Q. What is the best diet program for losing weight?

Q. Do I really need to take vitamins or supplements when I am already following a healthy diet?

It is a good idea to take a multivitamin mineral supplement daily as recommended by the Institute of Medicine.  Even with a healthy, varied diet, it is difficult to get all of the vitamins and minerals we need to keep us healthy.  And, most of us don’t vary our diet very much but instead eat the same 15-20 foods each week.  Additionally, women are even less likely to meet their micronutrient needs through food because they take in less food overall (fewer calories) than men do.

Q. Why are liquid supplements such as Wellesse recommended for bariatric weight loss surgery patients?

Weight loss procedures impact vitamin absorption and can result in nutritional deficiencies. Most patients cannot take pills or tablets because they are unable to digest and absorb them. Liquid supplements are fast absorbing and easy to swallow making them a great alternative for chalky chewables. They absorb quickly into the body so you are able to utilize all the provided essential nutrients.

Q. What are some of the most recommended supplements for after bariatric weight loss surgery?

The severity and type of nutritional deficiencies experienced after weight loss surgery can vary depending on the type of procedure. A complete multivitamin is very important for overall health to prevent deficiencies in vitamins A, E, D and B-Complex. Lack of Calcium and Vitamin D is common both before and after surgery and generally requires supplementation beyond what a multivitamin can provide. B-12 must often be administered an additional supplement especially for malabsorptive surgeries such as RYGPB or Duodenal Switch, as B-12 is a key contributor to the body’s proper use of iron. And finally, Iron is needed to prevent iron deficient anemia inherent in bariatric weight loss surgery patients.

Q. What exercises are recommended for before and after Bariatric weight loss surgery?

Research studies on obesity and weight loss continue to support exercise as a key component to weight loss maintenance. A recent study done out of Brown Alpert Medical School and Miriam Hospital in Providence, Rhode Island found that of 199 patients who underwent gastric bypass, those who became more active after surgery lost more weight over one year than those who remained relatively inactive. (Bond DS, Phelan S, Wolfe LG, Evans RK, Meador JG, Kellum JM, Maher JW, Wing RR. Becoming physically active after bariatric surgery is associated with improved weight loss and quality of life. Obesity 2009;17:78-83.(2009).

Phase 1: Pre surgery (ideally 4 weeks)
Always check with your health professional before changing or adding to your excercise program. Get a journal to track your progress - either a Weight Loss/Exercise specific journal or just a blank one. Start with 10 minutes a day (most if not every day of the week). During those 10 minutes you can do whatever activity feels comfortable. This might include limbering movements, light stretching, breathing exercise, chair exercise, contract and release muscle exercise, or simply closing your eyes and picturing yourself doing exercise.

Phase 2: Post Surgery (typically 4 to 6 weeks)
At first after post surgery you can get right back to your pre-surgery ‘no sweat’ workout commitment and only perform those movements or exercises that are easy to do without interrupting the healing process. This may be limited to light stretching, deep breathing and simple contract/relax exercises in your bed. Start Slowly!

Once you have your doctor’s permission to exercise a bit out of bed you will want to add in some light walking on level surfaces. Start off slow and easy building up to 10 minutes non-stop. You may need to wait a good four to six weeks before you can get a bit more aggressive with your cardio routine. Always check in with your physician for approval before increasing your workout intensity.

Phase 3: Beyond Recovery (a life-time commitment)
Once you have been given the green light to engage in a more complete training program you will want to include some muscle strengthening work to your cardio routine. So during phase 3 you will want to add muscle strengthening to your weekly workouts. You can continue with your 30 minutes of cardio, most if not all days of the week and simply add in the strength training exercises on 2 to 3 of the days (non-consecutive) extending those workouts to about 50 or 60 minutes; or you can alternate your workouts and spend 30- 45 minutes every day in either a cardio or strength routine.

More info

Q. What are the best foods for promoting joint and bone health?

Dairy foods, which are naturally rich in calcium, are best for promoting joint and bone health, especially milk because it is fortified with vitamin D.  Vitamin D promotes bone formation and mineralization.  In addition, it plays an essential role in the absorption of calcium and phosphorus from food.  Other vitamin D rich foods include cooked salmon and mackerel, canned tuna fish and sardines.  -. Foods rich in magnesium are also good for bone health.  And, magnesium is a mineral that we often fall short on (and most multivitamins do not contain 100% DV).  Try breads or pancakes made with buckwheat flour and adding bulgur, oat bran, halibut, chocolate, spinach, barley, pumpkin seeds, soybeans, beans or trail mix to your diet.

Q. Will an anti-inflammatory diet help my arthritis?

An anti-inflammatory diet may help your arthritis.  It certainly won’t hurt and therefore foods that may help mitigate inflammation are worth trying.  Foods that are loaded with anthocyanins (antioxidant rich pigments) may help limit inflammation and tissue degradation while improving local circulation.  These include red and black legumes, chokeberry, eggplant, black currants, red currants, cherries, berries (think red, purple and blue foods), and red grapes.  Mangosteen (found in some juices) may also help fight joint inflammation.  You can also try spicing up your foods with ginger, tumeric (cucumin) and adding foods rich in choline (eggs, wheat germ, pork, cod, chicken, oat bran, shrimp, salmon, Brussels sprouts, broccoli, cauliflower, beef and pistachios) and betaine (wheat bran, wheat germ, spinach, shrimp and beets) to your diet.

Q. Are there foods that can cause inflammation (of the joints)?

A diet high in omega 6 fats (most oils) and low in omega 3s may promote inflammation.  This can be combated by ensuring that you eat omega 3 rich foods such as fatty fish (salmon, mackerel, herring, halibut, tuna steak). Also, foods high in arachidonic acid such as meat, poultry and dairy may promote inflammation.  

Q. Is it OK to drink alcohol when you have arthritis?

Actually, consuming three or more alcohol beverages per week has been shown to lower one’s risk of rheumatoid arthritis.  However, I wouldn’t recommend adding alcohol to your diet to decrease your risk.  It is also important to make sure that alcohol can be safely consumed with any medication you may be taking. Talk to your personal physician about whether or not alcohol may be included in your diet.  

Q. What exercises help maintain bone health/strength?

Studies reveal that genetics, diet and activity levels all influence bone health.  While can’t do much about the genes we inherit, we can adopt a bone-healthy diet and exercise regimen. Weight-bearing (e.g. walking, stair climbing, jogging) and resistance-training exercises (e.g. weights, bands, calisthenics and isometrics) improve bone strength and density.  Here are a few important points to keep in mind when training for bone health:

• Bone training is site specific, so you need to work out the muscles around each of your major joints. 
• Walking offers a great cardiovascular and lower body workout, but be sure to add some strength moves into your routine for upper body and core support. 
• If you have already been diagnosed with osteoporosis or its precursor osteopenia  choose stationary exercises conducted in a stable, supported posture (e.g. recumbent stationary bike, chair exercise, water exercise).  Avoid activities with an increased risk of falling (e.g. use of free weights, skating, therapy balls, hiking, biking). 

For tips on a bone-healthy diet, see Marie Spano’s post

Q. What Exercises are Best for Minimizing Joint Pain?

Assuming we are referring to chronic joint pain, there are three main recommendations for exercising in the presence of joint limitation or discomfort.* 

1. Choose non- or low-impact activities:
Swimming and use of non- to low-impact cardio equipment (e.g., elliptical trainers,  gliders) can help you lose any excess weight that causes unnecessary joint stress.  It’s also good for the heart.

2. If you feel pain, try short range or isometric strength exercises:
If you feel pain with any movement, isometric or held contractions may be a better option.  These contractions involve pushing or pulling against an unmovable object (e.g., a wall), holding the pose for up to 6 seconds.  Try to build tension by tightening the muscle during the pose.  Breathe throughout the hold.

3. Build into your program gradually:
Allow your muscles and joint tissues time to develop and better support your joints during exercise. Evaluating how you feel about 2 hrs after a training session.  If you are still experiencing increased joint pain or discomfort, cut back your activities.  If not, add more elements to your exercise program in small increments every few weeks. 

Overall exercising your heart and muscles is the key to living a healthy, functional lifestyle, even for those with bone and joint limitations or disease.

In other words, “Use it or lose it!”

*Note, if you have acute or injury-related joint pain, don’t exercise an injured joint until it has healed.

Q. What exercises should be avoided for those with Arthritis? 

Studies have shown that even those people who suffer with degenerative diseases such as arthritis can benefit from a gentle exercise program.  To keep your program joint healthy, follow the 3 R’s:

• Reduce Impact: Stay on the light side.  Walk rather than jog; forgo stair-stepping machines and try a cross country glider or elliptical type trainer which distributes the work between your upper and lower joints.  If machines don’t appeal to you, try a water-exercise program.  
• Reduce repetitions and resistance:  For strength training, begin with only 4-6 reps using light weights (about 30 to 50 % your maximal effort). 
• Reduce ranges that cause extreme discomfort or pain: stop each exercise as soon as pain in the joint increases and slowly return to the start position.  If you feel pain with any movement, try some isometric (non-moving) contractions.  Push or Pull against an unmovable object (e.g., a wall), holding the pose for up to 6 seconds.  Try to build tension by tightening the muscle during the pose.  Breathe throughout the hold.

There is a slight difference in recommendations for osteoarthritis (OA) verses rheumatoid arthritis sufferers.  It has to do with the best time of day for exercise.  Typically, those with OA feel best working out earlier in the day, when muscles and joints are fresh and haven’t dealt with the load and stresses of the day.  With rheumatoid arthritis the opposite is the case.  Stiffness and pain are usually worse in the morning and joints are more ready to exercise later once the body has been moving.  For both types of arthritis, a long warm up period of 10 to 15 minutes is recommended to increase joint mobility and lubrication.   

Q. What are some good tips for starting an exercise program?

A:  To get your program off to a great start, try a few strategies recommended by personal trainers as well as behavior therapists.  These include self evaluation, goal setting and pre-program planning.  Here are some tips to get you started.

1.) Have a Dream.  Take a look at where you are and what you want out of your fitness program.  A healthier body? Weight loss?  More energy?  Get excited by the prospect of what exercise, if done regularly, can deliver. 

2.) Know Your Numbers.  Get a physical exam to learn your important health measurements such as blood pressure, cholesterol, bone density, and a body composition measurement (e.g., body fat, weight or inches).  Use these figures to track your progress and results. 

3.) Make Goals Meaningful.   Keep goals attainable and realistic, tracking progress every 4 to 6 weeks.  If you’re not sure what’s reasonable, ask your physician or personal trainer for recommendations.  For example, if weight loss is a primary goal, aim to lose no more than 1 to 2 pounds per week.  If lowering your blood pressure is of utmost concern, recognize that change will happen slowly – it may take months.  By breaking your overall goals into smaller ones, you’ll avoid disappointment and increase program adherence.  

4.) Got Gear? Make sure you have the tools to succeed.  For example, do you belong to a health club membership or have a home gym?  Need a personal trainer or do you have a workout plan in mind?   Do you need new sneakers? If you take the time to pre-plan, your first workout experience will be much more enjoyable, ultimately leading you right into step two, three and four. . . and more great training sessions.
Good luck and get movin’!




Q.  I know cardio, weights and stretching should be part of my exercise routine, but how often should I do each element and for how long?  How can I create a well-rounded exercise program?  

A:   Follow the American College of Sports Medicine’s F.I.T. principle, where F stands for frequency, I represents intensity and T equals time or duration.  This is your recipe for training success... stay within these guidelines and you will be assured a program that is both safe and effective.

Here’s what F.I.T. means, for each exercise element:

Guidelines for Cardio Respiratory (Aerobic) Programming
F - 3 to 5 days/week
I -  64% - 94% of maximum heart rate (220 - age = maximum heart rate)
T- 20 to 60 minutes of continuous or intermittent (10 minute bouts accumulated throughout the day) aerobic activity

Guidelines for Muscular Strength and Endurance Programming:
F-    Exercise each muscle group 2 to 3 nonconsecutive days per week.
I -   Perform 1-3 sets of each exercise, while maintaining good form.
T- The time it takes to complete 1-3 sets of 8 to 15 repetitions of exercises that condition the major muscle groups of the body (typically 8 to 10 different exercises) . Perform each exercise in a controlled manner (~3 sec moving in one direction, ~3 sec return). 

Guidelines for Flexibility Programming:
F - Perform stretching a minimum of 2 to 3 days per week, and ideally 5 to 7 days per week
I -  Stretch to the end of the range of motion to the point of tightness, without inducing discomfort
T - The time it takes to complete two to four repetitions of stretches that address each of the major muscle groups of the body (holding each stretch for 15 to 30 seconds)