As of May 1st 2017,
our new hours will be:
Mon, Tues, Wed, Fri 8:00 – 4:00
Thurs 10:00 – 6:00
Sat 9:00 – 1:30
Are You Part of the Vitamin D Deficiency Epidemic? I Am!
New special for the month of March – see end of this article!
Recently I read an article on WebMD.com called “10 Nutrients You May Be Missing.” [See first link below.] It was an excellent article. Vitamin D was the nutrient that most interested me – because mine has been low for quite some time. When we first started testing patients for Vitamin D at Cordova Medical Clinic, I tested mine out of curiosity. I expected good results: I eat a pretty healthy diet, and I get a fair amount of sunshine. (10 minutes a day to arms, legs, and face can allow your body to produce enough.) Normal levels are 32-60. My level was only 11! A lot of the CMC staff checked their levels. Most were deficient, except for a few younger ladies who frequent the tanning beds (not a healthy option, but that’s another article).
Why should I care that my levels were low? Vitamin D deficiency can increase risk of death from cardiovascular disease, cause severe asthma in children, cause bones to weaken and muscles to function poorly. There is also initial evidence that inadequate Vitamin D can increase risk of some cancers: prostate, colon, and breast. And although causality has not been established, Vitamin D deficiency is associated with obesity.
I took booster supplements for two months, then began taking 2000 IU daily. In the past, researchers thought people only needed about 400-800 IU daily, but many researchers are now suggesting much higher doses. After a few months, my level was better, 28. So I took booster doses for another month, then went on 5000 IU daily, prescribed by my internist (yes, doctors don’t always treat themselves). When I rechecked my level, it was still under 32, so I added another 10,000 IU weekly. My last check was only 30! For some reason, my body seems to absorb Vitamin D poorly, or it metabolizes it too quickly. Now I’m on a very large dose, and I hope my next lab check will show something much better! (Vitamin D can be toxic, so very large doses should only be taken in conjunction with a doctor’s prescription and frequent blood level checks.)
If you’d like to learn more about Vitamin D, start with the link to NIH (National Institutes of Health) below. And if you’d like your Vitamin D level checked, come see us at Cordova Medical Clinic.
Clinic Special!
Now through March 31st, 2014 buy one shot, get another of same value free! (Limit one per week.) We have B-12, Lipo, and VitaChrom. You may choose to get a double shot for the price of one, or you may save the second shot for a future visit. Your choice!
http://www.webmd.com/diet/healthy-kitchen-11/10-missing-nutrients?page=1
New & Improved B12 Injections!
In dietary supplements, vitamin B12 is usually present as cyanocobalamin, a form that the body must convert to an active form the body can absorb. Our new and improved B12 is already in the methylcobalamin form (active form). As a result it is more effective, better absorbed by the body, and retained in higher amounts in bodily tissues. It is also five times more concentrated than before!
Cyanocobalamin |
Methylcobalamin – New & Improved! |
|---|---|
| Inactive form | Active form |
| 1000 mcg/mL per injection | 5000 mcg/mL per injection |
| Body must convert to active form | Already in active form, ready to absorb |
| Retained in higher amounts in tissues |
What is vitamin B12 and what does it do?
According to the National Institutes of Health, Vitamin B12 is a nutrient that helps keep the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak.
Am I getting enough vitamin B12?
Most people in the United States get enough vitamin B12 from the foods they eat. But some people have trouble absorbing vitamin B12 from food.
Certain groups may not get enough vitamin B12 or have trouble absorbing it:
- Many older adults, who do not have enough hydrochloric acid in their stomach to absorb the vitamin B12 naturally present in food.
- People with pernicious anemia
- People who have had gastrointestinal surgery, such as weight loss surgery, or who have digestive disorders.
- Some people who eat little or no animal foods such as vegetarians or vegans.
- Certain medications that may hinder the body’s ability to absorb B12. (Certain proton pump inhibitors used to treat acid reflux, Metformin, and medications for peptic ulcer disease such as Pepcid and Zantac all may inhibit the body’s ability from absorbing B12 naturally).
What happens if I don’t get enough vitamin B12?
Vitamin B12 deficiency may cause tiredness, weakness, and a condition called megaloblastic anemia. Other symptoms of vitamin B12 deficiency include problems with balance, depression, and poor memory. A vitamin B12 deficiency can damage the nervous system even in people who don’t have anemia, so it is important to treat a deficiency as soon as possible.
Citations:
“Cyanocobalamin Versus Methylcobalamin.” Cyanocobalamin Versus Methylcobalamin. N.p., n.d. Web. 08 Aug. 2013.
“Vitamin B12.” Dietary Supplement Fact Sheet: — Health Professional Fact Sheet. N.p., n.d. Web. 08 Aug. 2013.
Change Your Behavior For Weight Loss
We all know a better diet will help us lose weight, and there are a thousand of them out there. We are also aware that exercise will help us lose weight, and there are many to choose from. Why is it that we often choose to eat bad foods and fail to exercise if we know these choices will not help us lose weight? The answer is complex, and the way to correct this bad behavior is through the third pillar of weight loss: behavior modification.
Behavior modification is the process of thinking through your bad choices and deciding how to avoid that choice in the future. It is frequently difficult to just extinguish a bad behavior. It may be a lot easier to replace a bad behavior with a better one.
Why do we do bad things, like eating a bowl of ice cream when we’re full, or sitting in front of the TV all night when we know we need a workout? There are two reasons: habit and reward. If you always have a snack to nibble on while watching TV, or if you always go out to eat every Friday and Saturday night, you’ve got yourself a bad habit, my friend.
And where does the reward come in? It comes from a surge of dopamine in your brain. When you eat sugary or fried foods, you get a little squirt of dopamine in your brain, which you experience as pleasure. For 99% of human existence, the real threat to survival was starvation, not obesity or its related ills. So we evolved a desire for things that helped us store up calories – sweets and fats. It’s just natural that we like these things. So how do we avoid them? By using cognitive therapy: teaching and reminding ourselves how much damage they can do to our bodies and our lives. Actually, it will work better if we do the opposite and accentuate the positive. We should constantly remind ourselves that eating lower fat and lower carb diet and reasonable portions will do us a lot of good. We will be thinner, feel better, take less medication, spend less time in the hospital and at doctors’ offices, live longer, and so on.
Back to the habit part of this equation. Habit is the road to success… or disaster. We make lots of choices every day, but most of our responses are habits. We rarely have to think very hard for most day-to-day decisions. We just choose what we’ve gotten into a habit of choosing. This is where the good news comes in. If you develop good habits, you will continue to do good things without really trying very hard.
Step 1: Weight Loss Journal
I suggest keeping all your food diary and exercises on paper for at least 3-4 weeks, maybe permanently. Once a week, on Sunday perhaps, analyze what you did and try to reason why. It will help if you jot little notes relating to the choice, such as “ate chips while watching TV” or “ate a brownie that a coworker brought to office.”
Step 2: Substitute
If you snack in front of the TV, try planning on having carrots and hummus available instead of chips. Or some other healthy snack. If you try to just stop the bad snacks, hunger may force you into a bad choice, so substitute a good food instead. Or better yet, try adding exercise where a snack used to be. Ride your stationary bike or walk the treadmill while you watch TV instead. Write down positive choices as well. If you did something good, write down not only that you went for a swim, but why?
Step 3: Goals
We all do things better if we plan, and especially if it is a written plan. At the end of the first week, write your goals for weight loss in your journal, but be specific as to behaviors. Don’t write “lose 2 lbs a week for 10 weeks.” That’s a worthy goal, but we’re working on behavior, so these goals should be things like “go for a walk after lunch break” or “plan healthy snacks for work and home” or “join a softball team” or “avoid all fast food” or “learn about nutrition/exercise for 30 minutes each week.” Put down all the behaviors you need to stop, and if you can, some substitute good behavior. Add in any new good behaviors you want to start.
Step 4: Evaluate
At the end of the second week, evaluate how well you did at changing your behavior. Here is a key to avoiding failure: do not overdo it. If you try to change 10 or 20 behaviors in one week, you have unrealistic expectations, and you will fail. Choose one or two behaviors the first week, and add a new one each week, but only if you’ve succeeded at the prior goals. And start with the easier behaviors. This makes you more likely to succeed, and as the saying goes, “nothing breeds success like success.” Small successes slowly accumulated will motivate you to do better the next week. And as you go along, the behaviors you started weeks and months ago will become ingrained habits, and therefore easier to do.
I am confident that if you follow these steps, you will succeed in your weight loss goals. There are many paths to weight loss success, but all of them must include discarding bad behaviors and gaining new good ones. That, in a nutshell, is behavior modification.
Clinic Special!
Now through June 15th, 2013 buy one shot, get another of same value free! (Limit one per week.) You may choose to get a double shot for the price of one, or you may save the second shot for a future visit. Your choice!
Cardio is great, but…
It’s not everything! When you are working on weight loss, cardio exercises such as running, biking, swimming, and rowing, are great for burning calories and if you get your heart rate up to at least 70% of maximum (see previous blog “No More Couch Potatoes”), you are also getting a heart and lung workout, which is good for you in other ways. However, you don’t have to limit yourself to cardio if you’re serious about losing weight.
If you’re new to exercise, over 40, have a health problem, or take regular medication, check with your primary care doctor before starting a fitness program.
Strength training will burn calories and build muscle, which has a number of health benefits. Strength training generally burns fewer calories than a cardio workout, but in the long run you could burn a significant amount. The primary benefit of strength training is that it increases your RMR (resting metabolic rate). We all burn calories just sitting at our desks or driving our cars or any of the other mundane daily tasks that we do, but it’s not much. Studies show that women who participate in a strength training program for 12 weeks increase their RMR by 15% or more. That means that you burn calories not only during your workout, but during the other 23 hours of the day you burn at a higher rate, because muscle requires a lot more energy to maintain even at rest. 15% means you burn an extra 300 calories a day, which translates to over 109,000 calories a year, or over 31 lbs of weight lost! And you could be losing as much or more through cardio workouts and proper diet.
We frequently get this question from patients: What can I do to increase my metabolism? This is it! All exercise, whether cardio or strength training, helps to build muscle, which increases your metabolism.
Additionally, strength training reduces pain and dysfunction of arthritis, reduces risk of osteoporosis, and increases insulin sensitivity. Stronger muscles means better ability to do daily tasks, both on the job and at home. Exercise of all kinds reduces anxiety and depression symptoms.
And bigger muscles makes you look hot! Guys nearly all want bigger muscles, but women are usually resistant to the idea of improving their muscle size. They are afraid to look too muscled, like the women on the cover of body sculpting magazines. I’m sure there are some who see beauty in that, but I agree – a woman whose physique reminds me of Arnold Schwarzenegger in The Terminator is not attractive. But trust me, you won’t even get close to that look without exercise becoming your “job” 4-5 hours a day. If you work out 2-4 times a week, you will improve muscle tone and size to a moderate degree. You will look better, feel better, and you’ll be healthier!
If you’re new to strength training, join a gym and get a personal trainer there to get you started right. If you want to do it alone, there are instructional DVDs for sale on Amazon, or you can look up videos on YouTube. I’m going to remind you to try MyFitnessPal app on your phone; it rocks! It will give you calories burned for your exercises as well as keep up with your food intake (it becomes an easy food diary, which is an important part of a weight loss program). I also suggest you try the WebMD site and subscribe to their weekly slideshows in your email. They have great ideas about healthy eating, exercises, and many related things. Below is the most recent slideshow. Check it out!
WebMD Slideshow 7 Most Effective Exercises
No More Couch Potatoes!
Cordova Medical Clinic group bike ride on the Green Line at Shelby Farms!
I recently listened to a lecture by a bariatric physician who began his talk with this phrase: “the key to weight loss is reducing calorie intake; the key to maintaining weight loss is exercise.” Very basic, but of course, for best results, you should start both healthy eating and exercising simultaneously in your weight loss program. What if you just dieted and refused to exercise? Some people do lose weight this way. But long-term studies have shown that more than 90% of people who have lost weight and maintained it over 5 years or more are regular exercisers. To put that another way, if you lose weight and don’t exercise, the chances you are going to stay thin are… well, slim. Very slim. (Only 10%.) No one really wants to lose weight temporarily, so if you’ve been a couch potato, it’s time for a change!
How do you start an exercise program if you’ve done very little exercising in years? There’s a phrase for that, too: “Start low, go slow.” If you try to overdo it, you’re going to hurt yourself or exhaust yourself, and then you’ll give up.
Walking is easy. Most people already have sneakers, and it doesn’t require a gym membership or a treadmill. Walk outside, or at the mall in bad weather. Start with 15 minutes a day and go up by 5 minutes a week. By the end of a month, you’ll be doing 30 minutes a day.
If you’re somewhat active and want more strenuous exercise, you can work up to running. This can be hard on bad joints (hips, knees, feet), and if you have these problems, you may do better with something that puts less stress on joints, like swimming or biking. Biking outside is great fun. A stationary bike is good if the weather is bad, or if you exercise at night, or if you want to watch TV while exercising. (I have a fantastic stationary bike that is silent: Tunturi E30R.) Try to find some form of exercise you enjoy. If it’s all work and no fun, it’s going to be hard to continue long-term. Vary your workouts. Try to do 2 or 3 different forms of exercise each week.
The main thing that you need to do is make exercise a priority. If it’s just one of the 10 things you’d like to do today, if you’re like most people, you’ll only get 3 or 4 of them done because our days rarely go as planned. So make exercise one of your top 2 or 3 things to do. Keep a record of your progress: put it down in a calendar or chart, and review it weekly. (If you have a smart phone, I strongly recommend the MyFitnessPal app. It not only stores your progress, it easily calculates your food calories and burned calories for you.) If you fail, that’s only temporary. Start over by trying to analyze what caused the failure, then resuming in a way that will circumvent that obstacle.
What is the eventual goal? For weight loss, most experts suggest 60 minutes of moderate exertion 5 times a week; to maintain weight loss, 30 minutes of moderate exertion 5 times a week. Moderate exercise is when you are sweating and breathing hard, but can still talk fairly easily. If you want to be more scientific about it, you will have to use some math. You should get your pulse to 70-85% of your maximum heart rate for most of your workout. Maximum heart rate is 220 – your age. Take that number and multiply by 0.70 or 0.85 to get the range. For example, I’m 52 years old. 220-52 = 168, my maximum heart rate. 168 x 0.70 = approximately 118. 168 x 0.85 = approximately 143. So I try to get my heart rate between about 120 to 140 beats per minute while exercising. Count your pulse for 10 seconds and multiply by 6. After you’ve done this many times, you’ll get to where you’re able to tell by feel when you’re in that range.
But remember, these strenuous longer workouts are the eventual goal for couch potatoes. “Start low, go slow.” But start, and restart if necessary. Persistence will pay off in weight loss, looking better, and feeling better.
Exercise Guidelines
- Regular exercise is almost certainly a requirement for long-term weight loss. Researchers in Colorado and Pennsylvania studied thousands of people who lost more than 30 lbs. and kept it off for at least 2 years. The most common factor was that 91% of them were regular exercisers. Only about 30% of American adults are regular exercisers.
- Walk! If you don’t have an exercise habit, walking is a low-impact exercise that requires no special or expensive equipment, and you can do it just about anywhere.
- Balance your exercise. Aerobic burns calories better, but strength training (weights, sit-ups, push-ups) makes you feel good and gives other muscles a break. Try alternating aerobic and strength training 6 days a week, and rest completely one day a week.
- Start slowly and build up. Doing too much too fast can cause injury or burn-out. Start with 10-15 minutes daily, and add 5 minutes every two weeks. In just two months you’ll be up to 30 minutes a day.
- Exercise physiologists tell us that to maintain our weight, we need 30 minutes of daily exercise 5 times a week. But in order to lose weight, we need 60 minutes of daily exercise 5 times a week.
- Make exercise a priority! If you exercise after you’ve done everything on your “To Do List”, you’ll never get to it. Make exercise one of your top 2 or 3 things to do each day.
Diet Information
There are dozens of diets available, and the information can be confusing. Here are some general guidelines to follow.
- Low-carb diets work, but they provide little fiber. The average American only eats 11 grams of fiber a day, and we’re supposed to eat 25-30 grams. The low-carb dieter probably eats much less than 11 grams. This diet can work well, but you may need to supplement with extra fiber.
- Low-fat works, and is healthy. In general, if you follow USDA food pyramid guidelines, you’ll be eating the right proportions. Fat has about 9 calories per gram, while carbohydrates and protein have only 4 calories each. Also, low-fat dieters retain muscle mass better than low-carb dieters.
- Though protein seems good, be careful how you eat it: meat and dairy have lots of protein, but are usually high in fat. Some are low-fat. Learn to read labels, and don’t buy products that have more than 2 or 3 grams of fat per serving. Legumes (beans and peas) are high in protein and fiber. Just be sure they weren’t prepared “southern-style” – with a hunk of fat in the cooking pot.
- If you’d like calorie guidelines, most people lose weight steadily while eating 1000-1200 calories a day for women, 1200-1500 for men. If you work out for 30-60 minutes, add another 300 calories to your daily intake.
- Portion control is also important. Besides looking carefully at the kind of food you eat, make certain you don’t get too much of a good thing. Most brand-name healthy frozen meals have about 240 to 350 calories in them. If you wash the plastic containers they come in and save them, they can give you a good idea about how much of your home-made healthy foods you should dish out for your meals: just fill the container with your own food, and don’t eat more than what fits into it.
- Keeping a food journal is very helpful, and can be easily done on your smart phone. It tracks your daily calories and nutrition information, and can also track your exercise and weight. There are several available, but we like MyFitnessPal.
Who Qualifies?
We will treat adults 18-64 years of age with appetite suppressants. If your Body Mass Index (BMI) is 30 or greater, you qualify. If your BMI is 24.5 to 29.5, you qualify if you have a family history of diabetes, hypertension, heart disease, stroke, high cholesterol, or obesity. Anyone who does not qualify will receive a refund of his or her office visit fee.
Teenagers from 16-17 years old may also qualify, but they must have a parent with them to sign the consent form on the first visit and have a BMI of 27 or greater. Patients 65 years old or more will not be prescribed appetite suppressants, but may be treated with Xenical.
We can treat diabetics. We also treat patients with hypertension, but your blood pressure must be under good control with your medication. We do not treat patients with previous history of heart attack (myocardial infarction), congestive heart failure, or angina.
Follow-up Visits (usually 20-30 minutes)
Follow-up visits are once every 4 weeks, and are generally much quicker than your first visit. They follow the same steps as your first visit, except there is no paperwork for you to fill out.