to as the “do-nothing group.”

Recently, a New York Times article on June 1, 2016, entitled, “Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis,” reported that prescriptions for medications to treat the disease have fallen by more than 50 percent from 2008 to 2012 because of the fear of the side effect profile that include rare instances of atypical fractures and jawbone necrosis (1).

In the article, one doctor mentions that patients prefer diet and exercise, but that it does not work. Well, he may be partially correct. Diet and exercise may not work if they’re not implemented. However, if people actually make lifestyle modifications, there could be substantial benefit. Just to give up on the medications for osteoporosis or to refuse to take them is not going to improve your chances or reduce your risk of getting fractures in the spine, hip, wrist or other locations. In other words, the “do-nothing” approach won’t help and may significantly increase your risk of fracture and other complications, such as death.

At the top of the list of risk factors for osteoporosis is nontraumatic fractures — in other words, breaking of bone with low-impact events. In this case, once you have had a fracture, the probability of having a recurrent or subsequent fracture increases more than three times in the first year, according to a recent Icelandic study (2). Lest you think that you are in the clear after a year since your first fracture: After 10 years, the risk of subsequent fracture still remains high, with a twofold increased risk.

Osteoporosis involves bone loss. We typically measure this through the bone mineral density (BMD) biomarker using a DXA scan. However, another component is bone quality. Sarcopenia, or loss of lean muscle mass, may play a role in bone quality. There are vitamins, such as vitamin K2, that can have beneficial effects on bone based on bone quality as well. No, this is not the same as the more well-known vitamin K1 used in clotting, which may also have a smaller benefit in preserving bone.

Let’s look at the evidence.

Avoiding sacropenia

Sarcopenia is a fancy word for a depressing phenomenon that occurs as we age and become more and more sedentary; it is the loss of lean skeletal muscle mass at the rate of 3 to 8 percent each consecutive decade after 30 and also loss of strength (3). It may have significant effects on about one-third of those over age 60 and half of those over 80. Unless, of course, you are physically active on a regular basis. In the Study for Osteoporotic Fractures in Men, results show that sarcopenia plus osteoporosis, taken together, increases the risk of fracture more than three times in older men (4).

The researchers assessed muscle wasting by using the European Working Group on Sarcopenia in Older Patients (EWGSOP), which takes into account weakness (grip strength <20 kg for men), slowness (walking=0.8 m/s) and low lean muscle mass (< 20 percent). This involved over 5,000 men with a mean age of about 74. The group with sarcopenia had significantly lower grip strength and was less physically active. In another study, those who were healthy 65-year-old adults who had sarcopenia or low lean muscle mass were at a greater than two times risk of experiencing a low-trauma fracture within three years (5). This was according to the EWGSOP1 cutoff criteria for sarcopenia.

Preventing sarcopenia

Well, beyond the obvious of physical activity and formal exercise, there is a medication that has potentially shown positive results. This is the bisphosphonate alendronate (Fosamax). In a study, results showed that alendronate increased muscle mass significantly over a one-year period (6). In the appendicular (locomotive) skeletal muscle, there was a 2.5 times increase in muscle mass, while in lower limb muscle mass there was a greater than four times increase. This was a retrospective (backward-looking), case-control study involving about 400 participants. While these results are encouraging, we need a prospective (forward-looking), randomized controlled trial. For those who don’t want to or can’t for some reason exercise, then medication may help with muscle mass.

Exercise! Exercise! Exercise!

In a meta-analysis (a group of 10 trials), results showed there was a significant 51 percent reduction in the risk of overall fracture in postmenopausal women who exercised (7). This study involve over 1,400 participants. Does exercise intensity matter? Fortunately, the answer is no. If you like jogging or running, that’s great, but walking was also beneficial. This is important, since you want to do the type of activity that is more enjoyable to you, especially since the benefit of exercise dissipates when you stop doing it regularly (8).

The importance of K2

In a recent study, vitamin K2 was shown to reduce the risk of hip fracture by 60 percent, vertebral fracture by 77 percent and nonvertebral fractures by a whopping 81 percent (9). According to the authors, this benefit may be derived from bone strength (BMC, or bone mineral content) rather than from bone mineral density (BMD). There were 325 postmenopausal women in this study. It was a randomized controlled trial with one group receiving vitamin K2 (MK-4, menatetrenone) supplementation of 45 mg/day and the other a placebo group.

Don’t forget fruits and vegetables

In the Singapore Chinese Health Study, a prospective population-based study, results showed that there was a 34 percent reduction in the risk of hip fracture in the highest quintile of vegetable-fruit-soy (VFS) intake, compared to the lowest quintile (10). This study involved over 63,000 men, premenopausal and postmenopausal women with an age range from 45 to 74 years old. The results showed a dose-dependent curve, meaning the more VFS, the higher the reduction in hip fracture risk. Interestingly, there was no difference in risk of fracture when meat in the form of meat dim-sum was used instead of plant-based protein. The researchers concluded that an Asian plant-based diet may help reduce the risk of hip fracture. I’m not saying to take medications for osteoporosis, but you need to do something — either medications, lifestyle modifications, supplements or all three — especially if you have a history of low-trauma fractures, because your risks of disability, complications and death increase significantly with subsequent fractures. But, do not be part of the growing “do-nothing” group.

References:

(1) J Bone Miner Res. 2015;30(12):2179-2187. (2) World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases 2016. Abstract 0C35. (3) Curr Opin Clin Nutr Metab Care. 2009; 12(1):86–90. (4) American Society of Bone and Mineral Research 2013. Abstract 1026. (5) Age Ageing.2010;39:412-423. (6) Osteoporos Sarcopenia. 2015;1(1):53-58. (7) Osteoporos Int. 2013;24(7):1937. (8) Ann Intern Med. 1988;108(6):824. (9) Osteoporos Int. 2007;18(7):963-972. (10) J Nutr. 2014;144(4):511-518.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Your guide to a healthy winter

By Lisa Steuer

It’s easy to become sedentary and gain a little extra weight during the winter. After all, the frigid temperatures tend to keep us indoors, there are holiday parties with goodies that tempt us and an extra weight gain can simply be hidden under a few more layers of clothing.

But if you take a few steps toward your health and fitness this winter, you can lose or maintain your weight and then be prepared to be in your best shape when the warmer months hit yet again. Here are some tips to keep you on track this winter.

Plan it out
Each Sunday, take the time to look at what you’re doing the week ahead. Plan out what days you’ll work out and what the workout will be. Scheduling them in like appointments may just become habit and make you less likely to miss them. Plus, prepare your healthy meals for the week on Sunday to save time and make it easier to stay on track during the week. For a simple guide to food prep, visit www.fitnessrxwomen.com and search for the article “10 Tips for a Quicker and Easier Food Prep.”

Work out — no excuses
Living a fit lifestyle doesn’t mean you have to miss out on sweet treats at holiday parties and other gatherings. If you know you’re going to be indulging in a few extra calories one day, be absolutely sure to get in a workout that morning so you don’t feel too guilty about it.

Eat beforehand
Before a party or gathering, have a satisfying but healthy snack like a protein shake or fruit like a banana so that you don’t attend the party starving and end up making poor food choices due to being so hungry.

Fill up on veggies
When you go to a party, go right to the veggie tray and fill up.

Stay away from eggnog and other high-calorie drinks
If having alcohol at a party, try a glass of dry red wine or vodka with cranberry. Liquid calories can add up extremely fast. If you do drink alcohol, make sure you’re also drinking plenty of water.

Experiment with healthy baking and cooking
A lot of times, with a few simple substitutions, it’s easy to cook and bake healthier without sacrificing taste. For example, you probably won’t be able to tell the difference if you use Greek yogurt in place of sour cream on lean chicken tacos. Visit www.fitnessrxwomen.com for tons of healthy, easy and delicious meals and desserts that won’t leave you feeling like you’re missing out on your favorite foods.

Fitness classes
Taking fitness classes can help keep you motivated, and you may even meet new friends who can help inspire you to get to class. The instructor running the class can help, too. Let him or her know your fitness goals for the winter, and they can probably help give you that extra push and also offer suggestions to help you meet those goals.

Work out at home
When it’s cold and snowy, you may be more likely to make excuses to stay home and avoid the gym. Instead, invest in a few simple items that don’t take up a lot of space but allow you to get a good workout in right in your living room — dumbbells, a medicine ball, exercise bands, etc. Try fitness DVDs and free on-demand fitness videos (if you have cable, go to the on-demand menu, select Free On Demand, then Sports then Exercise Sportskool).

Have an incentive
Check out www.dietbet.com and the app, which has games where players bet as little as $30 to meet a specific weight loss or fitness challenge within a specific time frame, and the winners split the pot. You can even start your own game and challenge your friends.

Sign up for a 5K
This will force you to get up and moving! Plus, meeting a challenge you never thought you could do is an indescribable feeling.

Don’t be so hard on yourself
If you overindulge a little bit over the holidays, don’t beat yourself up too much. The good news about getting fit and healthy is that you can always get back on track. Put it behind you, recommit yourself, have a goal and then get to work getting it done.

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For more fitness tips, recipes, training videos and print-and-go workouts that you can take with you to the gym, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

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By Lisa Steuer

In the 1990s, low-fat food products lined the shelves. Consumers believed that choosing a product with a low-fat label was essential for optimal health and fat loss. But today, experts say that a low-fat diet can be detrimental — as food that has the fat removed can instead be high in sugar and calories to make up for the lack of fat.

“The whole low-fat phase was problematic because people substituted refined carbohydrates, and that is a huge problem,” said Dr. Josephine Connolly-Schoonen, Ph.D., RD, the executive director of Stony Brook Medicine Nutrition Division and author of “Losing Weight Permanently with the Bull’s Eye Food Guide: Your Best Mix of Carbs, Proteins, and Fats.”

So with so many diets out there today, which work best for weight loss and health? Here is Connolly-Schoonen’s input.

Going Gluten Free
Gluten is a name for proteins found in wheat, and some common foods that contain gluten include pasta, bread, flour tortillas, oats, dressings, cereals, sauces and more. Go to any grocery store these days and you will most likely find a “gluten-free” section. And while people with Celiac disease cannot eat gluten because they will get sick, many people who aren’t allergic to gluten are touting the weight loss and health benefits of going gluten free.

But if you don’t have a gluten allergy, is it necessary or nutritionally wise to go gluten free?

“I think that many people are gluten intolerant and can benefit from a gluten-free diet,” said Connolly-Schoonen. “But, [it should be] a high-quality gluten-free diet — foods that never had gluten. So your starches are going to be from potato and rice and quinoa, not from gluten-free bread and gluten-free pasta.”

So while foods that are naturally gluten free are generally healthy, those who are not gluten-intolerant should be wary of processed foods that have had the gluten removed, as there now exists a big market and opportunity for companies wanting to take advantage of the gluten-free trend — and products such as “gluten-free cookies” may not necessarily be nutritionally sound.

“In my practice, I’ve seen many people benefit from gluten-free styles of eating, but using whole foods, not processed gluten-free food … A slice of gluten-free bread is rather small and has the same or perhaps a little bit more calories than regular bread,” said Connolly-Schoonen. “Foods that are naturally gluten-free are quite healthy and I really do think people may benefit from a gluten-free style of eating, but it has to be natural.”

The Paleo Diet and Going Vegan
The idea behind the paleo diet is that we should eat as our ancestors or “cavemen” ate, including meat, fish, vegetables and fruit, and excluding processed food, grains and dairy. And while many people have reportedly lost weight on the diet, some argue that the paleo diet does not necessarily follow what our ancestors ate, and there is now a market for processed paleo bars and drinks.

But Connolly-Schoonen says the concept of consuming fewer processed foods is a good one to follow, especially when it comes to sugar-laden beverages.

“With the advent of the high fructose corn syrup, it became so cheap to make sweetened beverages … that have the equivalent of 17, 19, 20 packets of sugar in them, and we genetically cannot handle that.”

In addition, some people choose to go vegan or vegetarian for a variety of reasons — moral, health or a combination. Both vegans and vegetarians do not eat meat, fish or poultry, while vegans also do not use other animal products and byproducts, such as eggs, honey, cosmetics, and more.

“I don’t think you need to be a vegetarian to be at your optimal health, but there is a lot of research over an extended period of time showing that vegetarians, more than vegans, who eat a high-quality vegetarian diet — so no Snickers bars — do quite well in terms of decreasing the risk for chronic illnesses like diabetes and heart disease, and there really is a lot of research behind the vegetarian diet to support that,” said Connolly-Schoonen. “Vegan diets could be healthy, but it’s much more challenging to make sure that you get all of your micronutrients.”

Juicing Up
Juicing is still considered healthy in moderation and as a quick way to get antioxidants. But when you use a juicer, the juice is extracted from fruits and vegetables, leaving behind a pulp that is often thrown away. In addition, this strips the fruit of its fiber but leaves the sugar.

“Even if you’re juicing vegetables, you’re still getting the sugar … and making the sugar much more highly available,” said Connolly-Schoonen. “And most people are more satiated when they chew their food.”

In addition, many people subscribe to the idea of doing juicing “detoxes” or “cleanses” every so often — which have found to be not really necessary, as we already have a natural detoxification system that occurs in our livers. In addition, any sort of diet that deprives one of nutrients is never a great idea. Instead, work on supporting your body’s natural ability to detox.

“If you have an unhealthy gut environment, you’re taxing your liver’s detoxification system. So first you want to have a healthy gut environment, which means lots of fiber and a good source of probiotics,” said Connolly-Schoonen. “Then you need to support your liver’s detoxification system with a wide array of micronutrients, which is going to come from a wide array of whole foods like protein, fish, lean meats, beans and then your vegetables, fruits and nuts.”

The Bottom Line
Instead of following a super strict diet, you may want to simply remember Connolly-Schoonen’s “two key factors” for healthy nutrition: quality and quantity. In terms of quality, choose foods that are less processed — lean proteins like chicken and fish, a huge variety of vegetables, beans, nuts and olive oil for healthy fats.

Once one works on the quality of foods in his or her diet, “it’s been my experience that patients can then much more easily work on moderating the quantity,” she said. “Once you’re eating whole foods and you’re mixing your quality proteins and fats, it becomes much easier to manage your appetite.”

Does this mean you can never have dessert again? Not at all.

“I tell patients if you’re eating ice cream, it should be real ice cream made from whole milk fat and real sugar. You shouldn’t get artificially sweetened products,” she said. “When you want chocolate and you want ice cream, have the real stuff. And that you should be able to include in your diet, maybe not every day, maybe a few times a week — it all just depends on how active you are.”

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For fitness tips, training videos and healthy recipes, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

Get healthier before the season ends

By Lisa Steuer

Summer is in full swing. Ideally, you would have started working toward your summer body a few weeks or even months ago. But if you still have some progress to make, here are some last minute steps to get in better shape before summer ends.

Increase water intake. Leave a full 24 to 32-oz water bottle by your bed every night, and when you wake up in the morning, immediately drink that as you get ready. During the night your body hasn’t taken in much liquid, so it’s thirsty in the morning. Drinking water immediately in the morning gets your systems running and can aid in fat loss. You’ll also find that it’s very energizing. In addition, increase your water intake throughout the day, aiming for a gallon. Stay away from soda and other sugar-laden beverages.

Drinking water immediately in the morning gets your systems running and can aid in fat loss.

Eat a healthy breakfast. This can set you up for eating healthy the rest of the day. Try Greek yogurt with fruit, an omelet with veggies, or throw some fruit, natural peanut butter and almond milk in the blender for a delicious smoothie you can take on the go.

Prepare your lunches for the week every Sunday. Being prepared is one of the most important keys to success when it comes to health and weight loss. An example of a meal you can easily make in bulk: 4 oz. of lean ground turkey or chicken, one-fourth cup of quinoa, and one cup of veggies like broccoli. Bake the broccoli in the oven while making the quinoa and meat on the stove, and before you know it you’ve got a week’s worth of healthy lunches.

Replace your morning coffee with green tea with lemon at least a few times a week. While black coffee is healthy, the cream and sugar that often accompanies coffee is full of calories. Green tea has zero calories, contains antioxidants and has been shown to aid in fat loss.

Order smart at restaurants. It’s not as difficult as one may think, especially because many restaurants now have healthier menu sections. As a basic rule, look for words on the menu like grilled, baked or broiled and stay away from anything fried or breaded.  If possible, view the menu online before you go so that you’re prepared.

Increase cardio activity. Try to do something at least five days a week. Schedule a run every morning or a walk every evening. Go for a bike ride or swim laps. Sign up for a new and different fitness class each week. Just get out and get moving!

Have fun experimenting with new recipes. Eating healthy doesn’t have to be boring. Experimenting with new recipes can help keep you motivated. Try out healthy swaps— for instance, more often than not, you won’t even notice the difference when you swap out sour cream for Greek yogurt. Check out fitnessrxwomen.com for some great ideas.

Green tea has zero calories, contains antioxidants and has been shown to aid in fat loss.

Be active during downtime. While at home watching TV, do some crunches, planks, sit-ups, jumping jacks, etc. Do some squats while you’re heating something up in the microwave. Get creative!

Cut down on sugar, alcohol and sodium. It’s OK to have a treat once a week or so, but you may find that when you cut out sugar and alcohol, you’ll feel much better anyway. When a sweet craving strikes, try a small piece of dark chocolate or a chocolate protein shake. And while we do need some sodium in our diet, too much will lead to bloating.

Track your food intake with a food log or app like My Fitness Pal. You may be surprised at how much you’re actually consuming without realizing it.

Sign up for a 5K that occurs in the fall. It will keep you on track this summer and help motivate you to stay active. Even if you’ve never done a 5K before, it’s a great way to challenge yourself. You’ll feel amazing when you cross that finish line after all your hard work!

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For more fitness tips, training videos, healthy recipes and print-and-go workouts that you can take with you to the gym, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

The Metabolic Reboot Smoothie, pictured above. Photo by Lisa Steuer

By Lisa Steuer

Contrary to what some may believe, there are many tasty ways to eat healthy. Whether your goal is to lose weight or improve your well being, smoothies are a great and easy option.

Making a smoothie — when you blend ingredients together — is different from juicing. When juicing, the juice is extracted from fruits and vegetables, leaving behind a pulp that is often thrown away. In addition, this strips the fruit of its fiber but leaves the sugar.

While juicing is still considered healthy in moderation, having a fiber source with your healthy drink is important, said Shoshana Pritzker, RD, CDN, who owns Nutrition by Shoshana in East Islip. Fiber keeps you feeling fuller for longer, is good for digestion and helps control blood sugar.

Still, many people turn to juicing-only type diets in order to “cleanse.” However, this is not really necessary, Pritzker said.

“You have a liver and a kidney that do a phenomenal job at making sure your system is clean and healthy, so there really is no way to detox better than what your body does already on its own,” said Pritzker. A better option, instead, is to focus on filling your diet with plenty of fiber-rich fruits and vegetables to keep you healthy and your system running smoothly.

The kind of smoothie you make can be dependent on your goals. For instance, add green tea to a smoothie to help boost your metabolism if you want to lose weight. Or make a health blend with antioxidant-rich ingredients like blueberries. “Overall, you should just be looking for a healthy blend of ingredients you like. Because if you don’t like it, you’re not going to drink it,” said Pritzker.

Making the Perfect Smoothie
Like any healthy meal, the ideal smoothie should contain all three macronutrients: protein, complex carbs and healthy fats. For protein, you could use a scoop of protein powder, non-fat dairy milk or non-fat yogurt (either Greek or regular, depending on your personal preference); the healthy fat could be fish oil, flaxseed, peanut butter, nuts, coconut oil or even an avocado (“You can’t even taste it. It makes it really thick and creamy,” said Pritzker). And your complex carb could be a high-fiber cereal or granola. A smoothie that contains all three macronutrients could even work as a meal replacement.

In addition, if you’re concerned about your fruit going bad before you get a chance to use it, give frozen fruit a try, as it’s just as healthy as fresh fruit (just check the label to make sure it contains no added sugar). “The only thing you want to stay away from is canned fruit,” said Pritzker. “Canned fruit is usually kept in syrup.”

Here are three smoothie recipes Pritzker shared. For more recipes, visit her website at nutritionbyshoshana.com, where you can also download a free smoothie recipe e-book.

Metabolic Reboot Smoothie: Makes 1 serving
Ingredients:
1 scoop vanilla whey protein powder
1/2 frozen banana
1/4 fresh avocado
1 cup chopped kale
1 cup fresh or frozen blueberries
1/2 – 1 cup brewed green tea, cooled
Ice
Directions:
Add ingredients to blender and blend until smooth. Enjoy!

Antioxidant Power Smoothie: Makes 1 serving
Ingredients:
1 cup fresh or frozen mixed berries (blueberries, raspberries, strawberries, blackberries, etc.)
1 cup frozen chopped spinach
1 apple, cored and cubed
1/2 frozen banana
1 tablespoon flaxseeds or ground flaxseeds
1/2 – 1 cup water or milk of choice
Ice (optional)
Directions:
Add ingredients to blender and blend until smooth. Enjoy!

PB & J Breakfast Smoothie: Makes 1 serving
Ingredients:
6 ounces plain, nonfat, Greek-style yogurt
2 tablespoons natural peanut butter
1/2 cup fresh or frozen purple grapes
or strawberries
1/2 cup dry oats
1/2 to 1 cup milk of choice
Ice (optional)
Directions:
Add ingredients to blender and blend until smooth. Enjoy!

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For fitness tips, training videos and healthy recipes, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.