The Most Important Meal of the Day?

Did you know that it September is National Breakfast Month? We have been told for a long time that breakfast is the most important meal of the day; the reality is that every meal is important.

For the last few years, I have eaten the same breakfast almost every day: a half-cup (uncooked) of 1-Minute Oats with a tablespoon of brown sugar and a bit of cinammon. It takes little time to prepare and the calorie count is relatively low, and it has many nutritional benefits for older adults: it is high in fiber, iron, and magnesium, and is a good regulator of gut health. I also find it quite filling when it is all prepared.

Not everyone is a fan of oatmeal, though, so what are some other good options for breakfast? [Hint: it is not sugary cereals!] According to the National Institute on Aging (NIA), every meal should contain 25-30 grams of protein; good sources are eggs, nuts, greek yogurt, cottage cheese, and peanut butter. Breakfast should be lower in carbohydrates as this is thought to prevent or delay cognitive decline. Whole grains are also important and are easy to find in breads, oatmeal, and some cereals–just make sure they are not also loaded with lots of added sugar. Another part of a healthy diet for older adults is nutrient rich vegetables and fruits–berries are especially recommended.

The NIA suggests the following options as healthy breakfasts as we age: smoothie made with spinach, fruit, and yogurt; vegetable omelet with whole-grain toast; avocado breakfast bruschetta; banana split oatmeal; and eggs over kale and sweet potato grits.

Of course, there are many other options that can help us get our day off to a great start. Most importantly, put some thought into breakfast so that it is healthy and filling…and whatever you do, avoid skipping this meal altogether! Good morning and good breakfast!

Is Going Backward Ever OK?

Time Magazine recently featured an article that was brought to my attention by one of my alert clients. Angela Haupt discusses the benefits of walking backwards. You have probably seen some folks doing this on a treadmill and wondered whether it is effective or just plain silly. It might even remind you of an old Monty Python sketch. Does it really help? According to the article there are at least five distinct benefits.

People of any age and fitness level can try it. It is especially effective for older adults because it helps to improve balance and coordination, which can in turn prevent falls.
It works different muscles than the ones we typically use or works the ones we do use in a different way. Studies have shown that walking backwards can increase muscle strength.
It has been shown to help those with injuries or pain. Walking backwards has long been a part of PT and OT strategies. Research has shown that it can reduce pain for those with arthritis in the knees, as well as alleviating the symptoms of plantar fasciitis and lower back pain.
Backward walking can increase flexibility. We know that sitting all day (being sedentary) is an epidemic and can cause muscles to tighten up. Walking backward can stretch muscles and lead to greater flexibility and reduce the risk of injuries.
It can improve gait. Physical therapists use this technique to help patients improve their gait patterns. It can assist with slight limps or range-of-motion issues. As mentioned above, it can help with balance control by forcing us to really focus on the way our muscles and joints are moving, as well as being aware of what is around us.

It is imperative to ensure safety when trying backward walking. Start slowly in an area that is free of hazards. Begin with just a few minutes a day and work toward more time and greater speed.

Typically, going backward is not seen as a positive. In this case, however, it can help us–especially older adults–to improve our health and fitness.

Super Agers: What Are They and How Can We Become One?

It is no secret that Americans are living longer and longer. Just because the quantity of our years is going up does not necessarily mean that the quality of those years (especially closer to the end of our lives) is going up as well. In fact, one of the greatest fears of older adults is remaining physically sound while losing cognitive and mental capacity.

There are, however, those who manage to live well into their 80s and beyond while remaining “sharp as a tack.” Those who reach the age of 80 with the cognitive capabilities of someone decades younger is referred to as a Super Ager. Who would not want to be a Super Ager? It is the best of all worlds! The good news is that researchers have found six “habits” that Super Agers have in common that can guide us as we hope to achieve this status.

Super Agers maintain a healthier diet. 2 servings of vegetables/day, 2 servings of berries/week, and one serving of fish/week have a positive effect on brain health. Other foods to include for better brain health include nuts, whole grains, olive oil, beans, and poultry.
They have connected social lives. Studies show that more loneliness leads to greater chances of memory loss. Super Agers seek out social networks and meet new people.
They are better at managing stress. Older adults who find ways to manage stress (through exercise, meditation, etc.) have better health outcomes. (More about this below.)
Super Agers are intentional about getting enough rest. The more sleep-deprived we are, the lower our cognitive ability, the worse our mood, the weaker our immune system, and the more difficult it is to manage blood sugar. 7-8 hours of sleep per night is recommended.
They engage in a variety of brain-stimulating activities. Aging can cause declines in our cognitive abilities due to increased dysfunction in the pre-frontal cortex of the brain. Activities like crossword puzzles, Sudoku, reading, listening to lectures and music, as well as some word games can actually improve brain function, problem-solving skills, and the ability to think nimbly.
They exercise regularly. This very much related to #3 since exercise can be a stress-reducer. Regular exercise (both aerobic and non-aerobic) increases the production of Brain-Derived Neurotrophic Factor (BDNF), a protein in the brain and spinal cord that helps nerve cells survive and grow. Aerobic (or “cardio”) specifically reduces cognitive impairment and the risk of dementia.

The trend seems to be toward continued rising life expectancies. Medical science has focused on the quantity of years; our personal behavior, energy, and priorities should be focused on the quality of those years. Following the steps above are no guarantee that we will become Super Agers, but it is noteworthy that Super Agers share these commonalities.

For some of us, this will require a lot of adjustment (especially in our diet). Even modest changes can have an impact. The effort certainly seems to be worth the payoff.

Help! I Need Somebody….

Many of us are familiar with the Beatles’ song “Help!” Not only is it a great tune, but the lyrics connect with so many of us. We have all been “down” and felt like we needed someone (not just anyone) to be ’round for us and help us get our feet back on the ground.

Since that song was released, however, there has been a societal shift in attitude. We are supposed to be strong and handle things on our own. Reaching out for assistance can be seen as a sign of weakness. Only more recently has the pendulum begun to swing back; we are once again being taught (in most, but not all, settings) that it is OK to need help. We can be vulnerable. It is a normal part of being a human.

In my interactions with many older adults, the question of when to seek help is ever-present. It is not just a matter of physical health, but mental well-being too. Older adults wonder when it is appropriate to seek medical attention, housekeeping services, psychological care, grief counseling, etc. How do you know when you need help?

For everyone this is highly personal. Some people are much more resilient…or stubborn. Here are some guidelines:

Most importantly, if your ability to function in a regular way is impaired, it is time to seek help. Everyone has aches and pains. We also experience emotional ups and downs. If, though, they prevent us from carrying out the activities of daily living (getting dressed, eating, working, exercisings, etc.), it is time to reach out for help.
If your mood has changed significantly and it lasts for two weeks, this is also a sign that something is going on. We all have days when we are bummed out. If we are depressed, down, or inconsolable for an extended period, it is time to seek assistance.
If your sleep patterns change significantly–sleeping too much or unable to sleep–this can be a sign of a problem. On a related note, inability to concentrate or enjoy the things you usually do (hobbies, being with friends, work) is noteworthy and should be discussed with a professional.
If you are engaging in behaviors that are risky, this is also a time to get assistance. If your behavior is affecting your work, studies, friendships, or if it could put you in legal trouble or physical danger, this an indication that you need help.

So where should you reach out for help? Friends and family that you trust are always a good first line of action. The people who love and care about you can help you see things more clearly and recommend strategies for improving the situation. Those strategies may include talking to a clergy-person, a primary care physician, or a therapist.

At one time or another, we all need some kind of help. It is nothing to be ashamed of. It does not show weakness. Rather, it shows that we are human. I hope this helps….

Is Hospice just “Giving Up?”

Working with older adults means that every once in a while a client of mine will become either too ill or frail to continue to work out with me. I have even had a few clients who have passed away; I blogged about this the first time it happened. The truth is that none of us will live forever; sometimes, however, we are fortunate to be able to “orchestrate” what the end will look like.

As a relatively young rabbi in Toledo, OH, I was invited by the local hospice to learn about what hospice is. In Judaism, it is taught that one of the greatest kindnesses that we can bestow upon a loved one is to choose for them a “beautiful death” (in Hebrew mitah yafah). What exactly does this mean? It means to provide someone with a death experience that is as dignified, peaceful, and pain-free as possible. At the workshop provided by the hospice in Toledo, I found that the hospice movement (intentionally or unintentionally) helps to fulfill the idea of a beautiful death.

What exactly is hospice care? Hospice care is a program that provides care, comfort, and quality of life for people who are near the end of their life and have stopped treatement to cure or control their disease. Hospice care focuses on treating the patient’s “total pain” which includes physical, emotional, social, and spiritual concerns. It also supports the patient’s family as they cope with the end of life and during bereavement. Years after that workshop, both of my parents were able to receive hospice care–my mother for Mesothelioma and my father for Parkinson’s Disease. In both cases, nine-and-a-half years apart, there were no further treatments that could make a difference; we focused instead on creating a quality of life rather than a quantity of life. What good, we reasoned, was it to stay alive longer if only in misery? For my mother, her passing was a meaningful experience over seven days with loved ones surrounding her. My father’s passing was different; none of his children was there, but he died before the situation got to a point that could have been much worse had it dragged on. None of us in the family–including my parents–really felt like we were giving up. We were making the best out of a situation that was clearly no longer in our control.

If you are looking for more information about hospice, a simple on-line search can tell you about organizations in your area. If you are part of a religious community, they may have their own hospice as well. Librarians can also be a great source of guidance.

The work that I do as a personal trainer for older adults is aimed at helping to improve the quality of life for my clients. As I said above, none of us lives forever. When the end is near (and sometimes not so near) there are still ways to help improve our quality of life. Hospice is not “giving up,” but rather continuing on the same path of living the best life possible for as long as we have. It is a way of choosing a “beautiful death.”

You Say “OT,” I Say “PT,” Let’s Call the Whole Thing Off?

Over ten years ago, I was diagnosed with Tennis Elbow (lateral epicondylitis) even though I have never played a game of tennis in my life; it turns out that there are other causes. A few months ago, I began developing symptoms that reminded me of my Tennis Elbow; I saw a doctor in my primary care physician’s practice who suggest icing, wearing a brace, and treating the pain with acetamenophin (Tylenol). It did not improve much and then I took a tumble while traveling earlier this month; I landed on my knees, as well as (you guessed it) my elbow. The bruises were quite impressive.

After consultation with my PCP, I was able to get an appointment with a Physical Therapist (PT) for an evaluation. Imagine my surprise when she informed that she could only deal with my knee, since my elbow was considered to be in the realm of Occupational Therapy (OT)–at least that is how it works at the Cleveland Clinic. Instead of being able to have it all cared for at one time with one therapist, I now have two therapists and twice the number of appointments!

What is the difference between physcial therapy and occupational therapy? There is a lot of overlap, but some important distinctions as well.

Physical therapy focuses on improving a patient’s physical function, mobility, and strength. PTs treat patients of all ages with many different diagnoses, including neurological, cardiovascular, respiratory, and musculoskeletal conditions. They treat the whole body from head to toe (unless, apparently, it is your elbow!), and may focus on restoring range of motion.

Occupational therapy focuses on improving a patient’s ability to perform meaningful activities as independently as possible. OTs treat patients who have experienced birth injuries or defects, sensory processing disorders, traumatic brain or spinal cord injuries, autism, and other developmental disorders, or mental or behavioral health problems. OTs may work on the upper extremity, or the whole body, to help patients develop, recover, improve, and maintain the skills needed for day-to-day living. This could include helping a child with autism participate in classroom activities, a young adult with down syndrome develop job-related skills, or an older adult who had a stroke learn self-care tasks. OTs may adapt, modify, or change daily activities by altering the activity, the environment, or the patient’s skills. For example, they may teach stretches or exercises.

In my case, PT is dealing with my knee to improve my function, mobility, and strength. My OT is dealing with my elbow because the problems I am having interfere with my ability to carry out certain task with my arm and hand that I need to do on a daily basis.

In the final analyis, I wish I could get one therapist who could do both of those things…but that is not the way it played out here. At the very least, it has helped me to understand the different roles that each kind of therapy plays. I am confident that my therapist will both work in concert to get me back to 100%. After all, I have to learn to play tennis before it is too late!

The Very Fiber of our Being

As we age, we may find that more of our mental energies and even our conversations center on whether or not we have had a bowel movement, or too many BMs, or not enough, or even the consistency. This is not surprising given that our digestive habits change as we get older.

One of the key factors is how much dietary fiber we consume on a regular basis. Fiber is more important in our diets because we may have a slower metabolism, have less muscle mass, and get less physical activity than we used to when we were younger. For men over 50 the daily amount should be 28 grams, and for women it should be 22.4. Unfortunately, most Americans barely consume half of what they should. Getting the right amount of fiber is important to keep our digestive system in good operating order. Fiber can help improve your digestion and lessen the impact of other health concerns like constipation, high cholesterol levels, and high blood sugar levels.

There are two kinds of dietary fibers: soluble and insoluble. Soluble fiber absorbs water and helps to keep “things” moving along down there; it can be found in fruits, vegetables, legumes, whole grains and oats. Insoluble fiber passes through our system with nothing happening to them; they also help keep “things” moving through the system. Insoluble dietary fiber can be found in fruit and vegetable peels, seeds, cornmeal, brown rice, as well as some vegetables and cereals.

How can we introduce more fiber into our diets? Start slowly and gradually add more; a sudden increase can actually do harm. Add whole grains; add oat bran and wheat germ to foods, check food labels for products that have higher fiber content, use whole wheat flower, and switch to brown rice. Additionally, increase legumes as well as consumption of fruits and vegetables.

Not only will these changes help to keep us regular, but adding more dietary fiber has the potential to improve our overall health. And that, my readers, is the poop on dietary fiber!

Just One Little Snack….

As a child growing up, my favorite snacks were always Little Debbie treats (pictured above). I still love them on the rare occasion that I eat one, but my tastes have evolved over the decades. I am one-quarter Hungarian so I have a love of all things pastry: cakes, pies, tarts, you name it! Unfortunately, there are times (often) when I do not make the wisest choices when it comes to snacking. In this, I am not alone.

A recent study published by PLOS (Public Library of Science) Global Public Health concludes that Americans consume 400-500 calories per day in snacks; this is the equivalent of a meal’s worth of energy and accounts for about 20% of total caloric intake. The research involved 23,700 adults over the age of 30.

To break down the report, Americans consume two snacks per day; most often those snacks are of poor nutritional quality. The largest proportion of these snacks are those high in carbs, sugar and fats such as potato chips and donuts (yum); this is followed by sweets, alcoholic bevarages, and sugary drinks. Sadly, fruits and vegetables make up less that 5% of the total snacking, and protein only about 8%. Interestingly, individuals with controlled Type 2 Diabetes ate more healthfully compated to non-diabetics; this is most likely attributed to their efforts to control blood sugar levels through diet.

A separate study in the European Journal of Nutrition showed that those who eat unhealthy snacks may actually be undoing the good that comes from eating healthy/nutritious meals.

What does this mean for us? We should be more aware of the kinds of snacking that we do. Of course, a Little Debbie now and again is not the end of the world. Consistent unhealthy noshing, however, can lead to all kinds of health problems. When we think about our overall diet, perhaps we should focus not on the fact that we feel the need to snack (that is natural), but rather on the kinds of snacks we consume. Let’s aim to switch out an Oatmeal Creme Pie for some carrots and celery, or some blueberries, or a banana….

Is Dieting the Answer to Longevity?

I have blogged many times in the past about maintaining a healthy weight. Obesity leads to many negative health outcomes such as heart disease, stroke, and coronary artery disease. Additionally, there is is a greater risk for Type 2 Diabetes, certain cancers, musculoskeletal disorders, breathing problems, digestive issues, liver and kidney disease, and even menthal health issues. All this, along with a concern with physical appearance, has led to an unhealthy obsession for many with dieting in order to lose weight.

A recent study conducted at University of California – San Diego reported in Journal of Gerentology: Medical Sciences, indicates that women over the age of 60 have a greater chance of living past 90 if they work at maintaining weight rather than losing it. The study of 54,000 women (of whom 56% survived to age 90) showed that a loss of more than 5% or more of body weight (intentionally or unintentionally) was associated with lower odds of longevity compared to those who kept a stable weight.

This has implications for the way that we view fitness. Even though more studies will be needed–including ones which examine men as well–this new research suggests that we should focus less on exercise and eating right as a means to losing weight, and more as a means to building a healthy lifestyle. It is noteworthy that many gyms still offer Weight Loss Challenges which may encourage unhealthy habits in order to “win” the contest. Other gyms have switched over to Fitness or Healthy Habit Challenges that focus less on the outcome (ie., pounds lost or percentage weight loss) and more on visits to the gym, fitness classes taken, healthy meals eaten, etc. When the aim is to maintain and build a healthy way of life, the goals are often more attainable. What this study from UCSD adds to the mix is that (for older women, at least) the change in focus can actually lead to living longer.

As always, there is a kind of balance to be achieved here. On the one hand, carrying around too much weight has its own hazards. On the other hand, excessive focus on weight loss has its dangers as well.

This is the first study of its kind. More research will hopefully show us more precisely where to put our energy.

Eating Healthier (this week?)

Did you know that this week is Healthy Eating Week? You may not because it seems to be mostly a British thing, although some American organizations have joined in as well.

Eating healthy is kind of an amorphous idea. What exactly does it mean? There are many components: portion size, calorie intake, limiting sweets, eating the right kinds of fats, etc. The goal for Healthy Eating Week is to simply encourage us to try some new healthier foods and also to be more aware of what we are eating. Of course, if we only do it for one week, it is unlikely that we will make any real positive changes in our habits, but it is a start.

What are some strategies for this week (and the weeks, months, and years afterwards)?

Get 5 servings of fruits or vegetables in each day. This will require some planning, but a trip to the grocery store with a list makes it more attainable.
Limit red meats. Stick with lean meats, poultry, or fish for one week. You may even want to try being a vegetarian for a week (as long as it does not entail eating only pasta and pizza).
Control portion sizes. There are many ways to do this: eating more slowly (we stop eating before we have overeaten), hydrate (drink more water and we feel more full), keep a food journal (see just how much you are actually eating!), and actually measure the size of your portions to compare with what the package says about nutrition information.
Find a buddy. It is always easier and more effective to try something like this when you have a partner to encourage you and keep you honest and on track.

If one week works, aim for two. Then keep going. In short order, many people find that they have developed healthier habits. Eating healthier is one of the main building blocks (along with exercise, enough rest, and stress-reduction) that keep us in shape longer.

Have a healthy food week!