What to Eat to Heal from Surgery

What you eat can affect how well you heal from an orthopedic injury or surgery. When your body has to repair injuries, create new bonds, and strengthen tissues, its performance will depend on whether it gets the building blocks it needs. Imagine your food being digested into molecules, and those molecules being absorbed into your blood stream to be delivered to the site of healing.

Protein intake should be spread out evenly throughout the day in meals and snacks. Branched-chain amino acids (BCAA) are metabolized in muscles to provide energy and promote protein synthesis. BCAA found organic poultry, grass-fed beef, fish, soybeans, lima beans, eggs and nuts boost healing after musculoskeletal injury.

Vitamin C is required to make collagen to repair tendons or ligaments and heal surgical wounds. Good sources include citrus, broccoli, strawberry, kiwi, and bell pepper.

Zinc enhances wound healing. It is found in free-range beef, oysters, pumpkin seeds, and cashews.

Beta-carotene is a precursor to Vitamin A and promotes stronger bones, healthy scar tissue, and elasticity of skin. Good sources are sweet potato, kale, squash, carrot, prune, apricot, and mango.

Antioxidants (Vit C, flavonoids, Vit A, Zinc, Selenium, B vitamins, folate) neutralize the damaging effects of free radicals and repair cellular damage from injury or surgery. Found in leafy greens like kale, vegetables, fruits, legumes, whole grains, lean meat/poultry, fatty fish, nuts and seeds.

Flavonoids reduce swelling and protect cells. Flavonoids are found in cocoa, tea, red wine, fruits, vegetables, legumes, garlic, turmeric, green tea, blueberries, apples, citrus, and pineapple.

EPA and DHA Omega 3 fatty acids reduce joint stiffness, improve bone health, and provide anti-inflammatory benefits. You can find it in oily fish such as wild salmon, sardines, and anchovies.

Iron is required for oxygen delivery to the site of injury or surgery, and for wound healing. In addition to animal products, iron is found in dark leafy greens, legumes, beets, raisins, and black beans.

Calcium and Vitamin D optimize tendon-to-bone healing after injury or surgery. Calcium is found in dark leafy greens, salmon, rainbow trout, white beans, and fortified foods like almond milk and oatmeal. Vitamin D is found in mushrooms, salmon, tuna, soy milk, and egg yolks.

Healthy fats from avocado, olive oil, coconut oil, nuts, and seeds will improve immune response and help your body absorb vitamins A, D, E, and K.  Avoid partially hydrogenated oil (in processed foods) due to their pro-inflammatory effect.

Fiber is necessary to avoid post-operative constipation. The pain medications required for orthopedic surgery, as well as the anesthesia used during surgery, can cause slowing of intestinal transit and constipation. Up your fiber intake from vegetables, apples, berries, prunes, whole grains, flax and chia seeds.

Why I Believe in Prolotherapy

For someone suffering from joint pain, prolotherapy can be a safe and effective way to get them back to their usual activities. My opinion is that a targeted treatment at the source of the problem is a better option than a systemic treatment that circulates to the entire body. Prolotherapy causes proliferative cells to migrate to the weakened area, targeting the problem.

Chronic joint pain is an astronomically common condition, especially given our aging population. In fact, the majority of people over the age of 65 will have radiographic evidence of osteoarthritis. As we age, body tissues such as vertebral bones, spinal discs, and knee cartilage, lose height due to decreased bone density, loss of vascularity, wear and tear, and disc degeneration. While these tissues lose height, the ligaments connecting the bones remain the same length, causing these supporting ligaments to buckle. These lax, weakened ligaments can lead to segmental instability resulting in pain.

Poor posture (head forward, slumped during prolonged sitting, rounded lower back) exacerbates the laxity of ligaments in the neck and low back. The laxity of ligaments causes an instability which stimulates proprioceptive nerve fibers and can lead to chronic muscle spasm in the body’s attempt to stabilize the area. Prolotherapy is an injection treatment using safe, natural, proliferant substances such as dextrose, to stimulate the body’s natural healing cascade where the ligament and tendon join to the bone. Prolotherapy treats the cause of the chronic pain by correcting the ligament laxity.

Prolotherapy has been shown to be effective in treating knee osteoarthritis by combining intra-articular (inside the joint) injections of proliferant solutions with ligament and tendon injections to stabilize the knee joint. Studies have shown improvement in pain, function, and stiffness when using prolotherapy to treat knee OA.

Clinical trial literature is growing which supports the use of prolotherapy in osteoarthritis, low back pain, ligament and tendon injuries. A newer use of prolotherapy has been gaining momentum called neural prolotherapy. Neural prolotherapy involves multiple subcutaneous injections of proliferent solution to treat the hundreds of small nerve fibers under the skin which can contribute to chronic pain when chronically activated.

While it does not work for everyone, proliferative therapy is a worthwhile technique in the tool kit of treatments for joint pain. Prolotherapy has fewer side effects than medications and fewer risks than surgery or platelet-rich plasma (PRP). Prolotherapy is far less expensive than PRP while studies show the two treatments to have similar outcomes. Prolotherapy is an effective modality when combined with weight loss to offload the joint and a focused exercise program to strengthen supportive muscles.

You can schedule a prolotherapy consultation at the Akasha Center in Santa Monica by calling 310-451-8880.

 

 

 

 

 

Prolotherapy for Knee Pain

If knee pain is stopping you from exercising, then you can expect your knee pain to get worse, not better. Studies have shown that exercise is crucial for people with arthritis. Prolotherapy can help people with knee pain get back to an exercise routine.

Prolotherapy is safe injection technique that can significantly decrease the pain of knee arthritis.

A study looking into the therapeutic effects of prolotherapy for moderate knee osteoarthritis appeared in the April 2015 issue of Therapeutic Advances in Musculoskeletal Disease. The study found that knee pain, range of motion, and function were all improved after 3 monthly prolotherapy sessions, and the benefit was maintained throughout the 6-month study duration.

Osteoarthritis (OA), the most common form of arthritis, typically onsets after age 40.  OA is due to the gradual loss of joint cartilage which can lead to bony endplate changes.

The most important thing we can do to delay or prevent OA is to keep our body mass index (BMI) in the ideal range from 18-25. You can calculate your BMI using your height and weight here: http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Our body is just a skeleton frame and was not meant to carry lots of extra weight. Imagine if you had to carry 20 lbs of bricks strapped to your back at all times.  That is no different than being 20 lbs overweight.  Extra weight is going to wear down your knees, hips, and the discs in your lower spine.

Keeping your muscles strong and limber is critical for joint health. Muscles, tendons, ligaments, cartilage, and joint-space fluid are the only things standing between bone-on-bone. When you keep the supporting structures in prime health, you protect the intraarticular surface inside the joint.  If you cannot pound the pavement due to knee pain, you can use swimming or a recumbent bicycle to achieve optimal muscle strength and cardiovascular fitness.

Other things we can do to prevent osteoarthritis include eating a healthy diet filled with nourishing antioxidants, amino acids, and nutrients. An anti-inflammatory diet with organic vegetables, fruits, beans, herbs, nuts, seeds, and whole grains like quinoa (not flour products) should make up the bulk of your food choices.  Healthy sources of fats like avocado, coconut, olive oil, nuts, and wild salmon should replace the unhealthy sources of fats found in processed foods.

Staying hydrated is necessary to avoid drying out the cartilage inside the joints. The synoviocytes (the cells that line the weight-bearing joints) produce a fluid that helps buoy the bones like hydraulic fluid.  When this fluid dries out, the joint is more likely to have bone-on-bone friction. The spinal discs contain a gel-like center that tends to desiccate with age, and benefit from daily hydration. Men should drink 3 liters water/day and women should drink 2 liters water/day.

Supplements can be helpful for joint health.  Glucosamine sulfate 1500 mg/day with Chondroitin 1200 mg/day has been shown to help reduce cartilage loss in several studies.  Resveratrol is an antioxidant derived from the skin of grapes that is associated with longevity and may protect joints.  Fish oil (omega 3) has an anti-inflammatory effect.  Anti-inflammatory herbal blends like Akasha’s InflaRegulator are a healthy way to decrease your joint swelling.  Akasha’s Joint Ease is a selective kinase response modulator that is useful for flares of joint pain.

Treatment focus has shifted away from removing damaged cartilage, to preservation of as much cartilage as possible while enhancing the healing cascade.

Prolotherapy is injections of a proliferative fluid to the intra-articular joint space and the extra-articular supporting structures where tendons and ligaments attach to the bone surrounding the joint.  The result is a stimulation of the body’s natural healing cascade and a stabilization of the supportive structures of the joint.

Prolotherapy is available at the Akasha Center for Integrative Medicine in Santa Monica, CA.  Call 310-451-8880 to make an appointment with Dr. Boston.

www.akashacenter.com

Gluten: Evil or Not?

Gluten is a hot topic, and this is a great article (“Should We All Go Gluten-Free,” by W. Balistreri, MD, see link below). My quick summary is that 1% of the population has celiac disease, and these folks absolutely need to be gluten-free all the time.

For the rest of us, you need to understand that processed foods are the greatest evil, so if you switch from wheat-flour cookies to gluten-free rice flour cookies, you are still just eating processed food cookies. Gluten-containing foods also tend to be high in sugar, and easily converted to more sugar once you eat them, spiking your insulin and leading to food coma and other negative effects.

The best approach would be to strive for a diet rich in plants that still look like plants (organic vegetables, fruits, beans, nuts, seeds, grains that look like grain, NOT FLOUR – think quinoa). No matter how many vegetables you eat daily, you could benefit from eating MORE VEGETABLES in place of what ever other food you are eating.

Does this mean you have to avoid all gluten all the time? Not necessarily. It means to minimize all flour-based products, even gluten-free ones, to the margins of your diet.

If you have gastrointestinal problems, then you should test for celiac antibodies before you go gluten-free, and then do a 1-month food elimination diet (including eliminating gluten), to see if you improve. Food sensitivity blood tests can guide your elimination diet. After a month, you can see how your symptoms have responded to the elimination and re-introduction of foods.

I love to guide people through this process at the Akasha Center for Integrative Medicine in Santa Monica.
http://www.medscape.com/viewarticle/857971?nlid=99603_491

HYDRATION

Hydration…I consider it my 3rd full time job after being a mom and a doctor. That’s how important it is, and also how much of a hassle.

The human body is 60% water, and all of our cells function optimally when we are well-hydrated. When we don’t drink enough water, our brain feels tired, foggy, and headachy; our muscles and joints feel sore and unlubricated, and our skin looks dry and papery. Our body’s ability to detox is hampered when we don’t drink enough water to flush through our kidneys and liver. Water is also imperative for healthy gut function, avoiding constipation and the build-up of toxic sewage in our large intestines when things aren’t moving along.

So, how much water should you drink? In general, a good rule of thumb is that women should drink about 2 liters of water a day, and men should drink about 3 liters a day.

I use a 20-oz glass water bottle that has a silicone sleeve, and I drink about 4 refills a day of filtered tap water. I make sure I drink my first 20 oz of water before my cup of coffee in the morning as a reward. It is time-consuming and makes me have to stay close to a bathroom, but I notice immediately if I don’t drink enough water…by feeling sluggish, brain-foggy, and tired.

You need even more water when exercising. The American College of Sports Medicine says that you should drink 3-8 oz water every 15 min while exercising for less than an hour, or 3-8 oz of a sports drink every 15 min if exercising for more than an hour.

Can you drink too much water? Yes. If you drink too much water, you can dilute your electrolytes which can be dangerous.

So, stick to the guidelines, and rejuvenate your dry cells to a nourished state every day.

Do I Need Heavy Metal Detox?

Could my headaches, mood swings, insomnia, nervousness, irritability, joint pains, tingling, or fatigue be from exposure to heavy metals?  The answer is possibly.

Heavy metals, like mercury, arsenic, and lead, surround us in our environment.  Our body’s internal detoxification process can handle a certain low level of exposure to heavy metals.  If the level of exposure overwhelms our ability to excrete the metals, then we can be left with symptoms that require treatment.

In order to estimate the likelihood that you have been exposed to heavy metals, it is important to understand the common sources of metals in our environment.

MERCURY:  The most common source of mercury is seafood in our diet.  Larger fish (that eat smaller fish) tend to have more mercury.  The EWG (environmental working group) has a great consumer guide to mercury in seafood.  (http://www.ewg.org/research/ewgs-good-seafood-guide).  Other common sources of mercury include fossil fuel combustion, cement plants, waste incineration, steel production, thermometers, preservative thimerosal in multi-dose vaccines, and amalgam fillings for teeth.

ARSENIC:  Arsenic is a metal present in the earth’s crust, and can leach from soil and rocks into drinking water.  It can be found in some soil-derived foods like rice and grains.  Shellfish and seafood from arsenic contaminated water.  Pesticides and herbicides can contain arsenic (another reason to choose organic, no-spray produce).  Chicken that has been fed arsenic supplements for intestinal parasites (another reason to eat organic, free-range chicken).  Pressure treated wood and fossil-fuel combustion are also sources.

LEAD:  In the USA, the main sources are contaminated water or soil, lead paint, lead pipes, brass plumbing fixtures, and lead solder on copper pipes.  The plumbing sources cause lead-contaminated drinking water.  Lead is also in leaded gasoline, batteries, ammunitions, cables, wires, kohl eyeliner, glazes on some ceramics, and sometimes contaminated products from overseas.

You might have just one or multiple signs and symptoms of heavy metal toxicity.  Signs and symptoms of mercury exposure can include headache, insomnia, mood swings, nervousness, irritability, tremors, weakness, tingling, skin rashes, abnormal kidney or lung function. Signs and symptoms of arsenic toxicity include numbness, tingling, weakness, drowsiness, confusion, white lines in fingernails, darkening of skin, diarrhea, abnormal liver and kidney function tests, or cancer of skin, bladder, kidney, or lung.  Signs and symptoms of lead toxicity include irritability, fatigue, sluggishness, loss of appetite, learning difficulties, developmental delay, abdominal pain, vomiting, constipation, numbness, tingling, hearing loss, or joint pain.

The CDC recommends using blood levels or 24-hour urine collection levels to determine your how much heavy metals are in your body.  I recommend adding a heavy metal panel to your annual blood work if you eat fish more than twice a week, or if you have any concern about heavy metals in your environment.  Provoked urine tests in which a chelating agent is given prior to urine collection, are not recommended as they will show too many false positives.

Treatment is needed for anyone who is symptomatic or whose labs reach a certain threshold.  Treatment must start with removing the source of the heavy metals in your environment.  This might entail eating less seafood, choosing low-mercury fish, having your mercury amalgam fillings removed and replaced with resin-based composite fillings.  Investment in a water filtration system for your tap water is worth every penny, to ensure you are not drinking heavy metals.  Filtered tap water is preferable over water bottled in plastic due to plastic chemicals leaching into water, as well as the environmental impact of plastic waste.

A comprehensive heavy metal detox plan is available at the Akasha Center for Integrative Medicine.  Depending on your symptoms and labs, you might require chelation medication to help pull the metals out of your system.  Supporting the channels of elimination during the detox period is important in order to effectively reduce your metal burden.  Recommended supportive treatment includes supplements to boost glutathione which is the most important detoxifying molecule in your body, supplements to support the health of your liver which will be sent to task getting rid of your metals, a natural supplement to help bind the metals prior to elimination, fiber support to help you eliminate the metals effectively in your stool, colonics to remove toxic residue from your colon after the detox process has begun, and intravenous Myers cocktails with glutathione to optimize your immune system and hydration during the process of detoxification.

If you are interested in having your heavy metal labs checked or treated, you can call the Akasha Center for Integrative Medicine at 310-451-8880.  You can read about the Akasha Center at www.akashacenter.com.

 

 

Tennis or Golf Elbow…But I Don’t Even Play Tennis or Golf!

What is it? Epicondylitis is inflammation of the bony parts on either side of the elbow where some tendons of muscles attach. The lateral epicondyle is where the wrist extensor muscles attach, and inflammation here is called lateral epicondylitis or “tennis elbow”. The medial epicondyle is where the wrist flexor muscles attach, and inflammation here is called medial epicondylitis, or “golfer’s elbow”.

How did I get it? You don’t have to play one of these sports to experience an injury that causes inflammation at the elbow. Epicondylitis can happen due to repetitive forceful wrist motion, or from trying to keep the wrist stable against an external force, or due to a traumatic injury.

How do I know if I have it? You can tell you have “tennis elbow” if it hurts to touch the lateral epicondyle, and the pain increases when you extend your wrist against resistance. You can tell you have “golfer’s elbow” if it hurts to touch the medial epicondyle, and the pain increases when you flex your wrist against resistance. Your physician can check these maneuvers for you if you are not sure.

How do I treat it? The first and most conservative treatment is rest – take a break from the activity that caused the epicondylitis. You can use ice or heat for 10 minutes three times a day. A counterforce brace to the forearm can be used to decrease the tug of the muscles on the elbow. A counterforce brace is the strap that you sometimes see on athletes encircling their forearm just below the elbow, which you can typically get at your local pharmacy. There are some over-the-counter remedies you can try such as topical Arnica gel, Traumeel ointment, or a Salonpas patch to help decrease pain and swelling.

What if I still have pain? Then, it is time to see your physician. Your physician will perform a physical exam to rule out other diagnoses and to confirm lateral or medial epicondylitis. Your physician may want to order an x-ray to rule out an avulsion of the epicondyle, which is when a little piece of bone gets pulled away with the tendon during a forceful movement. An injection at the location where the wrist muscle tendons attach to the elbow can help decrease the pain. I recommend not injecting steroids because they can weaken the tendon making it more likely to rupture. I prefer to inject natural pain-inhibiting substances like Sarapin and local anesthetics. I also like to use Kinesio tape over the forearm and elbow in a pattern that inhibits the wrist extensor or flexor muscles while the area is healing.

What if it has been more than 2 months, and I still have elbow pain? Then, your body has not fully healed the injury and might need some assistance to do so. Prolotherapy is a series of injections of a safe, proliferative solution to the spots where the muscles and ligaments attach to bones. Prolotherapy stimulates your body to lay down more collagen, strengthening the tendons and ligaments of the elbow, fixing the problem.

My elbow is all better. Can I go back to my activities? How do I prevent myself from getting epicondylitis again? The best thing to prevent future bouts of lateral or medial epicondylitis is a stretching and strengthening program for your wrist flexor and extensor muscles. Start with isometric strengthening, which is when you flex or extend your wrist against resistance without moving it. You should be able to see the muscles in your forearm contracting. You can stretch the wrist flexors and extensors by using your opposite hand to gently push your hand into further flexion or extension than you can achieve on your own and hold for a count of ten. Your physician can teach you these maneuvers or refer you to a physical therapist. Once your elbow is pain-free, strong, and limber, then you can return to your activities.

Contact Dr. Boston at the Akasha Center for Integrative Medicine if you are interested in being evaluated and treated for elbow pain.  The Akasha Center is located at 520 Arizona Ave, Santa Monica, CA 90401.  (310)-451-8880

 

Sacroiliac Joint Pain – It’s a Pain in the Butt!

Sacroiliac joint (SIJ) pain is more common than you think. What is the SIJ? Well, you know those dimples you have at the top of your buttocks, one on the left and one on the right? That is the location of the top of the sacroiliac joints. Imagine an upside-down triangle starting at those dimples down to your butt crack…that is the path of the SIJ’s. The sacroiliac joints connect the pelvis (iliac bones) to the sacrum (the lowest portion of the spinal column), and transfer force and weight between the upper body and the lower body.

These joints have some mobility which increases in women after childbirth. The ligaments holding the pelvis tight are relaxed during pregnancy by a hormone called relaxin. Sometimes the increased SIJ mobility continues indefinitely after the baby is born, and never gets back to the pre-childbearing level of tautness. The SIJ’s are true synovial-lined joints that can swell just like any other arthritic joint. They can cause a radiating pain that starts in the buttock and radiates down the back of the leg, resembling sciatica. In fact, some practitioners believe that most cases of “sciatica” are actually due to SIJ dysfunction.

You ask yourself, “Do I have SIJ pain? Is that what my low back pain is?” To find out whether your low back/buttock pain is due to SIJ dysfunction, your doctor can do some physical exam maneuvers that will stress the SIJ, which if your usual pain is reproduced or increased, makes it likely to be SIJ dysfunction. Imaging techniques such as x-ray or MRI are not always necessary, but can show arthritic changes, inflammation, or sclerosis.

Why do I have SIJ pain? You might have increased mobility at the SIJ due to ligament laxity, inflammation of the joint due to synovitis, arthritis of the joint due to wear and tear (sports, gymnastics, trauma), spondylitis due to an inherited condition, or sclerosis of the joint due to degenerative changes.

What can be done? SIJ dysfunction is a condition that typically has flairs and remissions. There are many treatments that are useful in managing SIJ dysfunction. The first and foremost treatment is prevention (prevention of SIJ pain or prevention of worsening of SIJ pain). This includes maintaining a healthy body weight, because carrying extra weight on the bones of your lumbosacral spine and pelvis is a recipe for pain. Maintaining good nutrition and hydration to keep the bones, joints, ligaments, and tendons of the SIJ region healthy is also necessary. If you have the weight, nutrient, and hydration pieces squared away, but still have SIJ pain, then it is time to institute a targeted exercise program for strengthening and stretching, and some treatment modalities.

Exercises to limber up and strengthen the buttock, low back, hip, and hamstring muscles can be taught to you by a physiatrist, physical therapist or qualified personal trainer. The gluteus maximus, gluteus medius, piriformis, and quadratus lumborum muscles attach in proximity to the SIJ. Targeting these muscles can help to stabilize the SIJ. While you are strengthening the region, it might help to have your physician or physical therapist to use kinesiology tape in a crossing-over fan pattern over the SIJ region to provide proprioceptive feedback.

As strange as it sounds, you can also have your physician or acupuncturist try using a press-tack tiny acupuncture needle on your ear at the lumbosacral site. Some patients find the ear acupuncture treatment extremely helpful at decreasing SIJ pain during flairs. Full acupuncture sessions might also help to bring relief from SIJ pain.

Lastly, there are injections that can be done for SIJ pain. Traditionally, steroids were used when injecting the SIJ to decrease inflammation in the joint, but studies have now revealed that steroids can damage cartilage and cause negative side effects. I prefer to inject natural anti-inflammatory substances into the SIJ to decrease pain and inflammation. If a person has chronic or repeated SIJ pain, then Prolotherapy is a more definitive, longer-lasting treatment. Prolotherapy is injecting a safe, proliferative substance to the whole SIJ region where the ligaments attach to the bones to promote healing of the involved ligaments. After a series of Prolotherapy injections, a person can typically expect to have lasting pain relief unless they reinjure their SIJ at another time.

Dr. Boston treats patients for SIJ pain with a comprehensive approach.  You can contact her at The Akasha Center for Integrative Medicine, located at 520 Arizona Ave, Santa Monica, California,  310-451-8880

New Year Post: Top Ten Tips to Improve Your Health

January is a wonderful time to reflect on the past year and make decisions about the upcoming year.  We can make choices about which behaviors to concentrate on changing to optimize our health and our happiness.

1.  Invest in a reusable 32oz cup.   Fill and drink it twice a day with filtered tap water.

Most Americans need to drink more water.  They are walking around dehydrated all the time.  Every cell in your body requires water.  When we are chronically dehydrated, our tissues (such as spinal discs and ligaments) dry out and become more brittle and prone to injury.  If we wait until we are thirsty before we drink, we are already in 1L water deficit.

2.  Walk for 10 minutes after every meal.

When you walk after eating, you improve the ability of insulin to lower your blood sugar by pumping fresh oxygenated blood to your muscles.  The delivery of glucose to the cells which use it for energy becomes possible when insulin allows the entry of glucose out of the blood stream and into the cells that need it.  A 10 minute walk after eating also helps your intestinal tract mobilize the food boluses which improves digestion.

3.  Eat more fresh, organic vegetables.

Vegetables are the most important source of antioxidants, vitamins, and fiber in your diet.  Truthfully, we all need to eat more vegetables.  A diet high in vegetables has been linked to longevity and a decreased risk of cardiovascular disease and cancer.  Juicing is one way to get the antioxidants, but it eliminates the fiber you need for a smoothly working digestive tract.  In my own quest to eat more fresh vegetables, I have found it very useful to cut the veggies into sticks and dip them into dry spice blends.  My favorite spice blends right now are Penzey’s Murals of Flavor (a salt-free blend that includes shallots and lemon peel) and Penzey’s Pizza seasoning (a distinct fennel flavor I love).  I find it very satisfying to snack on veggies this way rather than crackers or chips.  Another trick I use to get more vegetables in my family’s diet is to add pureed fresh spinach to smoothies and in place of water in recipes.

4.  Eat less processed food.

When I see the professionally marketed boxes and bags of processed food in the grocery, it looks appetizing on the cover.  But, once you look at the ingredients of food that comes in a box or a bag, you see some very unappetizing, sometimes revolting truths.  The chemicals and preservatives and empty, possibly  toxic, calories that lie within are tasty due to their fat, sugar, and salt content.  But, they are terrible for your health.  Try to choose foods with the fewest ingredients possible and those that are closest to the natural state.  Choose whole grains where you can still identify the grain by looking at the product, rather than refined, bleached flours.  If you don’t keep junk food in your home, then you will be much less likely to eat it.  Out of sight, out of mind.  If you have a junk food that  you want to indulge in, then have one encounter with it away from home, and don’t bring the leftovers with you.

5.  Prioritize exercise.  Identify 3 priming songs.

The American College of Sports Medicine says that if you want to reap the cardiovascular and health benefits of exercise, you need to find the time to do moderate exercise 150 min/week.  Another way to put it would be to exercise for at least 30 min a day, five days a week.  The exercise you do should ideally be a mix of aerobic exercise, resistance training, balance training, and stretching.  Regular exercise has been proven to help treat anxiety, depression, diabetes, and cardiovascular disease.

The best way to make sure you exercise enough is to make it fun so that you look forward to it.  If you are not currently exercising on a regular basis, then you need to look at your schedule and see where you can fit it in, and actually write it on your calendar.  Identify 3 priming songs.  Priming songs are songs that when you hear them, you just want to get up and dance or move your body.  Put these songs on your listening device, and use them to get your mind and body ready and geared up for exercise.  I find my priming songs to be incredibly powerful motivators, especially on cloudy days when I am less likely to want to exercise.

6.  Sit less.  Move more.

The human body was not designed to be as sedentary as the typical American regimen has become.  Our hip flexors are shortening from sitting all day, and our low back is straining from the slumped posture that prolonged sitting encourages.  We will feel better and more energized if we move more and sit less.

Build tiny bouts of increased joint range of motion and body-weight strengthening into your daily life.  For example, while you are filling your car with gas or waiting in line, you could use those few minutes to do heel raises, leg extensions (barely placing your straight leg behind you until you feel your buttock muscle engage in contraction), or stretching your arms over head.   For every hour that you spend sitting, you should get up and move for at least 10 minutes.  Take your large joints through their entire range of motion a few times a day.  Stretch your hamstrings.  Feel the improved blood flow and the release of tension that comes with regular movement of your muscles and skeleton.

7.  Eat smaller portions.

As we age, our caloric requirements go down.  This is because our lean body mass decreases and our metabolic rate slows down.  These natural effects of aging can be mitigated by decreasing our caloric intake to match the decreased caloric need.  Low calorie diets have been associated with longevity.  If you eat more calories than you burn, then you gain weight.  The American food portions are often grotesquely large.  There is no need to go around feeling hungry, since you can always eat more fresh vegetables.

8.  Protect your skin barrier.

Our skin is an important part of our immune system.  It is the barrier between our organs and the outside world.  Every part of our internal anatomy is connected to our skin by just a few degrees of separation because our skin involutes to our internal body at our eyes, ears, nose, mouth, urethra, and anus.  As we age, our skin becomes less hydrated and less elastic, making it easier to get micro fissures in the skin.  This can disrupt the natural, protective, healthy bacteria that live helpfully on our skin but should not contact our internal micro biome.  To protect your skin barrier, I recommend using a mild, dermatologist-recommended bar soap, like Dove, in your warm (not hot) shower.  Avoid harsh, anti-bacterial soaps unless you are cleansing your hands after contacting germs.  Women should avoid using soap on their vagina, as it disrupts the natural, healthy flora – just use water.  I also feel it is important to add moisture to your skin daily with a mild, dermatologist-recommended, unscented, daily moisturizer, preferably paraben-free.  Frequent hand-washing can help keep us healthy, but hands should be thoroughly dried afterwards, and a moisturizer applied.  As we age, our feet require more attention to keep the skin healthy and free of fungus, dry skin, and cracks.   Get a professional pedicure monthly or do it yourself to eradicate the thick, dry skin, and use a moisturizing ointment on the soles of your feet every night to prevent the re-accumulation of keratin.  Ointments I use daily on my hands include Un-petroleum by Alba Botanica and  Organic Healing Balm by Honest Company.  I use these products on my children as well.

9.  Improve your sleep habits.

While we are sleeping, our bodies and minds enjoy a restorative period during which our metabolic processes are able to recuperate.  Plenty of scientific literature has shown the benefits of getting 8 hours of sleep a night.  Sleep is not wasted time, but rather an investment in your health and well-being.  Make sure you have a comfortable sleep environment, an ergonomic sleep position (don’t sleep on your stomach), and a routine that helps your mind and body wind down for sleep.  Getting regular exercise and setting aside time to meditate during the day can help you achieve better sleep at night, readying your mind and body for their nightly reward, restful , rejuvenating sleep.

10.  Find gratitude.  Choose happiness.

We all live with some level of stress, yet we can identify others who are enduring much more stress than we.  When we remember there are other humans living in extreme poverty, or as prisoners of war, or as human slaves, or with a life cut short by disease, we should use these remembrances to help ourselves find gratitude amidst our own life stressors.  We are kindred to all the humans on Earth, and we are born into environments beyond our control.  What we can control is how we respond to our situation.  Finding gratitude and not taking our life for granted is key to choosing happiness.  Happiness is a choice, and we can all choose it anew every day.