Optimizing Bone Health: Decrease Risk of Low Bone Density and Fractures

Prevention is key for bone health – as with many health issues. Bone density peaks around age 30.  For most people after that, it steadily decreases with age. This even starts in the womb. Mom’s calcium and vitamin D levels influence bone density later in life, as does breastfeeding.  During childhood and young adulthood building a “bone bank” through adequate nutrition and weight bearing exercise is key to developing maximum peak bone density.  But, it’s never too late to start with healthy changes.  Maintaining good bone health can decrease the rate of bone loss and maintain quality of the bones, and there are many factors that play a role in this.

Food

Nutrition plays a big role in bone health. Calcium is often the first thing people think about, and though calcium is important it can be overdone. Too much calcium, especially if it is not balanced with magnesium and vitamin K can build up on artery walls.  Also, don’t rely on dairy – there is minimal link between dairy and bone health.
Try the foods in this list from the University of Wisconsin to promote bone health instead.

Onion family Fennel Parsley
Arugula French beans Pomegranate
Broccoli Garlic Prunes
Celeriac Leeks Red Cabbage
Chinese cabbage Lettuce Turmeric
Cucumbers Mushrooms Wild garlic
Dill Oranges & other citrus Soy (whole soy foods)

Too much of certain things can have a negative impact on your bones as well – so keep it to less than one alcoholic drink per day, and minimize cola and caffeine (except for tea) and don’t take more than 3000 iu of vitamin A.  Limit animal protein intake as well. The theory is that animal protein causes our blood to be slightly acidic, and to neutralize this effect our body steals calcium out of the bones.  Eat plenty of vegetables and fruit. A high vegetable to animal diet ratio seems to be protective against bone loss.

Vitamins and Minerals

Make sure you get adequate vitamin D. Vitamin D helps your body absorb calcium properly. Living in this area of the Northeast, we’re unable to make enough through the sunlight. Talk to your doctor about your levels and supplements.
Vitamin K, an important balance with calcium, is required for the activation of the hormone that tells our body to build bone.  Consider supplementing with vitamin K2 45-100mcg.  Magnesium helps keep the bones flexible. Try taking 400-800mg before bed. Talk to your doctor first if you are on blood thinners or if your magnesium dosage causes loose stools. Vitamin C, B vitamins, Potassium, and Zinc are all likely to be important as well.

Exercise

Benefits of exercise are seen at all age groups. Walking, other weight bearing exercise, and resistance training are all helpful. Vigorous walking at more than 3.8 miles per hour shows better benefit.

Smoking

Another reason to quit! Smoking increases fracture risk by as much as 40% compared to non-smokers.

Preventing Falls

The ultimate goal of prevention of bone density treatment is to avoid fractures, so preventing falls is a very important aspect of bone health. Exercise decreases fall risk and it maintains strength and coordination. Tai chi has been shown to reduce falls by improving balance.
Try these other tips from the Mayo Clinic to also help prevent falls:

1.  Talk to your doctor about your medications – some medications could cause dizziness
2.  Wear sensible shoes – avoid floppy slippers or shoes
3.  Remove tripping hazards – remove throw rugs that slip or stick up
4.  Make sure areas are well lit – use night lights
5.  Use assistive devices when necessary – like grab bars

Getting Your Bone Density Checked

Overall women have a higher risk of developing problems with low bone density because they have a lower peak bone density. Men with certain medical conditions or taking certain medications may be at higher risk too. Getting your bone mineral density checked is recommended if you are a woman over 65 years of age, or have the same fracture risk as a woman over 65.  You can calculate your fracture risk using this tool.  https://www.sheffield.ac.uk/FRAX/.

Bone density is checked with a test called a DEXA scan. Bone density in the hip and lower spine are the areas of the body that are X-rayed and then compared to a healthy 30-year-old of the same sex and given a score, called at T score. The more negative the number, the less dense the bones.  Osteoporosis is diagnosed with a T-score lower than -2.5.

Medication might be right for you if you have osteoporosis.  Talk to your doctor about this or any questions you have about your bone health or getting your bone density tested with a DEXA scan.

Why Environmental Health Matters

Each first full week of April celebrates National Public Health Week. The goals of this week are to identify the issues that impact poor health and disease risks for individuals and communities and to start conversations and develop strategies that help build a healthier nation. Each day of the week focuses on a different aspect of public health, and our focus is Environmental Health.

Why is environmental health important? According to Office of Disease Prevention and Health Promotion (ODPHP) the environment plays a key role to the length and quality of your life. Poor environmental health is not only costly, but very hazardous. Per the ODPHP, 23% of all deaths (26% among children 5 years old or younger) are caused by preventable environmental factors. Therefore, to further understand it’s importance, below are some environmental factors that can affect your health.

  • Outdoor Air Quality
    • Poor air quality can lead to many issues: cancer, respiratory/cardiovascular system damage, and premature death.
  • Surface and Ground Water
    • Minimizing your exposure to contaminated water sources is important to your health as contaminated drinking and recreational waters from chemicals or infectious agents can cause serious illness.
  • Hazardous Substances
    • Substances like nitrogen dioxide from gas cookers or the removal of hazardous waste can filter into your water and air supplies, which when absorbed can be a dangerous health risk (especially for children).
  • Climate
    • Climate can affect air, food, water, disease risk, and mental health. It can increase asthma events and heat-related deaths, but can also impact sea level and cause natural disasters – which may spread diseases and also cause damage to your mental health during recovery periods.
  • Homes and Communities
    • With much time spent either at home, work, or school, your health can be impacted by the space you occupy: Indoor air pollution, inadequate heating or sanitation, or lead-based paint hazards can affect your health.

As you see there are plenty of environmental factors that can impact your health, but the Health Department at the University of Minnesota shared few suggestions on how to live a more sustainable life.

  1. Limit the use of toxic substances and unknown chemicals
  2. Buy organic, fair-trade products
  3. Carpool, bike, or use public transportation to prevent further air pollution
  4. Recycle

While there’s a need for long term sustainability to optimize public health, it’s important to take the initiative to ensure you’re living in a healthy environment. Check your homes, check the products you buy, but most important check in with your doctor to make sure you’re void of any disease risks.

Spring Into Action

It appears winter is behind us (fingers crossed!). Short sleeves, ice cream, and warm nights aren’t the only reasons to get excited for spring. The season also brings surprisingly great health benefits as well.

Of the many benefits that encompass spring, Everyday Health narrowed it down to six things that should excite you and your health.

  1. Extra Daylight
    • Lack of Vitamin D can put your bones at risk, but during the spring you can soak up all the nutrients your body needs. (Remember to take precautions in order to balance healthy sun exposure versus burning.)
    • Extra sunlight serves as a natural mood booster and helps with seasonal depression some people suffer from during the dark fall and winter months.
  2. Healthier Home
    • Spring time means spring cleaning. Not only is it a great calorie burning exercise, but the cleaning of your home, car, office, and other areas can rid you of bacteria that may free you from spring colds and help seize control of your allergies.
  3. Spring-cleaned Diet
    • Around the warmer months you’ll find yourself eating less and going out more.
    • When you do eat, there are more healthy options available since many fresh fruits and vegetables are ripe for the taking.
    • Look for your spring produce at your local farmer’s market.
  4. Outdoor Exercise
    • With warmer temperatures you’re more inclined to explore the outdoors.
    • Studies have shown time outdoors helps with reduced stress and lowering blood pressure.
    • Warmer weather also offers more opportunity for outdoor exercises (e.g. runs, walks, swimming, etc.)
  5. No winter skin
    • Gone are the days of dry skin and with the added vitamin D you’ll surely be moisturized.
  6. Spring Break
    • These are the best times for vacations. Whether near home or getting away, getaways are great ways to manage stress and has been linked to reduced risks of breast cancer and cardiovascular disease.

As you see, there’s plenty to enjoy during these upcoming months, but be sure to keep your health as a priority. Reach out to your doctor if your experiencing any changes during these times, so you make the best of this season.

Healthy and Affordable Shopping

Grocery shopping can seem overwhelming especially as you are getting used to eating and preparing foods in a new way. It can be especially difficult on a budget. My belief is that investing in healthy food is investing in your health. I recently shared some tips with my patients at our R-Health Cherry Hill Healthy Shopping on a Budget event. Here are some of my favorite pieces of advice.

First let’s broadly define “healthy” as there are many controversies.  However, let’s focus on key elements of agreement.  They are: eating whole unprocessed foods, especially fruits, vegetables, nuts and seeds, avoiding empty carbohydrates such as those in sweets and refined flours, avoiding additives including chemicals and added sugar and salt, avoiding pesticides, antibiotics and hormones and getting adequate amounts of healthy fat, protein, and fiber.

Reading labels is empowering! It takes extra time at first, but once you know the products that are right for you, shopping will get faster again.  Not all food labels are helpful in making decisions.  For example, “natural” does not have a clear definition that is regulated by the FDA.  Companies can label their food natural and it still contain high fructose corn syrup for example. Also, beware of Heart-healthy statements as well as they can have plenty of refined carbohydrates that raise your blood sugar and trigger inflammation.  A few things to think about food labels in general.

  • Ingredient list: QUICK HINT – look for names you can pronounce and foods you have in your own kitchen.
  • MANY OF THE BEST CHOICES WILL NOT HAVE A LABEL – Think the produce section!
  • Calories: Not all calories are created equal – don’t worry so much about the calorie count, when you are able to get rid of processed foods usually you can trust your body to tell you when you have had enough.
    • Your body processes a Twinkie much differently and with different metabolic effects than a handful of nuts even though they have the same amount of calories.
  • Check the portion size. (Sodium content can be misleading when that tiny can of soup has 2.5 servings!)
  • Watch for fats
    • Buy healthy fats – nuts, seeds, olive oil, etc. and avoid trans fats
    • Foods can be labeled as having 0 gm of fat or trans fats if they have ½ gram or less.
  • Fiber is good for your body, especially for healthy gut bacteria
  • Watch for additives especially sugar and salts
    • New guidelines now ensure labels now contain “added sugars”
    • Try to avoid concentrated natural sugar in high quantities too (e.g. fruit juice or dried fruit)
    • Work on sticking to the recommended limits of no more than 6 tsp of added sugar for women and children and 9 tsp for men per day
    • For salts, much of the sodium and added sugar comes from salts and sugar added to processed foods. This helps the food industry to make the food more addictive. Read labels carefully and cook home-made meals whenever possible.
    • Look for chemical additives or artificial flavors/colors. You might be surprised when you first start reading labels to find how much more is in your can of beans, tomato sauce, or yogurt than you thought.

Saving money on anything usually requires planning ahead.  Look at circulars for sales and make a meal plan for the week.  Look online and in magazines for great ideas for your palate and budget.  Try searching “clean eating on a budget.”  On our grocery trip we toured Aldi.  Not only does this grocery store offer healthy natural (their Simply Nature labels are verified by a third party) and organic options, but surveys show Aldi’s prices on average contain 20% more savings than larger retail stores.  Remember to bring a quarter and your own shopping bags.

Other cost saving tips:  If you have the time, avoid pre-cut servings.  Stock up on nonperishable and frozen items when on sale, and shop frequently for perishable items so they don’t spoil before you can use them.  Try looking above and below eye level, compare store brands, and of course not shopping while hungry are other cost saving tips.

Also know when to invest in organic produce and when to save on conventionally grown produce. According to the Environmental Working Group’s 2017 list below are products to look for.

  • DIRTY DOZENFruits and Vegetables with the most pesticides (Shop organic when possible for these!)
    • Strawberries
    • Apples
    • Peaches
    • Pears
    • Spinach
    • Tomatoes
    • Celery
    • Potatoes
    • Sweet bell peppers
  • CLEAN 15Fruits and Vegetables with the least pesticides (Okay to buy conventionally grown produce for these!)
    • Pineapples
    • Mangoes
    • Papayas
    • Honeydew Melon
    • Kiwi
    • Cauliflower
    • Eggplant
    • Sweet Corn
    • Cabbage
    • Avocadoes

Hopefully this is a good start for your next grocery store trip.  Please feel free to reach out to your R-Health doctor for more information and if you have specific medical conditions for your doctor to get you on the best health and nutrition plan.

Everyday Tips to Relieve Constipation

There comes a point where almost everyone goes through it – constipation. A period of infrequent bowel movements or hard stools.   Constipation can be a very uncomfortable state, especially the longer it lasts. Though not severe, if not taken care of, constipation can cause damage to the veins and skin in your anus, in addition to significant damage to intestines.  Chronic constipation is also a risk factor for colorectal cancer.

Per the Mayo Clinic, there are a few risk factors that may increase your risk of constipation:

  • Older age
  • Women
  • Dehydration
  • Low fiber diet
  • Little to no physical activity
  • Blood pressure medications/treatments
  • Mental health conditions

Luckily our R-Health doctor, Julia Snyder, MD, offers tools to prevent and relieve constipation.

  • Eat a whole foods, high-fiber diet
    • Eat foods in their unprocessed forms without additives (i.e. sugar, salt, flavorings or preservatives)
    • Consider a trial of dairy and gluten free (two food groups that are likely to cause constipation for people)
  • Try adding 2 tablespoons of ground flax seeds to your daily diet for extra fiber
    • Grind the flax yourself every 2 days for an extra healthy fat boost
  • Eat more good fats and try coconut oil
    • g. – wild fatty fish like sardines and salmon, avocados, and olive oil (which lubricates the digestive system)
  • Supplement with magnesium, vitamin C and probiotics
    • Use 200 mg to 1,000 mg of magnesium citrate daily. Gradually increase the dose until you go once or twice a day. If you take too much, you will get loose stools. If that happens, back off a bit.
    • Vitamin C – you can take 2,000 to 4,000 mg in divided doses two or three a day, along with magnesium supplementation. The same principle applies here: If you begin to get loose stools, just back off a bit.
    • Many people who struggle with constipation are often deficient in healthy gut bacteria, so adding probiotics can help – try adding them for one month. The increased fiber in your diet will give them food to eat and they will be happy to stay.  Also add fermented foods/drinks to your diet.  (Fermented vegetables are found in the refrigerated section)
  • Drink about half your weight in ounces of water each day (add more for hot weather or exercise)
    • Try starting off your day with water and lemon (room temperature to warm)
    • Cold drinks slow down the bowels.
    • Try coffee or tea with an apple and walnuts/pecans/almonds for breakfast
  • Exercise regularly
    • Get up and move – just 10-15 minutes of walking a few times a day will make a big difference
    • Try Yoga – the combination of relaxation and movement aids in triggering the bowels to release
  • Give yourself time to go and listen to mother nature’s call!
    • Schedule time in to your morning – just like potty training your little ones!
  • Position yourself correctly
    • Put your feet up on a stool to mimic a squatting position. This allows the muscles to relax and the stool to exit more easily.

 

 

Following these suggestions are sure aids in constipation prevention and management. However, if you have questions, or have frequent constipation, notice blood in your stool, and have severe pain in your bowel and/or experiencing weight loss, be sure to reach out to your R-Health doctor for assistance.

Why do we react to foods?

Why do we react to foods? The most immediately serious reason is true food allergy.  A food allergy is mediated by the fast-responding antibody IgE. It might result in an immediate and intense reaction, such as anaphylaxis.  The most common symptoms include: tingling or itching in the mouth; hives; itching; and swelling of lips, face, tongue and throat or other parts of the body, among others. Treatment usually involves avoiding the culprit foods, using medications for reactions as needed, and possibly, desensitization through allergy shots.

Food sensitivities are less understood, but are thought to be a chronic, low-level reaction which can have a delayed response of one to three days after eating a triggering food. The most commonly associated symptoms are arthritis, IBS, migraines, asthma, eczema, and chronic fatigue.  If you have symptoms, IgG/IgA testing or other immune response testing can be useful for confirmation, and can be the basis for an elimination diet that could improve your symptoms.

Cross-reactivity to environmental allergens involves foods with similar proteins as outdoor allergens.  For example, if you have ragweed allergy you may also react to eating the melon family.

Celiac disease is an autoimmune response to gluten (found in wheat barley and rye).  Treatment is a lifelong gluten-free diet.

Reactive hypoglycemia and post-prandial syndrome happen when insulin levels rise after a meal and trigger symptoms.  Eating a balanced diet rich in protein, healthy fat and fiber, while avoiding high carb foods-especially refined carbohydrates or sugary drinks are first-line management.

Keeping Your Heart Healthy – The Importance of Blood Pressure Screenings

While February may be best known for Valentine’s Day, it’s also American Heart Month. This is a period geared towards spreading awareness of cardiovascular disease, and encouraging your family and friends to be proactive in monitoring their heart health. One of the best ways to do that is getting a heart health screening.

There are many screenings available – Fasting Lipoprotein Profile (cholesterol), Body Weight, Blood Glucose, Smoking/Physical Activity/Diet – but chief among them may be the blood pressure screening. According to the American Heart Association, this is one of the most important screenings because there are typically no symptoms for high blood pressure (HBP). If you have HBP you are at a much higher risk of:

  • Heart failure
  • Heart attack
  • Stroke
  • Chronic kidney disease

It’s important to check your blood pressure regularly, especially if it’s outside the range of 120/80 mm Hg. If so, it’s recommended you get this screening at least every two years. While your blood pressure levels may be affected by short-term factors such as emotion, stress, pain, and caffeine use, there are many other risk factors that can contribute to the rise of HBP:

  • Age
  • Race
  • Family History
  • Obesity
  • Tobacco Use
  • Low levels of Potassium/Vitamin D

While there may be many risk factors, the CDC believes there are many things you can do to take control of your blood pressure, and most importantly, developing healthy habits.

  1. Healthy Diet – A balanced diet, individualized for your health needs, can be crafted by your R-Health doctor.
  2. Maintain a Healthy Weight – Additionally, your R-Health doctor can work with you to determine a healthy weight range.
  3. Physical Activity – Physical activities not only help maintain healthy weight, but keep your heart active and healthy.
  4. Do Not Smoke
  5. Limited Alcohol Use

Though there are healthy habits to follow, and risks factors that may increase chances, the best first step is to get a blood pressure screening. With no true signs or symptoms, this screening is a vital step in preventing cardiovascular disease and a first step towards making lifestyle changes. In addition, your R-Health physician can help you decide upon individual lifestyle adjustments to keep your heart and your body healthy and happy.

Recipes for Success

Part of having a good team is having great team members, and our R-Health doctors are exactly that. Not only are our doctors always accessible to their members, but they constantly share insightful and intriguing information unrelated to medicine that our team and our members certainly enjoy. We asked Dr. Miller, our doctor at R-Health Voorhees, if she had any recommendations for our members, and she shared with us both a book and a delicious recipe.

For her book, Dr. Miller recommended Small Great Things by Jodi Picoult. Debuting #1 as a New York Times bestseller, the story follows a nurse who gets sued while battling the ever-present challenges of our time such as prejudice, justice, and race. Garnering great success since its debut, Small Great Things was recently added to the National Network of State Teacher of the Year’s (NNSTOY) booklist in 2017.

Furthermore, if you’re looking for a healthy meal, look no further than Dr. Miller. An R-Health doctor by day and amateur chef by night (we think), Dr. Miller loves to cook. She shared her recipe for Kale Soup below.

Dr. Miller’s Kale Soup

Ingredients:

  • Green Pepper Diced
  • Red Pepper Diced
  • Medium Onion
  • Turkey Kielbasa
  • Red Kidney Beans
  • 16 oz. Stewed Tomatoes
  • 32 oz. Beef Stock
  • 28-32 oz. Chicken Stock, Low Sodium
  • 2 Carrots, Peeled and Chopped
  • 2-3 Potatoes (other than white is healthier), Peeled and Diced
  • Frozen Package of Kale (10 oz.)

Recipe

  1. Sauté red pepper, onion and green pepper in olive oil
  2. Add it to the beef and chicken stock that has 2 tbsp. of adobo and 1 tbsp. of dried jerk simmering
  3. Sauté the kielbasa to brown and add to the pot
  4. Add diced potatoes and sliced carrots cook until tender – take some out and mash then add back to thicken the soup
  5. Add the stewed tomatoes
  6. Add the kidney beans
  7. Add the frozen kale and simmer for a couple of hours
  8. Serve it with sourdough or garlic bread

 

As you can see, our doctors are multifaceted but above all, are experts in primary care. Be sure to schedule your appointment with your R-Health doctor, and with all the time you have with them, maybe you can swap books and recipes too.

Growth: The Expansion of R-Health and Direct Care

The growth of Direct Care continues to spread across the country as more and more people begin to realize its positive influence on healthcare delivery. As awareness has grown, so too has R-Health – as one of the leaders of the industry, R-Health continues to expand its footprint in New Jersey by not only offering unprecedented relationship-based access to doctors, but curating a model that challenges the episodic, transactional, and volume-maximizing traits that presently exist.

Last year, Hint, a software organization that helps streamline administrative tasks for Direct Care practices, released a study on the practice trends of Direct Care, or Direct Primary Care. Hint reported that the average yearly patient panel growth for Direct Care practices is growing at over 8% per year. With more time with the patients due to the elimination of many administrative tasks, Direct Care is great for both the doctor and the patient.

R-Health follows right along these lines. Not only does R-Health offer individual memberships, but after signing a groundbreaking contract with the State of New Jersey, it is able to offer Direct Care as a benefit to over half a million New Jersey school and state employees and their families, completely free of charge.

With such an historic agreement, R-Health saw major growth over the past year. R-Health expanded to seven locations across New Jersey, three which came during the final quarter of 2017. Just like our approach to healthcare, our sites are committed to quality, excellence, and convenience. With comfortable assessment areas along with some of the latest technology in medicine, our locations offer the convenience of a one-stop-shop for all primary care needs whether you’re a patient or doctor. To see a list of all of locations, please visit our website.

Recognized as game changers, in 2017 R-Health received Philadelphia Business Journal’s Healthcare Innovator award for our efforts to reinvent the healthcare industry. Other news outlets such as the Wall Street Journal, Politico, and NJBIZ were just a few others who graciously acknowledged the hard work and commitment towards the success of this model.

In closing, this past year has been a great year for Direct Care, and an even greater year for R-Health. Now having laid a strong foundation in New Jersey, R-Health is driven to expand to more markets and develop new relationships with other businesses more than ever. As a tight knit group that puts our doctors and patients first, excitement ensues for what’s to come and we hope that more physicians join our clinical team to enjoy it with us.

Well, What?

What is a well woman visit and why it is important?

 
It is a designated time for you and your health care provider to discuss your reproductive health. It may also include an exam, screening tests, like a pap smear or blood work, and immunizations. If you have breasts, a uterus, and/or a vulva it is important to have this type of visit to check the physical organs, even if you do not identify as a woman.

 
A well woman visit can be important in different ways for different people, depending on their needs and stage of life.  For young women, it may just be a discussion about periods and immunization for prevention of cervical cancer.  For those who are sexually active, contraception and STD prevention will likely be discussed.  Those thinking about starting a family might have a discussion about optimizing their health for conception and pregnancy.  For those 21-65 the Pap test allows cervical cancer to be detected and treated before it causes problems.

 

For women over 40, getting a mammogram can help detect breast cancer earlier. Those approaching or facing menopause might discuss bone health, changes in their body, symptoms, and strategies to protect them from long term health risks. It may not be necessary to have an internal exam or breast exam every year.  You can discuss with your doctor the risks and benefits.

 

A well woman visit is another important way to be proactive about your whole health. From an evolutionary stand point, one of the most important functions of our body is to reproduce.  So, reproductive health can be an indicator for overall health and well-being.

 
It also is an opportunity to continue to build a good, honest relationship with the doctor. With unlimited access to your R-Health doctor, not only are you not pressured with remembering all your questions for a single visit, but no matter what is discussed, you’ll always get the time you need to fully understand and have your input applied to any course of action.