Meeting Mental Health Challenges of the Elder Boom

Meeting the Mental Health Challenges of the Elder Boom

BLOGGER: MICHAEL FRIEDMAN, LMSW

The elder boom has begun, and our nation is not prepared. Between 2011 and 2030, the number of adults 65 or older will increase from 40 million to 72 million and from 13 percent of the population to 20 percent. This drives growing concerns about the viability of Social Security, the sustainability of Medicare, and the availability of a workforce to provide health and social services.

Despite widespread concern about the physical health of older adults, mental health needs are mostly not on the national radar screen, a serious oversight for five reasons.

First, contrary to the ageist assumptions of our culture, people can live well in old age, but not without mental health.

Second, mental illness has a terrible impact on physical health. People with mental disorders are more likely to have physical disorders, and people with co-occurring physical and mental and/or substance use disorders are at higher risk for disability and premature death and have far higher medical costs than those with physical disorders alone.

Third, approximately 20 percent of older adults have diagnosable mental and/or substance use disorders, including dementia. This increases to over 50 percent of older adults by age 85, mostly dementia, the prevalence of which doubles every five years beginning at age 60. The range of mental health problems also includes:

• Anxiety and depression, which often co-occur with dementia
• Psychotic conditions, such as schizophrenia, bipolar disorder and severe depression
• Substance use disorders

Fourth, untreated mental disorders contribute to avoidable placement in institutions, such as nursing homes, driving up the costs of long-term care in the U.S. They also contribute to social isolation and high rates of suicide.

Fifth, all older adults face emotional challenges related to social and occupational role changes, diminished — but not lost — physical and mental abilities, losses of family and friends, and the inevitability of death.

Both the public and the private sectors need to take steps to meet the mental health challenges of the elder boom. These include:

• Making mental health promotion a key element of the health and aging services systems.

• Providing home and community-based services to enable people developing disabilities to live where they choose.

• Supporting family caregivers who provide 80 percent of the care for people with disabilities.

• Improving access to mental health and substance abuse services in the community.

• Improving the quality of mental health and substance abuse services in the community and in residential and institutional settings such as formal and “naturally occurring” senior housing, assisted living and nursing homes.

• Fostering integration of physical health, mental health, substance abuse and aging services.

• Enhancing the adequacy of services for minority populations, which will grow from 20 percent to 30 percent of the older population by 2030.

• Increasing research regarding effective mental health promotion and treatment of mental and substance use disorders and improving translation for research findings into practice.

• Providing outreach and public education to older adults and their families regarding mental health, effective treatment and where to find resources.

• Addressing the shortage of a clinically and culturally competent workforce, in part by recruiting and training more geriatric professionals and paraprofessionals and in large part by including older adults themselves in the helping workforce in both paid and volunteer roles.

• Restructuring methods of financing needed services so as to make them affordable, to enhance integrated care and treatment, and to support services in the home and in natural community settings.

• Making the mental health challenges of the elder boom more than a rhetorical priority in both private and public service systems.

In these times of cutback in government spending, addressing the mental health needs of older adults may appear to be an unnecessary frill. But the truth is that failing to address mental health needs will drive costs up in the long run. Ignoring this is very poor policy.

(This article is coauthored by Kimberly Williams, co-founder and Director of the Geriatric Mental Health Alliance of New York.)

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Did I Ever Tell You…?

BLOGGER:  MARY LANGUIRAND, PHD

There are days when it takes all the self control I possess to be with Carol, a pleasant 87 year old woman with mild age-related cognitive loss.  I can empathize with the complaints about the kids who don’t visit often enough, the aide who forgets to put her phone within reach, and the salad with the wilted lettuce.  However, I sometimes think that if I hear one more repetition of the story about how her husband bought her a cherished emerald ring in 1973, I may tear out my hair.  It’s a long story, it never changes, and I believe I’ve heard it at least twice a month for the past three years.

Short-term memory tends to fade with advanced age, as it is based on such factors as ability to attend to the environment, maintain focused concentration, and track complex information. As illness, diminished energy and perceptual changes erode some of those capacities, the ability to recall recent information diminishes.  In contrast, memories from years past strengthen, having been reviewed and repeated (and revised and edited) many times. Caregivers often marvel that Mom can’t remember her upcoming doctor’s appointment, but can tell you what she paid for milk in 1964.

You might think that listening to the same story over and over would be a neutral or—at worst—a mildly boring experience.  After all, we hear all sorts of things repeatedly—recorded messages on trains and busses, the music in TV jingles, liturgical passages at religious ceremonies—and many people find the familiar tolerable, and even soothing.  Why then, do so many caregivers report that hearing yet again about Dad’s heroic actions in the fields of Korea or Mom’s days as a cheerleader can drive them to drink?

Much of the frustration comes from the fact that this sort of repetition is one of the most inescapable “proofs” that someone has reached a point where they are more comfortable in the past than in the here-and-now, and that this isn’t likely to change.  The effort of attending to current realities is too much, and they’ve surrendered to the comfort of the familiar.  The content of these repeated tales is also rather telling, as it can give some clues to those events and experiences that impacted the person most profoundly: If a parent’s most cherished memory relates to things that happened long before you were born, what does that say about you?

Repetition apparently isn’t limited to the senior set…  When emailing a younger colleague recently, I shared a past experience that I thought resonated with some current events, and was quite chagrined when reminded that I’d already told that story.  I felt rather hurt that my misplaced effort at empathy (and the chance to recount how I’d saved the day ‘back in the day’) apparently generated boredom and annoyance, along with the message that I’m forgetful.  No kidding—I really don’t remember having told that one before…

Once I moved past the hurt feelings, I began to think about getting my act together and scoring some points in the present, instead of resting on past laurels, which is probably a good thing.   I also began to develop a new appreciation for Carol’s experience. I thought about my own response to her oft-told story about the emerald ring, and how I regularly discount her need to re-live a time when she felt loved and special. I just hope profoundly that I don’t communicate my impatience as clearly as my colleague did.

I can’t honestly say that the story took on a new glow when I heard it again, but I did realize that maybe Carol shares it with me because our interactions remind her of that time when she felt valued, and appreciated, with years of life yet to be lived and goals yet to be accomplished.  Maybe I need to put more effort into helping her to recapture those feelings in her current relationships.

Realize that when someone relates an experience to you you’re hearing about it for a reason.  Don’t just hear, listen.

Mary Languirand and Robert Bornstein are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press.  The second edition, revised and updated, was recently released.  Here’s the link: http://www.newmarketpress.com/title.asp?id=901

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On Meeting Up with Elders: The Early Bird Special

On Meeting up with Elders: The Early Bird Special

BLOGGERS: Mary A. Languirand, PhD & Robert F. Bornstein, PhD

A friend told us the story of her mother’s most recent visit. Her mom didn’t drive, and planned to come by train. While not thrilled by this plan, there were few realistic alternatives, so our friend agreed—reluctantly, to be sure—and promised to be waiting at the station to pick her up. She arrived 10 minutes before the train was due, only to find her mother shivering on the wind-swept platform, clutching her suitcase: She’d taken an earlier train, having arrived at her departure station well ahead of schedule. The inevitable “why didn’t you call?” was met with protests that she was perfectly fine, didn’t want to disturb her, and so on. Our friend’s initial response was guilt, quickly followed by irritation, generating more guilt.

As we age, our capacity to judge time accurately diminishes: Most people begin to perceive time as passing more swiftly. This tendency is magnified significantly in the early phases of certain forms of dementia, when minutes start to feel like hours. However, the behavior isn’t limited to people with dementia—many older folks become hyper-aware of how time is precious and fleeting, and not wanting to miss out on anything, even the most laid-back elders evolve into “early birds”.

Other age-related factors also contribute to this shift. Deteriorating night vision can lead to avoidance of rush hour traffic and crowds, while the need for frequent bathroom breaks may make your loved one insist on multiple pit stops everywhere you go. For some family members and friends these behaviors are seen as harmless quirks, good for the occasional joke about having dinner mid-afternoon. However, these quirks can actually lead to some significant stress, particularly when you’re their primary source of transportation and support. When your own schedule is already overbooked, Dad’s insistence on arriving for his doctor appointments half an hour early may grate on your nerves (especially if his doctor is notorious for running late….and whose isn’t). A dozen phone calls to remind you of the appointment beforehand along with requests that you “hurry up” while en route may generate tension. So do frequent “what time is it getting to be?” queries while you sit in the waiting room, powerless to move things along.

It’s hard not to resent Dad for getting you into this mess in the first place, and hard not to deliberately start running late on pickup days to regain control of the situation. So what can you do? Three things.

First, try to determine whether your loved one’s “need for speed” is motivated by underlying worries about issues other than concern with timeliness. You may discover that Mom’s fear of getting home late is actually due to concern about her dog, or that Dad’s insistence on dining early is based on his need to save a few dollars. Addressing those issues may lead to much relief all around.

Next, set a realistic time schedule, review it as needed, and stick to it. If you know from experience that it takes Mom at least 10 minutes to put on her coat, lock the door, and put her keys in her purse, factor that into the schedule. Explain what you’re doing: “Your appointment is at 10:00am. It takes 10 minutes to get out of the house, and 15 minutes to get there, so I’ll be at your place at 9:20. We’ll have plenty of time to get a parking space and hit the bathroom.” While unforeseen circumstances may arise, stick with the plan; with sufficient repetition, your loved one will realize that you’ll get where you need to be when you need to be there. (And if she wants to stand on the porch for a half hour before you arrive, that’s her decision.)

Finally, review your own attitudes toward time. “Wasted” waiting room time can be a valuable opportunity for a one-on-one chat with your loved one. It can also be an opportunity to catch up on your reading, draft this year’s holiday message, plan next week’s menus, or text that friend with whom you’ve been meaning to re-connect. It can also be a brief interlude of relaxation for you to enjoy. A bit of reframing on your part can go a long way toward making a frustrating situation much more tolerable….for both of you.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here’s the link: http://www.newmarketpress.com/title.asp?id=901

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Learning about Calcium

Learning about Calcium

BLOGGER:  JULIE WEBSTER

Of the calcium, 99% is stored in the bones with the balance being stored in the body fluids.  In the bones, it not only acts to maintain a strong skeletal structure but also serves as attachment points for the tendons of the muscles.  The calcium in the body fluids circulates as iodized calcium which helps to regulate muscle contraction, blood clotting, transmission of nerve impulses, the secretion of hormones and the activation of some enzyme reactions.

Calcium by itself cannot be absorbed by the body.  It needs other nutrients to enable that to happen.  Those nutrients include magnesium, phosphorus, vitamins A, C and D.  An example of this is magnesium.  Magnesium stimulates the production of a hormone called calcitonin.  This hormone is what keeps the calcium in the bones and out of the soft tissue.  It is believed that many forms of arthritis are due to an increase of calcium in the body fluids and a lack of calcium in the bones[i].  Another example is the need for Vitamin D.  Typically we absorb about 25% of the calcium we ingest.  Vitamin D helps to make the calcium-binding protein which is needed in order for us to absorb that 25%.  So as you can see, it is a bit more complex than we think.

To take this a step further, the 1% of calcium in the body fluids always remains the same.  If we are not consuming enough calcium through our diet, the body will actually take the calcium out of the bones to maintain that appropriate level in the fluids.  This process is silent, meaning we might actually not know this is happening.  Unfortunately as we age however, this can show up as osteoporosis.

With all of this said, it is important to make sure we are getting an adequate amount of calcium and its carriers in our diet.  The average adult should consume between 1,000 – 1,200 milligrams of calcium daily[ii].  This may sound like a lot but it really isn’t!  Let us take a look at what foods actually contain high amounts of calcium.

Of course the dairy industry wants you to believe that their source of calcium is the best.  Although cheese and milk do contain a high amount of calcium, often people are intolerant to dairy.  This can be due to being lactose intolerant, a deficiency in the enzyme that breaks down the lactose in the milk, or because high dairy diets can cause some people to be heavily congested after consuming them.

Personally I do ingest dairy but try to focus on the use of goat or sheep products rather than cow.  Goat and sheep tend to graze rather than be grain fed.  Grazing increases the nutrient value of the milk as the animals are ingesting more nutrients from the plants.  In addition, the fat molecules of the milk from these types of animals are smaller, thus easier to digest.  They are also lower in fat.

In addition to dairy there are some fantastic sources of calcium.  Below is a list of some of the best:

• Dried seaweeds such as wakame, kombu, kelp, hijiki, and arame
• Beans such as soy, garbanzo, mung, aduki, black and lima
• Nuts and seeds such as almonds, sesame, cashew, and filbert
• Whole grains such as buckwheat, millet, amaranth, and rye

Of course my favorite source is GREEN VEGETABLES!  Leafy green vegetables not only contain a good amount of calcium but they also contain lots of chlorophyll.  In the center of the chlorophyll molecule is found magnesium.  In addition, chlorophyll is a great source of phosphorus, vitamins A and C.  How can there be a better way of getting your calcium and all its carriers than eating green vegetables?

Having said all that, let us look at some of the best sources of vegetables for calcium:

• Mustard greens
• Turnip greens
• Bok Choy
• Kale
• Parsley
• Watercress
• Broccoli

We tend to think of spinach and chard as great sources of calcium as well but surprisingly they are not.  Although they contain a lot of calcium, they also contain oxalic acid.  This substance binds chemically with the calcium thus preventing it from being absorbed.  Now this is not to say that these vegetables are not chocked full of other nutrients, they are!  Just don’t use them as a source of calcium.

So start playing around with ways in which you can increase the amount of calcium in your diet.  Chances are you might be able to take in much more than you think.

[i] Paul Pitchford, Healing With Whole Foods

[ii] Understanding Normal and Clinical Nutrition, Seventh Edition

Julie Webster is a Certified Massage Therapist and Certified Health Counselor. She provides health education online and through seminars. In addition she has written a book titled “Regaining Good Posture” which is available as an ebook, with videos performing each of the stretches, through her website:www.julie-webster.com Julie is also available for presentations on posture and various health topics to corporations. To reach her visit her website or email her at info@julie-webster.com

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THE 12 POUNDS OF CHRISTMAS

THE 12 POUNDS OF CHRISTMAS: HOW TO BEAT BACK A BULGING HOLIDAY WAISTLINE

BLOGGER:  JARED DEFIFE, PHD

Did you pledge to slim your waistline in 2009, but find yourself packing on a few extra pounds this holiday season?  Here are a few ways to get your pants to fit again for 2010.

-Assess yourself
Put on your Sherlock Holmes hat and take a good look at your life and health habits over the past month. Were your holiday feasts a little too filling? Did you mindlessly graze through the sweets and snacks that were left out for the taking? Have too many cocktails at your cocktail parties? Were you less active than usual? Did feeling more down or depressed leave you with less motivation to take care of yourself? Have you been eating more as a way to cope with feelings of sadness or loneliness? Developing a meaningful measure and understanding of your behavior goes a long way towards effectively identifying goals for change. Keeping track with food logs or activity calendars is a great way to record your achievements and identify problem areas.

-Don’t repress yourself
Gaining weight can be disappointing, especially if you’ve spent a lot of effort trying to lose it. When people get upset or disappointed, I often hear them say that they know they should just “let it go”, “move past it”, or “forget about it”. I think that’s a load of hooey. Those are trite little psychobabble platitudes with the implicit message that feelings are bad and you shouldn’t have them. Anyone who has been hurt or disappointed knows that you don’t just “forget about it”. Feelings are inevitable; when you stop feeling, you stop living. How you choose to act on your feelings is the point where behavior becomes more or less adaptive. If you feel disappointed and angry over your holiday weight gain, you can choose to let those feelings shut you down, or you can let those feelings motivate you towards new behavior.

-To forgive is divine
Getting down on yourself for your holiday hedonism isn’t particularly helpful for anything. Regretfully ruminating about those two extra Christmas cookies you ate or that full day you spent on the couch watching football doesn’t burn cookie calories or turn couch surfing into cardio calisthenics. Feelings of shame and guilt about your holiday weight gain can quickly become demoralizing, undermining your motivation to eat wisely and stay active. Remember that when it comes to holiday weight gain, you are not alone. American adults gain on average around 1 to 2 lbs each year, mostly around the winter holidays. It’s not a crime to be a little self-indulgent. Try to look fondly on the parts of your holidays filled with good times and good food. Don’t let a couple extra pounds hold you down too much.

-…but don’t let yourself off the hook
Self-forgiveness does not mean shirking all personal responsibility. Ultimately, you are responsible for your own actions and indulgences. Take responsibility without blaming (yourself or anyone else).  There is a fine line between understanding the effects of a situation and blaming that situation for the consequences. For example, it may be a very useful insight to identify that a streak of bad weather prevented a couple of your daily runs. What you do with that insight is what makes all the difference. Blaming the weather for your inactivity and waiting for the sun to shine won’t do you any good. Knowing that winter weather keeps you housebound and preparing for that by planning indoor aerobic activities for when the snow hits turns an insightful understanding into effective behavior change.

-Make it about the process, not about the poundage
Scales can be useful diagnostic tools. However, scale watching is a lot like whale watching. Every now and then you get an exciting result, but there’s also a lot of inactivity and even disappointment. Staying active with regular exercise and eating a sensible daily diet should be much more important than the number at your feet on any given day.

-Get support
You should always let your physician know about your diet and exercise goals and routines. A psychotherapist can also work with you in developing your personal goals, tracking your progress, guiding your emotions away from self-loathing and towards self-achievement, and identifying if you’ve dipped below winter blues and into a more significant depression.  Enlist a few close and supportive friends for encouragement and the occasional reality check.  It takes a village to lose a pound, so groups like Weight Watchers, recreational clubs, and sports teams are great for guidance, support, and social networking.

Jared DeFife, Ph.D. is a research scientist in clinical psychology at Emory University and Associate Director of the Laboratory for Personality and Psychopathology. He writes a regular blog for Psychology Today at www.tinyurl.com/jdefife.

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Happy Holidays?

Happy Holidays?

(Or, Here’s Wishing the Grinch Would Just Steal Xmas Already)

BLOGGERS:  Mary A. Langiurand, PhD & Robert F. Bornstein, PhD

Across America, real-life families will soon gather around festive holiday tables to enjoy gourmet feasts, basking in the comfort of warmth and plenty, giving thanks for the many gifts they have received this past year. It goes without saying that the greatest gift of all is the gift of family—those beloved, loving people who stick by us in good times and bad, give our lives meaning, make us happy and proud. Oh, people have their little differences, of course, but truly, at the end of the day family is what matters. That’s why we have holidays…

Most of our patients believe all of the above. They are also convinced that theirs is the most dysfunctional, annoying clan on the planet. The leaky ceiling over the less-than-Martha-Stewart-worthy table could be tolerated, as could the mismatched chairs and cramped quarters. Ditto the dry turkey, lumpy gravy, and assorted vegetable horrors cobbled together by committee. Thoughtless gifts—the toolkit for you (who can’t change a light bulb), or the brightly lit magnifying makeup mirror for your sister (who frets endlessly over her crow’s feet)…..those too could be borne with humor and grace. After all, it’ll be a good story for your friends. But the people! How in a just world could you possibly be related to them? Maybe you were mixed up with someone else at birth. Imagine a room filled with willfully annoying fools who just happen to have your entire history at their fingertips (complete with youthful mistakes, former passions, 70s disco-era photos, and other horrors), and whose notion of a good time is making fun of you.

Or perhaps you’re the hostess, opening the home you slaved to clean and decorate, watching your guests put sucked-on bone fragments into your centerpiece, smear your good napkins with indelible lipstick, and render your bathroom unusable. Maybe you got everybody to agree to détente for just one day, only to find that your cousin’s notion of truce is to choose today to come out of the closet to his fundamentalist parents and introduce his lover to everyone at your party. Or maybe you’re the one who couldn’t take one more minute of your brother’s yammering on about his great career and big raise and over-the-top vacation, so you chose today to remind him of how his success came at your expense. At the end of the day, the house is a shambles, and everybody’s in tears (except for Cousin Mildred, who’s locked in the bathroom). Surely nobody else has to deal with this, nobody…

Let’s get real.

To some degree, everybody deals with this, all the time. Real life isn’t perfect, and neither are families. Illness and death, poverty and disappointment, bad choices and worse luck happen. Further, most folks don’t accept these experiences with dignity and grace all the time, and tend to let down their guard when surrounded by people close to them. If you choose to see this as intolerable and unacceptable, you’re not going to enjoy the holidays. But if you choose to see it as an unpleasant but tolerable fact of life, you’ve got a chance of salvaging the season.

Remember that you have choices, and you are where you chose to be. If you’re thinking, “You don’t get it—I can’t just not go” you’re wrong. If you really, truly don’t want to deal with the dysfunction of a holiday meal, you can opt not to attend—it’s your call. There will be consequences; your decision will make some people angry and unhappy, and you will eventually have to address that with them. But if you feel strongly enough that this really isn’t something you want to do with your life and time, you don’t have to do it

If you choose to attend, you can also choose to engage or not to take the bait when the dysfunction fires up. You know these people well enough to predict their behavior, so figure out what’s likeliest to get to you, and then plan how you’d like to respond to defuse the situation. Practice the response in your mirror a few times, and when the zingers start, use your now-practiced skills. Change the subject, respond minimally, take a walk around the block, or just don’t respond. You probably won’t get it quite right at first, so keep practicing—you’ll get better at it over time. If you don’t feel able to develop these strategies on your own, seek professional help (no kidding). Therapists have pre-holiday rushes of new patients for good reasons.

If you really want peace, do not escalate a volatile situation artificially. Alcohol may make some situations more tolerable in the short term, but it will ultimately disinhibit behavioral controls. Ditto sleeplessness, too much noise, too little space, too much or too little heat. Don’t overdo, and avoid the obvious pitfalls. Take care of yourself. Spend at least some time with the people who really do make you happy, doing things you really do like to do. These might be ordinary water cooler moments rehashing the game, or coffee with a friend, far from the madding crowd.

And when it’s all done, don’t forget to get your share of leftovers to take home. These are, after all, the best part.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press.  The second edition, revised and updated, was recently released.  Here’s the link: http://www.newmarketpress.com/title.asp?id=901

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THE EFFECTS OF STRESS

The Effects of Stress

BLOGGER:  JULIE WEBSTER

STRESS AS A NATURAL OCCURRENCE

Our bodies are designed to handle variations from diet, exercise, stress and weight.  It regularly produces assorted hormones for a period of time to take care of these situations.  All this is a normal cycle for the body.

STRESS & HORMONES

The challenge is when that stressor continues for a prolonged period of time.  This causes the body to overproduce hormones, thus stressing the entire system, breaking down cells, tissues, and organs.

When our body undergoes a stress, the adrenal glands produce adrenaline aka epinephrine.  This hormone stimulates the heart muscle, alters the rate of blood flow, and raises basal metabolic rate.  This is known as the fight or flight syndrome.  Epinephrine also prompts the secretion of glucagon by the pancreas, causing the release of nutrients from storage.  The steroid hormone cortisol is also produced.  It enhances protein degradation, which raises amino acid levels in the blood so that they become available for conversion of glucose.  The two other hormones induced by stress, aldosterone and antidiuretic hormone both help to maintain blood volume.[1]

Epinephrine does not stick around very long in the body however, when stress is prolonged, cortisol does.  This hormone will affect the body in many detrimental ways. [2]Excess cortisol will:

• Decrease metabolism by inhibiting thyroid function
• Depletes protein in the muscles, bones, connective tissue and skin which can cause fatigue, weakness, thinning of the bones, and bruising
• Decreases the production of androgens and growth hormones which build muscles
• Can cause insulin resistance[3]
• Increase fat accumulation, especially in the belly
• Increase appetite and carbohydrate cravings
• Will cause depression, anxiety, and mood swings

Is cortisol related to abdominal obesity?

“Yes. There is a link between high cortisol levels and storage of body fat, particularly “visceral” abdominal body fat (also known as intra-abdominal fat). Visceral fat is stored deeper in the abdominal cavity and around the internal organs, whereas “regular” fat is stored below the skin (known as subcutaneous fat). Visceral fat is particularly unhealthy because it is a risk factor for heart disease and diabetes.”[4]

The challenge with cortisol and weight is this.  First, when you are stressed you produce more cortisol which will lead to weight gain.  When you are overweight the adrenal glands produce more cortisol so it is a viscous cycle.

ADDITIONAL AFFECTS FROM STRESS

Free radical production

THE NEGATIVE ROLE OF CERTAIN FOODS & DRINKS

Food can play an important role in both exacerbating the problem and relieving the problem.

The following list will cause the adrenal glands to produce adrenaline and cortisol.  Over the long term this will eventually exhaust the adrenals:

• Caffeine, especially beyond one or two cups a day on a regular basis will actually act like long term stress in the body
• Chocolate in excess as it will act as a stimulant
• Soda will affect blood sugar levels as well increase production of stress hormones
• Heavy alcohol consumption will cause the adrenals to overreact
• Refined foods and sugar will affect insulin production and consequently blood sugar spikes and falls
• Refined foods will deplete the body of essential vitamins and minerals thus stressing the entire system
• Refined salt is chemically cleaned and devoid of all minerals and will increase blood pressure
• Can create a more acid pH in the body, which allows for disease to develop

THE ROLE OF HEALTHY FOODS

The following is a list of vitamins and minerals that will support the body during stressful times and therefore should be included in your daily meals:

• B Complex is necessary for the production of all neurotransmitters including Seratonin, which is a calming neurotransmitter, and it vital for the functioning of the adrenal glands.  Foods high in the B vitamins include:  dark leafy green vegetables, wheat germ, brewer’s yeast, most grains
• Vitamin C is depleted with prolonged bouts of stress and is also required for normal functioning of the adrenal glands.  Sources include:  fruits especially citrus and berries, tomatoes and green vegetables
• Vitamin A is an antioxidant thus maintaining the health of the cells.  Foods rich in A include:  milk, eggs, butter, and fruit
• Vitamin E is also an antioxidant.  Foods rich in E include:  nuts, germ oils and green leafy vegetables
• Minerals, especially magnesium which relaxes muscles.  Sources of magnesium include:  leafy green vegetables, beans and legumes, vegetables, seaweed, nuts (almonds, cashews and filberts especially) and seeds (especially sesame)
• Omega 3 fatty acids have a positive effect on moods.  Sources include:  salmon, tuna, sardines, flax seed oil, pumpkin oil, dark green vegetables
• Night shade vegetables as they have an expansive effect and therefore might be beneficial for someone tense from work, stress or activity which takes great concentration.[5] Nightshade include;  all peppers, tomatoes, potatoes, eggplant

WHAT YOUR DIET SHOULD INCLUDE

1. Salmon

2. Eggs

3. Lots of leafy and dark green vegetables

4. Night shade vegetables, if you can handle them

5. Almonds, cashews, filberts and sesame seeds

6. Beans and legumes

7. Citrus fruits and berries

OTHER THINGS TO LOOK AT TO REDUCE THE AFFECTS OF STRESS

EXERCISE

• Moderate levels are best with a duration lasting less than one hour
• Critical to maintain optimal cortisol levels and hormone balance
• Helps handle stress by improving cardiovascular and musculoskeletal systems
• Improves insulin resistance (studies have shown that as little as 3 weeks of regular exercise can lessen insulin resistance[6])

LAUGHTER

• Using a similar protocol, the current research found that the same anticipation of laughter also reduced the levels of three stress hormones. Cortisol (termed “the stress hormone”), epinephrine (also known as adrenaline) and dopac, a dopamine catabolite (brain chemical which helps produce epinephrine), were reduced 39, 70 and 38 percent, respectively (statistically significant compared to the control group).  Chronically released high stress hormone levels can weaken the immune system. [7]

MEDITATION

• The study, done in China, randomly assigned college undergraduate students to 40-person experimental or control groups. The experimental group received five days of meditation training using a technique called the integrative body-mind training (IBMT). The control group got five days of relaxation training. Before and after training both groups took tests involving attention and reaction to mental stress.
• The experimental group showed greater improvement than the control in an attention test designed to measure the subjects’ abilities to resolve conflict among stimuli. Stress was induced by mental arithmetic. Both groups initially showed elevated release of the stress hormone cortisol following the math task, but after training the experimental group showed less cortisol release, indicating a greater improvement stress regulation. The experimental group also showed lower levels of anxiety, depression, anger and fatigue than was the case in the control group.
• “This study improves the prospect for examining brain mechanisms involved in the changes in attention and self-regulation that occur following meditation training,” said co-author Michael I. Posner, professor emeritus of psychology at the University of Oregon. “The study took only five days, so it was possible to randomly assign the subjects and do a thorough before-and-after analysis of the training effects.”[8]

YOGA[9]

• Asana are the physical postures that help with muscle relaxation
• Savasana is usually at the end of a class and it is a pose for complete relaxation
• Pranayama breathing practice

BREATHING

• Pranayama / Yogic techniques[10]
• Paradoxical breathing
• More on breathing

The challenge is to not stress yourself out by trying to do all these things at once.  Pick one, two, or at most three of the aforementioned benefits and start incorporating them into your life.  As these become habit, start adding more.

To your health! Julie

Future articles will include more details about free radicals and paradoxical breathing. Sign up for our monthly newsletter which will keep you up to date when the newest articles come out.  (We will never sell your name!)

[1] Understanding Normal and Clinical Nutrition, 7^th Edition

[2] Hormone Balance, Scott Isaacs

[3] A reduced sensitivity to insulin in muscle, adipose, and liver cells, Understanding Normal and Clinical Nutrition, 7^th Edition

[4] Tom Venuto is a certified personal trainer, natural bodybuilder and author of the #1 best selling diet e-book, “Burn the Fat, Feed The Muscle

[5] Healing with Whole Foods by Paul Pitchford

[6] Per Hormone Balance, by Scott Isaacs

[7] The research is entitled Cortisol and Catecholamine Stress Hormone Decrease Is Associated with the Behavior of Perceptual Anticipation of Mirthful Laughter. It was conducted by Lee Berk with Stanley A. Tan, both of the Oak Crest Health Research Institute, Loma Linda, CA; and Dottie Berk, Loma Linda University Health Care, Loma Linda.

[8] http://www.sciencedaily.com/releases/2007/10/071008193437.htm

[9] Yoga can reduce cortisol levels, a finding which was documented in the October 2004 issue of the journal, Annals of Behavioral Science.

[10] http://www.kundaliniyoga.org/pranayam.html

Julie Webster is a Certified Massage Therapist and Certified Health Counselor. She provides health education online and through seminars. In addition she has written a book titled “Regaining Good Posture” which is available as an ebook, with videos performing each of the stretches, through her website: www.julie-webster.com Julie is also available for presentations on posture and various health topics to corporations. To reach her visit her website or email her at info@julie-webster.com

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“Eat Your Vegetables!” mother said…

BLOGGER:  JULIE WEBSTER

Did she really have all the information we do today or was this just instinct? What we really should eat hasn’t changed that much for a very long time. It is what we DO eat that has created the current health crisis. Not only have we gone away from real food and towards predominately eating processed food but the decrease in consumption of fruits and (especially) vegetables has increased tremendously!

More and more research is coming to the forefront about the importance of having fruits and vegetables as the major portion of our diets. According to the Center for Disease Control and Prevention, “At least one-third of annual cancer deaths in the United States are related to dietary factors. Increased fruit and vegetable consumption can reduce cancer risk, but less than one-third of U.S. adults eat the recommended servings of fruit and vegetables every day.” Yet, the idea is not new. Books have been written for years on this subject. Some say the concept goes back as far as Hippocrates!

So what exactly is the big deal? Why are these foods so much better for us?

To begin, fruits and vegetables are high in vitamins, minerals and fiber. They are loaded with antioxidants which keep our cells from being broken down so easily by free radicals. They are nutrient dense. In other words they are loaded with lots of healthful ingredients and low in calories so you can eat a ton of them, be completely satisfied and still be way lower in calories than when eating other foods. Best of all, they provide your tissues with an alkaline environment.

Alkaline environment… what does that mean? When foods are metabolized or broken down by the body, they provide the body with energy and leave behind ash. That ash can either be alkaline-forming or acid-forming; based on the mineral content of the foods. The alkaline forming minerals are calcium, magnesium, sodium, potassium, iron, and manganese. The acid forming minerals are phosphorous, sulfur, chlorine, iodine, bromine, fluorine, copper and silicon. So, those foods that are high in alkaline-forming ash will provide your body with a healthier environment.

If you consume too many foods that are acid-forming, it can wreak havoc on you. As said by Dr. Theodore A. Baroody, author of Alkalize or Die,” in my opinion, acid wastes literally attack the joints, tissues, muscles, organs and glands causing minor to major dysfunction. If they attack the muscles, you could possibly end up with myofibrosis (aching muscles). If they attack the organs and glands, a myriad of illnesses could occur.”

Amongst the biggest culprits for acid-forming ash are fast foods, processed foods, refined sugars, drugs, and chemicals. Proteins such as meat, dairy, and fish are also acid-forming and yet are important in the diet when taken in proper amounts. Grains and legumes are also acid-forming. Too many of any of these substances consequently leads to an acid environment in the body and can result in disease, infections and especially inflammatory conditions such as arthritis.

In addition, we need to have an alkaline reserve in our body for other situations. Lack of exercise can be acid-forming for exercise helps to regulate the acid/alkaline balance via respiration. Stress is a big acid-forming condition. If we are stressed out or angry, our bodies produce large amounts of acid-forming ash. Since this is quite prevalent in today’s society, offering your body more of the alkaline-forming foods is that much more important.

As you can see, there is a fine balance. This balance is referred to as pH or the measure of concentration of hydrogen in the body. A pH above 7 is alkaline. Theories vary as to how alkaline our body (ash) needs to be and yet the range is narrow. Most say a pH of around 7.4 is ideal. Based on what I’ve read that number can vary slightly and how to measure your precise pH (in your body) is actually quite difficult to determine. Having said all this, we do need to be on the alkaline side of the chart and this is mostly determined by what we eat.

Before we get into the foods themselves, let us look at one other major factor – an acid called hydrochloric acid or HCL. This is the only acid our body actually produces and it is essential to life. It is the first substance in the stomach that breaks down our foods. Lack of it and our foods would just be a mass of undigested waste. Along with water and enzymes, HCL digests protein into the eight essential amino acids vital to life. Without it, we would not be able to absorb B12 or folic acid. In addition, this strong acid kills most bacteria that enters into our body with the food we eat. Last, it keeps us alive by maintaining the proper alkaline/acid balance and becomes alkaline itself after doing its job.

Lack of or excess amounts of hydrochloric acid have the same symptoms – heartburn, burning sensation in the stomach. Most times, people think it is ‘too much acid’ rather than not enough and end up taking anti-acid tablets, thus decreasing the amount of HCL even further. It is more common that there is not enough HCL. Hydrochloric acid production starts to decline around the age of 40. If you suffer from heartburn, are over 40 or have eaten poorly for an extended number of years, you might consider consulting with a nutritionist about taking a HCL supplement.

So now that we know all this, how are we supposed to eat? To begin, let us look at the side of food that is confusing. One of the greatest alkaline-forming foods is the lemon. We often think of a lemon as being very acid in nature and yet the end result is the opposite. Lemons produce a very alkaline-forming ash due to their mineral content. As mentioned before, the minerals calcium, magnesium, sodium, potassium, iron, and manganese all end up creating an alkaline-forming ash. Well, lemons happen to be high in potassium, calcium and magnesium! See how it works?

Generally all fruits and vegetables are alkaline-forming while all other foods are acid-forming.  To maintain a healthy body, it is suggested that your diet is a minimum of 70% alkaline and 30% acid-forming foods.  This ratio is even better at 80% to 20% respectively.  If you suffer from any type of disease, inflammatory condition or have a great deal of stress in your life, you might consider upping the ratio to 90% and 10% respectively.  Also, based on the degree of alkalinity to acidity (for example some foods have a greater degree of alkaline or acid), you can play with what you eat.  I have provided a chart showing you most foods.  Simply download this pdf and keep it on your refrigerator.  Last, to make it easy when you are eating out, think about your plate being 70-90% full of vegetables and fruits with the rest of the plate being filled with protein.  You may think this is impossible but just ask.  I often ask for steamed spinach or extra vegetables instead of the bread or pasta they offer.  Usually they are glad to accommodate you.  (For thoughts on grains, listen to this podcast.)

For many of you this might be a new concept and very different way of eating. I strongly suggest you start slowly. Gradually add in more fruits and vegetables, with vegetables being the major addition. At the same time start decreasing the worst of the acid-forming foods first – such as junk food, fast food, processed food, and sugar. Give yourself several months to make the changes. Over time you will be amazed how much better you feel and how much more energy you have!

Julie Webster is a Certified Massage Therapist and Certified Health Counselor. She provides health education online and through seminars. In addition she has written a book titled “Regaining Good Posture” which is available as an ebook, with videos performing each of the stretches, through her website: www.julie-webster.com Julie is also available for presentations on posture and various health topics to corporations. To reach her visit her website or email her at info@julie-webster.com

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Why Healthy Posture is So Important!

BLOGGER:  JULIE WEBSTER

Let us look at this in greater depth. The body is designed to work at an optimal level within gravity. Joints, bones and ligaments are stacked in such a way to use the least amount of energy to hold us upright, to be able to stand or sit effortlessly.

Have you ever watched a young child sit? Do you notice they don’t typically lean back in the chair but rather naturally sit quite straight with no effort? What happens as we go through life that we start to rely on that chair back to hold us up? Or that we stand in such a way as to put more pressure on our entire being? These are some of the questions that started to arise as I became professionally involved in health.

To begin, posture plays a large role in how we approach life. If we are hunched over or in pain from poor posture, it shows. We give off signs of lack of self confidence, lack of intelligence, being overly tired, shyness, and more. In addition, if our posture isn’t optimal, the amount of energy it takes to go through daily life increases exponentially. No longer can we rely on the structural body to hold us up but rather our muscles now must be recruited to fight gravity, causing us to expend a great deal of energy. Our entire being is compromised and energy that should be used to enjoy life is used just to hold us up, literally.

So what really happens? To start, we have become a sedentary society. No longer do most of us make our living by working in the fields, walking long distances, carrying packages, and so forth. Instead we spend long periods of time sitting at a desk followed all too often by sitting in front of the computer or television when we get home. Our bodies have become lazy. Some muscles hardly have to work much at all in these situations. Not only do they not have to engage but, allow them to be in a shortened position for a long enough period of time and they will stay shorten indefinitely. Other muscles, at the same time, will be in an elongated position with some working overtime and others just becoming weaker. All this results in our muscles being imbalanced and our joints compromised. Along with these changes, we can experience pain, burning, numbness, weakness, tingling and more. Depending on the situation, nerves can be compressed and lead to syndromes such as Thoracic Outlet Syndrome and Carpal Tunnel. Low back pain, which is all too common, is often a result of poor posture and muscular imbalance. Consequently the typical answer to these complaints, often result in surgery or pain medications. Although this might be necessary under certain circumstances, they should never be the first choice of treatment.

Let’s start with looking at the head and neck. Under normal circumstances, the head should sit right on top of the shoulders, with the correct position being the ear vertically in alignment with the shoulder joint. Unfortunately all too often the head starts to jut forward. Some of the common reasons for this are from slouching, trying to read something that is too small (so you lean forward to read it), lack of lumbar support while sitting or from improper positioning of a computer screen. Our head typically weighs between 12 – 15 pounds; a lot of weight when you think about it and yet if sitting as it should, effortless for the muscles. Take it out of that ideal position however and multiple problems can arise. Dr. Rene Cailliet says that for every inch the head is forward of its’ ideal position adds 30 pounds of pressure onto the posterior neck muscles! In addition, this position can result in:

• Added pressure to the facet joints of the vertebrae which have a great deal of pain receptors, thus causing pain perception to increase
• Constriction of blood flow to the muscles, resulting in unhealthy muscles that become prone to injury
• Tight muscles that tend to refer pain to the head, resulting in headaches
• The health of the temporomandibular joint causing TMJ dysfunction
• Carpal tunnel symptoms

Let us move on to the shoulders. Typically the upper back has a slight convex curve. When in this position, the vertebrae are stacked properly and the ligaments on either side of the vertebrae maintain this position. As we start to slouch forward, the shoulders tend to round inward. The muscles in the upper back are in an overstretched position and are now having to work hard to keep you from falling over forward. The muscles in the front of the chest are becoming shorter with the potential to compress the nerves that innervate the arms. One of the most common results is known as Thoracic Outlet Syndrome. In addition, the following complaints can arise:

• Burning between the shoulder blades
• Chest pain
• Shoulder pain
• Carpal Tunnel syndrome
• Arm pain
• Inability to take a full deep breath

Next is one of the most common areas of complaint – the lower back. A great deal of work has been missed in our country from low back pain and much of it can be avoided. To begin, we will look at the role sitting plays. When sitting for a long period of time, the muscles in the front of the hips, known as the hip flexors, are in a very short position. They are used a great deal during walking so they do not tend to get weak, as the upper back muscles, but they do become very short. This results in changing the normal position of the pelvis and creating what is known as an anterior pelvic tilt. A small degree of anterior pelvic positioning is normal for women whereas men’s pelvis should stay neutral. The issues arise when this position is exaggerated. The pressure tends to be moved posterior to the discs, putting a great deal of pressure on the facet joints. Remember as mentioned earlier, facet joints are loaded with pain receptors.

In addition to sitting, the pelvis can end up in an anterior position due to being overweight, especially when we carry our fat in our bellies. Belly fat puts a great deal of added weight in front of the body. The only way to compensate for this added weight is to shift the positioning of the pelvis into that exaggerated anterior pelvic position, once again causing an increase in low back pain.

Along with general pain complaints from the low back, the following issues can arise:

• Sciatica
• Hip pain
• Neurological complaints in the legs

So what do we do about all this? It would be great if we could move away from sitting for extended periods of time but this is unlikely. Rather we need to work within the parameters of our society. The following is a list of ideas that can have a positive impact on our posture thus decreasing or eliminating the negative results of poor posture:

Movement or regular exercise: By getting the blood to flow throughout the entire body, the muscles are receiving fresh nutrients and eliminating waste products. These waste products in and of themselves can cause pain. Also by moving, we are taking the muscles through a greater range of motion which can be a start to add length and strength to the muscles.

Stretching: Working to lengthen the shortened muscles before strengthening the elongated weaker muscles will aid in realignment of the skeletal system. It is important that specific stretches are given in order to lengthen the appropriate muscles.

Strengthening: Once the shortened muscles are working towards being longer, it is then time to add in exercises to strengthen those muscles on the elongated side of the joint. This is important to allow the body to regain a healthy posture where the joints and ligaments are able to do their job thus decreasing the amount of energy it takes to remain upright in gravity.

Ergonomics: Assessing the position of the person to the height of the desk, the relationship to the chair, the positioning of the computer and so forth is a key. Only focusing on ergonomics will not change the posture by itself but rather help to maintain the healthier posture with the aforementioned suggestions.

Diet: Although not directly involved in posture, it does play a large role in the health of the muscles. Eliminating fast food, sugar, refined foods, soda, excess caffeine and more will enable the muscles to receive the nutrients need for maintaining health. A healthy diet will also decrease constriction of blood flow thus allowing the entire body to process waste products at a healthier rate.

These are just some suggestions to creating a healthier posture. Remember posture is much more than just looking good. By having a body that is fully supported by the appropriate joints and ligaments, we will have more time and energy to enjoy all aspects of life and to live it to its’ fullest. Isn’t it time to take a good look at your body?

Julie Webster is a Certified Massage Therapist and Certified Health Counselor. She provides health education online and through seminars. In addition she has written a book titled “Regaining Good Posture” which is available as an ebook, with videos performing each of the stretches, through her website: www.julie-webster.com Julie is also available for presentations on posture and various health topics to corporations. To reach her visit her website or email her at info@julie-webster.com

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Life’s Little Changes – THE FAT VS. MUSCLE FACTOR

Life’s Little Changes – The Fat vs Muscle Factor

BLOGGER:  JULIE WEBSTER

It is a known fact that as we age our bodies change.  Starting around the age of 45 we start to lose muscle mass at a rate of approximately 1% per year.  Although this doesn’t sound like a big deal, it really is.  The reason being is because at the same time our bodies are starting to lose muscle mass, most people are starting to gain weight.  The average American gains 1-2 pounds of weight per year as they age.  Again that doesn’t sound like a lot but if you average that over 10 years, you have gained 15 pounds!

Let’s look at that.  Muscle is about 18% denser than fat.  In other words, think about weight verses volume.  A pound is a pound but the amount of space one takes up verses the other is the key factor.  For an extreme example think about the weight of one pound of feathers verses one pound of brick.  Since the brick is so much denser, it would take up much less space than one pound of feathers would.  You get the point?

So, if muscle is 18% denser than fat and we are losing mass yet gaining weight what do you think we really gaining?  Fat, of course.  Our bodies are either staying the same size or, in many cases getting physically bigger.  Consequently our ratio of muscle to fat is changing dramatically.

Less muscle means less strength thus decreasing our ability to do even the little things.  I met a woman who could no longer carry her own groceries into the house because they had become too heavy and she was not very old!  Verses the woman who still lifts weights at 68 years old, looks fabulous and carries just about anything and everything she wants.  Big difference.  This doesn’t even address the bigger picture of doing the fun things.  I have a 77 year old friend that plays tennis like no body’s business.  She competed in a league a few weeks ago, played for 3 hours to win the overall competition, and she was playing against women in their 50’s.  Now that’s living!

A decrease in muscle mass does not only equate to less strength.  With less muscle, a decrease in bone density rises thus leading to the potential for osteoporosis.  In addition studies have shown that an increase in strength can:

·       Result in a decrease in arthritic pain

·       Improve balance and flexibility

·       Assist in balancing blood glucose levels

·       Have a positive impact on our emotional being

·       Strengthen the heart

·       And much more

So let us start by figuring out our own ratio of body fat to lean muscle.  There is a means of measuring this called the Body Mass Index or BMI.  BMI is a comparison of your height to weight.  This formula is being used more and more in the medical field and yet it is not necessarily an accurate way to measure body fat, in my opinion.  Take the individual who is very muscular and consequently quite lean.  They will come up on the BMI chart as having too high of a body mass index for their size.  Again this is because of the fact that muscle is so much more dense than fat.  A very small person, with a body fat of say 15%, will appear fat on with this measurement.  Or the body builder that is 5’6” and weighs 240 pounds.  His body fat may be around 12% and yet on a BMI chart he will show up obese.

A better way to determine the ratio is through actual measurement of body fat.  This can be done at a gym by using calibrators where skin is lifted from the muscle and measured on various parts of the body.  It can also be done in a pool by measuring how fast you sink; supposedly a better way and yet not too easily found.  For those of you that don’t have access to these kinds of measurements, I did find a source online that seems pretty accurate.  Simply go here to take that test:  http://www.healthcentral.com/cholesterol/home-body-fat-test-2774-143.html

Once you have this information you have the power to change it.  Rather than think, ‘I’m doomed!’ it is time to think positive.   It means you have an opportunity to make changes that can have an incredible impact on your health, your future and how to enjoy the balance of your life.  An Encore Life.  How great is that?

As time goes on and the kids are grown, there is more time to focus on ourselves separately and together with our partners.  It is a time to engage in new endeavors.  To think outside the box.  To explore things that we might have thought about in the past but just didn’t have the time to try.  It is time for an even better life!

Building muscle requires resistance.  When a muscle is challenged physically it puts stress on the bone.  The bone in response creates additional osteoblasts or cells that produce more bone.  The process is known as the piezoelectric effect.  Greater stress = more cell production=denser bones.  And, as mentioned, this is an excellent way to prevent osteoporosis.

Not only will that additional muscle strengthen your bones but it will increase your basal metabolic rate or BMR.  This is the basic amount of energy needed per day to function.  Additional muscle mass = higher BMR = additional calories burned.  Therefore a person with a higher ratio of muscle to fat can and actually needs to eat more.  Now isn’t that a great thing!  Of course what we eat is important as well.  To create these positive changes requires a blend of exercise and diet but for the purpose of this article let us focus on the exercise portion.  The diet will be addressed in a future article.

For now, let us take a look at the ways in which we can increase our muscle mass.  Of course there is the obvious – going to the gym to lift weights.  This is a great way and works fantastically for some.  For others this sounds like a death sentence!  Here are some additional ideas that can be really fun, give you a cardiovascular workout as well and offer resistance training:

·       Hiking up and down hills (my personal favorite).  Although this doesn’t address the upper body it is great for your legs and hips.  You would need to supplement with some upper body training.

·       Rowing.  This fun sport actually uses both your upper body and (to my surprise) a great deal of legs.  Overall it can really offer resistance as well as cardiovascular fitness.

·       Yoga can be a good form of resistance training, especially the more aggressive types such as Ashtanga Yoga.

·       Taking classes such as certain forms of dance, boot camps and so forth.

·       Kayaking.  This is more for building upper body strength but it is fast-paced and fun!

·       Rock Climbing.  Now this one might really take you to a new place!

·       Even the Wii Fit can offer those that want to stay inside a great workout.

These are just some ideas.  Play around with different types of activities that you enjoy and see if it fits into a strength or resistance training category.  Do not buy into the, ‘well I’m getting older…’ mentality.  Step out and up and make tomorrow even better than today!  You will be amazed at just how much you can change your body and fitness level!  We are only limited by our imagination so be creative, build muscle and head towards a more dynamic, healthy future!