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Exercise

Iron is important for exercise motivation and may play a role in peak mental functioning. Stock photo

I believe the most salient teaching point in medical school and beyond was when a professor explained, as it relates to the patient diagnosis, when you hear hooves think horses not zebras. What this means is think of the more common or more likely diseases or disorders in a differential diagnosis rather than the more esoteric or rare diseases. And when a patient presents with fatigue, one of the more common reasons is iron deficiency.

Major causes of low iron are anemia of chronic disease, iron deficiency anemia, sideroblastic anemia and thalassemia. Of these, iron deficiency anemia is the most common. However, there is a much less known, but not uncommon, form of low iron. This is called iron deficiency without anemia. Unlike iron deficiency anemia, the straightforward CBC (complete blood count) that is usually drawn cannot detect this occurrence since the typical indicators, hemoglobin and hematocrit, are not yet affected.

So how do we detect iron deficiency without anemia? Not to despair, since there is a blood test done by major labs called ferritin. What is ferritin? Ferritin is a protein that is involved in iron storage. When ferritin is less than 10 to 15 ng/ml, the diagnosis of iron deficiency is most likely indicated. Even healthy people with ferritin slightly higher than this level may also have iron deficiency (1). The normal range of ferritin is 40-200 ng/ml.

At this point, you should be asking who does low ferritin affect and what are the symptoms? Women and athletes are affected primarily, and low ferritin levels may cause symptoms of fatigue. It is also seen with some chronic diseases such as restless leg syndrome (RLS) and attention deficit hyperactivity disorder (ADHD) in children.

Effect on women

In a prospective (forward-looking) study done in 1993 looking at primary care practices, it was determined that 75 percent of patients complaining of fatigue were women (2). Interestingly, less than 10 percent of these women had abnormal lab results when routine labs were drawn, most probably without a ferritin level. Many of them had experienced these symptoms for at least three months.

There was a randomized controlled trial (RCT), the gold standard of studies, that showed women who were suffering from fatigue and low or low-normal ferritin levels (less than 50 ng/ml), but who did not have anemia, benefited from iron supplementation (3). When comparing women with these ferritin levels, many of those who were given 80 mg of oral prolonged release ferrous (iron) sulfate supplements daily saw a significant improvement in their fatigue symptoms when compared to those women who were not given iron. Almost half the women taking iron supplements had a significant improvement in fatigue symptoms. The results were seen in a very short 12-week period. This is nothing to sneeze at, since fatigue is one of main reasons people go to the doctor. Also, although this was a small study, there were 198 women involved, ranging from 18 to 53 years old.

There are caveats to these study results. There was no improvement in depression or anxiety symptoms, nor in overall quality of life. Even though it was blinded, stool changes occur when a patient takes iron. Therefore, the women taking supplements may have known. Nonetheless, the study results imply that physicians should check ferritin level, not only a CBC, when a premenopausal woman complains of fatigue. Note that all of the women in the study were premenopausal. This is important to delineate, since postmenopausal women are at much higher risk of iron overload, rather than deficiency. They are no longer menstruating and therefore do not rid themselves of significant amounts of iron.

Athletes

According to an article in The American Journal of Lifestyle Medicine, athletes’ endurance may be affected by iron deficiency without anemia (4). Low ferritin levels are implicated, as in the previous study. Iron is important for exercise motivation and may play a role in peak mental functioning, as reported in “Iron: Nutritional and Physiological Significance.” In animal studies, iron deficiency without anemia is associated with reduction in endurance because of a decrease in oxygen-based enzymatic activity within the cells.

However, this has not been shown definitively in human athletes and remains an interesting, but yet to be proven, hypothesis. Interestingly, female endurance athletes are more likely to be affected by iron deficiency without anemia, which occurs in about 25 percent of this population, according to studies (5). Low ferritin is not seen as much in male athletes. This difference in gender may be due to the fact that women not only menstruate, losing iron on a regular basis, but also their intake of dietary iron seems to be lower (6).

However, male athletes are not immune. At the end of the season for high school runners, 17 percent had iron deficiency without anemia (7). Do not take iron supplements without knowing your levels of hemoglobin and ferritin and without consulting a doctor. Studies are mixed on the benefits of iron supplementation without anemia for athletes.

Impact on restless leg syndrome

Iron deficiency with a ferritin level lower than 50 ng/ml affects approximately 20 percent of patients who suffer from restless leg syndrome (8). Restless leg syndrome, classified as a neurologic movement disorder, causes patients to feel like they need to move their legs, most commonly about a half-hour after going to bed. In a very small study, patients with restless leg syndrome who had ferritin levels lower than 45 ng/ml saw significant improvement in symptoms within eight days with iron supplementation (9).

Before you get too excited, the caveat is that 75 percent of restless leg patients have high ferritin levels. It is impressive in terms of being an easy fix for those who have low ferritin levels. And, it may be that high ferritin levels in RLS has the same symptoms as low ferritin for this is the case when it comes to iodine levels in hypothyroid patients. Iron is a trace mineral, meaning we only need small amounts to maintain proper levels.

Ferritin levels — both high and low — may play a role in a number of diseases and symptoms. If you are suffering from fatigue, a CBC test may not be enough to detect iron deficiency. You may want to suggest checking your ferritin level. Though iron supplementation may help those with symptomatic iron deficiency without anemia, it is very important not to take iron supplements without the direct supervision of your physician.

References: (1) Br J Haematol. 1993;85(4):787-798. (2) BMJ 1993;307:103. (3) CMAJ. 2012;184(11):1247-1254. (4) Am J Lifestyle Med. 2012;6(4):319-327. (5) J Am Diet Assoc. 2005;105:975–978. (6) J Pediatr. 1989;114:657–663. (7) J Adolesc Health Care. 1987;8:322–326. (8) Am Fam Physician. 2000;62(4):736. (9) Sleep Med. 2012;13(6):732-735. 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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By Lisa Steuer

When the holidays are finally over and January rolls around once again, it’s a time that can be overwhelming for many people. Most likely, the holidays were filled with indulgences, a lack of exercise, pounds gained and more. Plus, a new year inspires many people to make resolutions. But all too often, those resolutions are forgotten by February.

The good news is that if you really want to make a change this year, you do possess the tools to do so — no matter what your goal may be. Adam Gonzalez, Ph.D., is the founding director of the Mind-Body Clinical Research Center and assistant professor in the psychiatry department at Stony Brook University School of Medicine. In his role as a clinical psychologist, Gonzalez provides clinical services to the community and to patients at the hospital, with a focus on a holistic way of providing care to heal the mind and body. Gonzalez and his colleagues have conducted research to support the mind-body connection and help people work on stress management skills, improve their health and set and meet behavioral goals.

So exactly why is it so difficult for so many people to actually stick to their New Year’s resolutions and make a big change? Gonzalez pointed out three main reasons: setting unrealistic goals, getting distracted or losing focus, and finally, not knowing where to start. If you want to make a big change in your life, a good way to begin is to monitor your current behavior, notice where the behavior is occurring, your thoughts and beliefs about the behavior, as well as some of the thoughts you are having while the behavior is occurring, said Gonzalez.

“If I start thinking, ‘I’m a failure, I’ll never make this change, I can’t keep up with this,’ I’m likely not to keep up with it.” — Adam Gonzalez, Ph.D.

“All of our thoughts, behaviors and emotions interact, so if you work on your thinking style or work on managing behaviors, that can affect emotions and also the behavioral outcomes,” said Gonzalez.

For instance, if someone wants to make changes in their sleep, Gonzalez would have them monitor how much sleep they are currently getting, what their current bed time is, what time they wake up, etc. If a person wants to make changes to their eating habits, that person might want to think about who these behaviors are occurring with ­— who are the friends he or she is going out to eat with and where, and think about whether anyone else is helping to drive that behavior.

“You want to get supportive people around you who actually can be there to help foster the behavior change that you’re looking for,” said Gonzalez. “If the people that are around you aren’t supportive, I would suggest addressing it head on: letting the individuals know what, specifically, you need from them, whether it’s something you need them to do or not do.”

One pitfall that many people fall into when trying to make a change is getting discouraged when a lapse in the behavior change occurs — examples include slipping on your diet, having a cigarette if you’re trying to quit, etc.

“The way you interpret the hiccup or lapse will have a profound effect on your next step. So don’t get discouraged or beat yourself up too hard when you have a lapse in the behavior that you’re trying to change,” said Gonzalez.

Another instance where many people get discouraged is when they make a goal to get to the gym a certain amount of times a week and then fail to meet that goal one week, Gonzalez noted.

“If I start thinking, ‘I’m a failure, I’ll never make this change, I can’t keep up with this,’ I’m likely not to keep up with it,” said Gonzalez. “First is recognizing it for what it is — that you missed two days this week and next week you’re going to be going to the gym the four days you wanted … or, it’s re-evaluating the goal and your plans. Maybe four times a week … [with] your schedule is a little too intense. So maybe it’s scaling back your goals and making it something that’s more attainable.”

And once you reach your goal, how do you stay motivated? Many people, after losing weight for instance, may find it difficult to stay on the path and instead go back to old habits.

juggling-w“It’s important to consistently remind yourself of why the goal is important,” said Gonzalez. “So it’s building up motivation in your mind, and sometimes we will recommend that people put Post-its around that might have motivational statements on it or something that’s very personal or relevant to them to remind them of why this goal is important.”

 

SMART goal-setting

Gonzalez shared the SMART goal-setting technique, which is used in programs at Stony Brook’s Mind-Body Clinical Research Center:

Specific: Make sure your goals are straightforward, specific, and emphasize what you want to happen. “So you don’t want to just say, ‘I want to lose weight.’ It’s good to be specific and say, ‘I want to lose 10 pounds,’” said Gonzalez.

Measurable: Make a goal that you can make measurable progress on so that you can see the change occurring, and set time frames so that you can see if you’re reaching your goal or not.

Attainable: Identify goals that are most important to you and aren’t too far out of reach. “Losing 50 pounds in three months is probably a stretch, so you want to make sure it’s something attainable,” said Gonzalez.

Relevant: The goal should be something that you’re really willing to put effort in and work toward.

Time-based: Setting a time frame can be very helpful in achieving goals. Plus, setting long- and short-term goals can help you achieve them. For instance, set a short-term goal of losing five pounds. Once you meet that goal, it can motivate you to keep making progress toward a larger weight-loss goal.

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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.

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.

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By Lisa Steuer

Getting into shape after giving birth can seem like a challenge. You may have gained a little more weight than you ever have before, you are not feeling your best, the baby is up all night and your to-do list has increased dramatically. But with the right support and plan of action, it is possible to not only lose the baby weight, but to get in even better shape than you were before giving birth.

Fit4Mom
One organization that is helping many moms get into shape is Fit4Mom, a franchise with more than 1,300 locations nationwide, said Britney Pagano, mom of two and founder of Fit4Mom Long Island.  In fact, many Long Island moms have lost 70 or 80 pounds with the program, according to Pagano.

Fit4Mom Long Island classes are held at Sunken Meadow State Park in Kings Park, Heckscher Park in Huntington and Belmont Lake State Park in North Babylon. There are also classes in Nassau. For the full schedule, visit https://nassauandsuffolk.fit4mom.com. Stroller Strides, which is Fit4Mom’s most popular program according to Pagano, is a “Mommy and Me” type class. The children sit in strollers while the moms go through a 60-minute stroller-based workout that combines intervals of cardiovascular and resistance training. The nationally certified class instructors incorporate songs and activities to keep the kids entertained.

But Fit4Mom is more than just fitness classes, said Pagano. It’s about connecting moms, making friends and finding support. In addition to workouts, there are playgroups and monthly moms-night-out events.

gal-getting-ready-w“A lot of moms have told me that our program specifically has really saved them from postpartum depression because it’s given them something to do,” said Pagano. “It was helping them lose weight and meet friends, and they didn’t have the guilt of leaving their child in someone else’s care so that they can do something for themselves.”

Tips for Success
In addition to attending Fit4Mom classes like Stroller Strides, here are some other tips for getting your body back after baby:

Consult your doctor.
Before you start any kind of fitness program, be sure to check with your doctor. He or she knows your individual situation and can advise you when it’s best for you to return to being active. In addition, your doctor may be able to suggest a personalized approach for you.

Find a little time when you can work out during the day.
Once you get the OK from your doctor to work out and do any kind of cardio activity, get in a few minutes here or there doing squats, push-ups, crunches, high knees, other bodyweight or cardio moves or a fitness DVD, even if you can only do a few minutes at a time. You don’t have to do the workout all at once for it to be effective. Just find the time when you can. Visit www.fitnessrxwomen.com/life-health/fit-moms for tons of at-home workouts for moms and more tips.

Get out and go for a walk.
Get outside! Get the stroller and bring baby along for a ride.

Work on building your at-home gym.
Since you may find it hard to get to the gym, there are a few items that are fairly inexpensive that can help you get a good workout right in your own home. Resistance bands, a medicine ball, dumbbells, a jump rope and a stability ball are a good start.

Listen to your body.
If your body is telling you that you need to sleep, and the baby is sleeping, then you should sleep, too. If your energy is lacking, it’s all the more reason to get into a good fitness regimen, because this can help your energy levels, said Pagano.

Fuel up.
You won’t be able to get back in shape if your diet is not in check. Make sure to take care of yourself with a balanced diet: drink plenty of water, eat plenty of fruits and veggies and get your protein. Pagano encourages her clients to find the one day a week where they can get to the grocery store — when there is someone to look after the child — and use that day to plan out all the meals for the week. Chop up all the vegetables and fruit and put into single serve bags. “This way, during the week when hunger strikes, you just have to look in the refrigerator and everything is already done and prepared for you.”

Make time for yourself.
“A lot of times, especially with new moms, we kind of get lost in that and taking care of the baby,” said Pagano.  “But make it a priority to take care of yourself.”

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For more fitness tips, 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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North Shore native revives homegrown business, using late wife as motivation for revamped brand

By Jenni Culkin

After two decades, a Smithtown-based fitness clothing line that once enjoyed stellar success in the 1990s is making a brute and swift comeback.

Robert Alario stands with a model showing off his BRUTE FORCE fitness clothing line. Photo by Jenni Culkin
Robert Alario stands with a model showing off his BRUTE FORCE fitness clothing line. Photo by Jenni Culkin

Robert Alario, who was born and raised in Smithtown, started bodybuilding as a junior high school student.

He used his weight-lifting skills to develop his wrestling team reputation, eventually becoming co-captain of the team.

“Fitness has always been at the center of my entire life,” Alario said.

Alario originally began selling his products under the brand name BRUTE FORCE INC., during 1988 at Macy’s through a licensing agreement. The brand was completely homegrown with a Smithtown resident using Smithtown businesses to help propel him to fitness clothing prominence on a local scale and beyond.

But Alario eventually decided to take a break from the business, citing a problem with the licensing agreement.

Alario officially began bringing the line back in 2013, raising funds from private investors and crowdsourcing.

Alario is making his way back to success in his business without a licensing deal this time.

“I’m setting the stage for a multimillion-dollar platform,” said Alario. “I’m going for it.”

BRUTE FORCE’s website will be up and running in mid-May. The World Gym in Ronkonkoma will also be selling the clothing.

“I call it fashion-forward fitness ware,” Alario said about his clothing line.

Alario continued to describe the clothing line as sexy, explaining that the clothes don’t conform to the status quo.

Products from Alario’s BRUTE FORCE clothing line are being manufactured locally in a factory in Bellmore. But what motivates Alario most of all, he said, is bringing the clothing line back to life in the wake of his late wife Angela, who died from a pulmonary aneurysm after undergoing a surgery several years ago.

Angela was once a model for Gold’s Gym television commercials and was enthusiastic about fitness just like Alario. Alario restarted his business, calling her the inspiration for the new and improved line of clothing.

The tags on each piece of clothing even bear the words, Inspired By Angela.

“She’s amazing in every way,” Alario said about his late wife, explaining that she was always encouraging him to get back to his business. “I learned a lot from her and I see through her eyes.”

Alario currently lives in Miller Place with the hope of moving back to his hometown of Smithtown sometime soon to spread the word of his comeback. He has two stepsons, Angela’s sons, who are planning on becoming doctors.

BRUTE FORCE has huge plans, including plans to eventually expand into footwear to go with the clothing line. Alario can be reached at 800-326-9059.

“This is not a small-time thing,” Alario said. “We’re going to make it big.”