The story of a four-year-old boy in India who has been running distances of up to 60 kilometers has led to a lot of discussions, including among the Take The Magic Step® team. We spoke to Dr. Henning Ohlert about appropriate exercise for young children, as well as about some strategies for parents to deal with this issue.

Dr. Ohlert, 46, is a lecturer of training science at the University of Potsdam. He was a professional athlete for ten years, and as a 23-year-old ran the 800 meters in 1:45.9. He is working on a long-term study of motor skills and development of ten-year-old children.

©  Betty Shepherd

How much exercise can a child cope with?

Over the years, our attitude towards children’s capabilities has changed tremendously. Basically, you could say that children are “little champions of endurance.” The big advantage of children is that they stop what they are doing automatically when they feel that they are getting tired and reach their physical limits. If children are tired out during playing, they simply take a break, and once they have recovered, they get active again. I think that you cannot do anything wrong with children-you just cannot challenge them physically in the wrong way. They know how to adjust themselves, and will utter their disapproval when it gets too much for them. And this disapproval should be respected.

What you have to watch out for with children, however, is problems with their thermoregulation; that is, the loss of body warmth during physical activity. Children get red faces when they are playing, bouncing around or playing sports. The body warmth which develops causes fast panting while breathing. The reason for this is that their perspiration system with does not function as that of an adult yet. That’s why you have to be careful to prevent children from overheating. In general, however, children have quite a sensitive feeling for the right proportion of activity and rest. It is highly dangerous, though, what is demanded of the little boy in India.

How can parents tell what and how much they can expect and ask from their children?

I believe you can ask more from children than most parents would think. You can judge by certain subjective criteria if a physical activity is enough: the color of the skin (for example, if the paleness of the skin is extreme), the frequency of the breath, the heart rate as well as the quality of movements. You will realize pretty quickly that movements seem to become uncontrolled and the way children fall changes. These are clear indications for the necessity of a break.

© Betty Shepherd

At what age should children start to train on a regular basis?

In order to answer this question, you would have to define the term “systemically organized training” first. I think that until a child has reached the age of eight, we shouldn’t call it training. There is nothing wrong with daily exercise or physical activities. Children should be active in various non-specific ways and thereby gain a broad range of experiences. This is the best prerequisite for successful involvement in sports later on.

Is there such a thing as unathletic children?

In my opinion, there is no such thing as unsporty kids. At times someone gets called “unathletic” just because he is judged by certain skills and abilities. It is just normal, however, that you are not able to do things which you have never done or practiced before. Often you get also judged by your family background. But just because your parents consider themselves unathletic, it does not necessarily have to mean that the son or daughter is as well. Every child is athletic. The question is only if she is athletic enough to become a champion.

Don’t children have a natural urge to move?

Absolutely. Unfortunately, this urge is lost throughout the ontogenetic development. At puberty, this urge to move decreases. This is when young athletes often lose interest in their sport and don’t show up for training anymore.

Should parents try to intervene?

It would not be good if the enthusiasm for the sport got completely lost. It is normal and should be tolerated that there are phases of less motivation. You should still try to talk to your child, his or her coach and friends about the situation, options and possible wasted opportunities.

Children tend to change their enthusiasm for different things quite quickly. Today they are playing tennis, tomorrow they want to become a professional swimmer, the day after tomorrow a famous basketball player. Sometimes they are not sure at all. Should children do several kinds of sport or should they better concentrate on one?

I strongly recommend that children experience a rather broad range of physical activities. I assume that not every child should be trained to become a Davis Cup player. Instead, most children will just want to play tennis for fun, or they just want to go inline skating, running or play soccer. I am a great supporter of children practicing a variety of sports.

Is it naive to believe that children will be grateful one day if parents put some pressure on them and force them to keep up a certain sport, hoping that they will be successful and the sport turns out to be the right one for the child?

This wish or hope might be honorable, but children think differently. Children think very emotionally, and are not as rational as adults are. The reasons why children give up on something are not easily understood. A little bit of pressure might not be wrong. It is a great achievement, however, if children discover themselves what they like.

Should parents tell their children which expectations they have regarding their sporting performance?

Parents’ expectations should not put too much negative pressure on the children. There is a lot of evidence in pedagogy that children fail just because their parents were asking too much of them. Children often act paralyzed if they are put under too much pressure. Then they are often criticized for failing mentally, but no one realizes how much pressure has been put on them: “You have to do this, you have to do that!”

Parents have to learn to judge their children’s mental condition and figure out how they can teach them ambition and determination. As a matter of fact, a runner participates in a race to get to the finish line among the best and not far behind the first ones. Consequently, you can, of course, tell your children that sport is often about being better and faster than others. This should be done sensibly, however, and without any pressure. It is nearly impossible to get children’s enthusiasm back if you have put them off doing sports once and if sports have become a trauma for them. This is proven by scientific research. The next chance you get to convince them of doing sports again is when they have grown up and when stress at work and an unhealthy diet have caused health problems and the cardiologist tells them, “You have to get moving, you have to exercise!”

© Betty Shepherd

On the other hand, children are often highly motivated when their parents watch them at training or competitions.

It is obvious that children are extremely motivated when they realize that their parents fully support what they are doing. At some stage, however, their own motivation will become so high that they don’t need their mother’s or father’s support anymore. But even professional athletes are more motivated when their parents are in the stadium or along the race course, no matter if in tennis, soccer or running. The question is just how parents react to their children’s failure. It is important that you find out together-maybe even with the coach-where mistakes might have been made and how you could adapt the training. Children have to feel that you support them and don’t give up on them.

What should parents do if their child suddenly, after two years, does not like judo anymore and would rather want to do athletics or tennis? Should parents demand that their children continue doing what they have started to do and not to give up on something just because it is no fun at the time?

I don’t find it too bad to change from one kind of sport to the other. You should have a conversation and clarify why they don’t like the sport they used to do anymore. There are certainly understandable reasons for it. And if they are not understandable, you still should not act against your child’s wish.

What should parents do if they recognize sporting talent in their child, but are not sure if they want to support it?

If someone thinks his child has got talent in some area which is illustrated by being better at something than other children of the same age, I would recommend approaching a sporting club close by and asking if there are facilities to support this talent specifically. I don’t find it very good to place children in “talent factories” far away from home where they waste a lot of time traveling to and from the place. Children should be able to pursue their training without many hassles. If they further develop and prove their talent, there are more opportunities of support in young adulthood, such as elite sporting schools or scholarships.

And vice versa: How are mothers and fathers to act if children desperately want to become professional athletes, but just seem to lack the talent?

I would still give the child the same chances, as eventually the “moment of truth” will show if the child is as good as she thinks she is. In cases of constant failure, however, you should be honest with your child, and tell him that another kind of sport might be more suitable for him. There are a lot of children who change to another kind of sport after the advice of a friend or parents and who have become really successful at it. Children who are motivated and ambitious should initially do what they prefer and should try things out.

If parents for some reason think that they should apply sanctions against their child-maybe because of bad marks at school-are prohibiting going to training and doing sports reasonable disciplinary measures?

I find prohibiting sports as punishment pedagogically not wise. Children have a natural urge to move and to play in order to cope with stress and emotions, and you cannot just switch this behavioral pattern off. If they are aggressive at school, they will be aggressive at sports, too. But particularly here, those negative emotions can be turned around into positive ones-through the pure movement, through the contact with the coach, through the group dynamics in team sports where bonding and camaraderie are crucial.

Cellulite and Cellulitus are not the same or related conditions

Cellulitis facts

• Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin.

• Staphylococcus and Streptococcus are the types of bacteria that are usually responsible for cellulitis, although many types of bacteria can cause the condition.

• Sometimes cellulitis appears in areas where the skin has broken open, such as the skin near ulcers or surgical wounds.

• Cellulitis is not contagious.

• Cellulitis is treated with oral or intravenous antibiotics.

What is cellulitis?

Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Unlike impetigo, which is a very superficial skin infection, cellulitis is an infection that also involves the skin's deeper layers: the dermis and subcutaneous tissue. The main bacteria responsible for cellulitis are Streptococcus and Staphylococcus ("staph"), the same bacteria that can cause impetigo. MRSA (methicillin-resistant Staph aureus) can also cause cellulitis. Sometimes, other bacteria (for example, Hemophilus influenzae, Pneumococcus, and Clostridium species) may cause cellulitis as well.

Cellulitis is fairly common and affects people of all races and ages. Men and women appear to be equally affected. Although cellulitis can occur in people of any age, it is most common in middle-aged and elderly people.

What are cellulitis symptoms and signs?

Cellulitis usually begins as a small area of tenderness, swelling, and redness that spreads to adjacent skin. As this red area begins to enlarge, the affected person may develop a fever, sometimes with chills and sweats, tenderness, and swollen lymph nodes ("swollen glands") near the area of infected skin.

Where does cellulitis occur?

Cellulitis may occur anywhere on the body, but the lower leg is the most common site of the infection (particularly in the area of the tibia or shinbone and in the foot; see the illustration below), followed by the arm, and then the head and neck areas. In special circumstances, such as following surgery or trauma wounds, cellulitis can develop in the abdomen or chest areas. People with morbid obesity can also develop cellulitis in the abdominal skin. Special types of cellulitis are sometimes designated by the location of the infection. Examples include periorbital (around the eye socket) cellulitis, buccal (cheek) cellulitis, facial cellulitis, and perianal cellulitis.

What does cellulitis look like?

The signs of cellulitis include redness, warmth, swelling, tenderness, and pain in the involved tissues. Any skin wound or ulcer that exhibits these signs may be developing cellulitis.

Other forms of noninfected inflammation may mimic cellulitis. People with poor leg circulation, for instance, often develop scaly redness on the shins and ankles; this is called "stasis dermatitis" and is often mistaken for the bacterial infection of cellulitis.

What are cellulitis risk factors?

Most commonly, cellulitis develops in the area of a break in the skin, such as a cut, small puncture wound, or insect bite. In some cases when cellulitis develops without an apparent skin injury, it may be due to microscopic cracks in the skin that is inflamed or irritated. It may also appear in the skin near ulcers or surgical wounds.

In other circumstances, cellulitis occurs where there has been no skin break at all, such as with chronic leg swelling (edema). A preexisting skin infection, such as athlete's foot (tinea pedis) or impetigo can predispose to the development of cellulitis. Likewise, inflammatory conditions of the skin like eczema, psoriasis, or skin damage caused by radiation therapy can lead to cellulitis.

People who have diabetes or conditions that compromise the function of the immune system (for example, HIV/AIDS or those receiving chemotherapy or drugs that suppress the immune system) are particularly prone to developing cellulitis.

Conditions that reduce the circulation of blood in the veins or that reduce circulation of the lymphatic fluid (such as venous insufficiency, obesity, pregnancy, or surgeries) also increase the risk of developing cellulitis.

What causes cellulitis?

The majority of cellulitis infections are caused by infection with either strep (Streptococcus) or staph (Staphylococcus) bacteria.

The most common bacteria that cause cellulitis are beta-hemolytic streptococci (groups A, B, C, G, and F). A form of rather superficial cellulitis caused by strep is called erysipelas and is characterized by spreading hot, bright red circumscribed area on the skin with a sharp, raised border. Erysipelas is more common in young children. The so-called "flesh-eating bacteria" are, in fact, also a strain of strep bacteria that can sometimes rapidly destroy tissues underneath the skin.

Staph (Staphylococcus aureus), including methicillin-resistant strains (MRSA), is another common type of bacteria that causes cellulitis. There is a growing incidence of community-acquired infections due to methicillin-resistant S. aureus (MRSA), a particularly dangerous form of this bacteria that is resistant to many antibiotics, including methicillin, and is therefore more difficult to treat.

Cellulitis can be caused by many other types of bacteria. In children under 6 years of age, H. flu (Hemophilus influenzae) bacteria can cause cellulitis, especially on the face, arms, and upper torso. Cellulitis from a dog or cat bite or scratch may be caused by the Pasteurella multocida bacteria, which has a very short incubation period of only four to 24 hours. Aeromonas hydrophilia, Vibrio vulnificus, and other bacteria are causes of cellulitis that develops after exposure to freshwater or seawater. Pseudomonas aeruginosa is another type of bacteria that can cause cellulitis, typically after a puncture wound.

Is cellulitis contagious?

Cellulitis is not contagious because it is an infection of the skin's deeper layers (the dermis and subcutaneous tissue), and the skin's top layer (the epidermis) provides a cover over the infection. In this regard, cellulitis is different from impetigo, in which there is a very superficial skin infection that can be contagious.

How is cellulitis diagnosed, and what is the treatment for cellulitis?

First, it is crucial for the doctor to distinguish whether or not the inflammation is due to an infection. The history and physical exam can provide clues in this regard, as can sometimes an elevated white blood cell count. A culture for bacteria may also be of value, but in many cases of cellulitis, the concentration of bacteria may be low and cultures fail to demonstrate the causative organism. In this situation, cellulitis is commonly treated with antibiotics that are designed to eradicate the most likely bacteria to cause the particular form of cellulitis.

When it is difficult or impossible to distinguish whether or not the inflammation is due to an infection, doctors sometimes treat with antibiotics just to be sure. If the condition does not respond, it may need to be addressed by different methods dealing with types of inflammation that are not infected. For example, if the inflammation is thought to be due to an autoimmune disorder, treatment may be with a corticosteroid.

Antibiotics, such as derivatives of penicillin or other types of antibiotics that are effective against the responsible bacteria, are used to treat cellulitis. If the bacteria turn out to be resistant to the chosen antibiotics, or in patients who are allergic to penicillin, other appropriate antibiotics can be substituted. Sometimes the treatment requires the administration of intravenous antibiotics in a hospital setting, since oral antibiotics may not always provide sufficient penetration of the inflamed tissues to be effective. In certain cases, intravenous antibiotics can be administered at home.

In all cases, physicians choose a treatment based upon many factors, including the location and extent of the infection, the type of bacteria causing the infection, and the overall health status of the patient.

Can cellulitis be prevented?

Under some circumstances, cellulitis can be prevented by proper hygiene, treating chronic swelling of tissues (edema), care of wounds or cuts. In other cases, microscopic breaks in the skin may not be apparent and infection may develop. In general, cellulitis in a healthy person with an intact immune system is preventable by avoiding skin surface wounds. In people with predisposing conditions (see above) and/or weakened immune systems, cellulitis may not always be preventable.

What is the outlook/prognosis for cellulitis?

Cellulitis is a treatable condition, but antibiotic treatment is necessary to eradicate the infection and avoid spread of the infection. Most cellulitis can be effectively treated with oral antibiotics at home. Sometimes hospitalization and intravenous antibiotics are required if oral antibiotics are not effective. If not properly treated, cellulitis can occasionally spread to the bloodstream and cause a serious bacterial infection of the bloodstream that spreads throughout the body (sepsis).

The foods we eat can affect our risk of developing certain types of cancer. High energy and high fat diets can lead to obesity and are generally thought to increase the risk of some cancers. Plant-based diets high in fresh fruits, vegetables, legumes and wholegrain foods may help to prevent cancer.

Diet is just one of the lifestyle factors that influence the risk of developing cancer. Smoking, obesity, alcohol, sun exposure and physical activity levels are also important. Although some foods can affect cancer risk, there is no evidence that specific foods can cause or cure cancer.

Food and some common cancers
Some common cancers (and how they are affected by what we eat) include:

• Lung cancer – this is the leading cause of death from cancer in the world and smoking is mostly responsible. There is convincing evidence that diets high in vegetables and fruits are protective against lung cancer. It is thought that compounds called carotenoids (present in significant amounts in fruits and vegetables), as well as vitamin E, are probably responsible for some of this effect. However, the use of antioxidant supplements, such as beta-carotene and vitamin E, has not been proven to be effective in either prevention or treatment of lung cancer and may, in fact, increase the risk of developing cancer in those who smoke. While fruits and vegetables may offer some degree of protection, not smoking in the first place is by far the best prevention.

• Breast cancer – this is the most common type of cancer in women in the world. There is an increased risk of breast cancer with factors such as rapid early growth, greater adult height and weight gain in adulthood. Much of the risk of developing breast cancer involves factors that influence oestrogen levels during a woman’s reproductive life, such as age of menarche (first period), number of pregnancies and breastfeeding practices. Post menopausal women who are carrying too much weight, especially around their middle, have more than twice the average risk of breast cancer. Diets high in mono-unsaturated fat and high in vegetables and fruits may reduce the risk, while alcohol consumption increases the risk.

• Prostate cancer – a quarter of all new cancers diagnosed in men in UK is prostate cancer. Vegetables, soy in particular may decrease the risk, while a high fat diet that comprises mostly animal fat sources (such as dairy products, fatty meats and takeaway foods) may increase the risk. Lycopene is a potent antioxidant found in tomatoes, tomato-based products, watermelon and strawberries. It may also help lower the risk of prostate cancer.

• Bowel cancer – this is the fourth most common cancer in the world. Up to 70 per cent of cases can be prevented by following a healthy lifestyle. Keeping a healthy weight, being physically active and a diet high in vegetables and fibre are protective, while consuming a large amount of red meat (especially processed meat) and alcohol may increase the risk.

Foods to ‘eat less’
Foods to limit in your diet or eat less of include:

• Fatty processed red meats

• Highly processed foods that are low in fibre

• Heavily salted and pickled foods.

Foods to ‘eat more’
The strongest protective anti-cancer effect has been shown with:

• Vegetables, especially raw vegetables or salads

• Leafy green vegetables

• Carrots

• Tomatoes

• Citrus fruits

• Cruciferous vegetables like broccoli, cabbage, brussels sprouts, bok choy and other Asian greens.

Include more of these vegetables and fruits in your diet along with other varieties.

Seven a day
Eating seven or more serves daily of a variety of grains, grain products, legumes, roots and tubers will also provide protective benefits against cancer. The less processed the grains, the better. Diets high in refined starch and refined sugar may increase the risk of stomach cancer and bowel cancer.

Meat and bowel cancer
There is now convincing scientific evidence that eating processed meat increases bowel cancer risk. The World Cancer Research Fund (WCRF) has recently recommended that people avoid eating processed meat. Processed meats are any meat that has been preserved by curing, salting or smoking, or by adding chemical preservatives. These meats include hot dogs, ham, bacon and some sausages and burgers.

It is recommended that children are not given processed meats at all. This is because many of the habits we develop as children last into adulthood. Substitutes for processed meats that are recommended for children include poultry or fish, low fat cheese or small amounts of lean meat.

The WCRF also recommends limiting the amount of fresh red meat we eat to 500g (cooked weight) a week. This is because there is convincing evidence that red meat also increases a person’s risk of bowel cancer.

Some research suggests that eating burnt or charred meat may increase cancer risk, but the evidence is unclear.

Fats and cancer
There has been a great deal of interest in the possible association between fat and cancer. Current evidence does not indicate a direct link between fat intake and particular types of cancer (with the possible exception of prostate cancer). However, a high fat diet may lead to obesity, which is a risk factor for several cancers including cancer of the colon, breast, kidney, oesophagus, gallbladder and endometrium.

Supplements are not the answer
Results of studies that show a protective effect of foods containing certain nutrients should not be taken to mean that these nutrients, when isolated and taken as supplements, will provide the same benefits for cancer prevention. In some cases, there has been an increased risk of cancer in those people who take nutrient supplements at doses higher than the amount of that nutrient normally eaten in foods.

Suspect foods examined
While a high energy, low fibre diet may increase a person’s risk of developing cancer, some individual foods have also been singled out as potentially causing cancer (carcinogenic). These include:

• Artificial sweeteners – such as aspartame, saccharin and cyclamate. Laboratory rats can develop bladder cancer if fed huge amounts of saccharin or cyclamate, although this is at levels thousands of times greater than a normal diet. International studies agree that humans aren’t affected in the same way. Artificial sweeteners are considered safe to eat.

• Cured, pickled or salty foods – there is no conclusive evidence that red meat causes cancer. However, bacon and other cured or pickled meats contain a substance called nitrate, which has the potential to cause cancer in laboratory animals when eaten in huge doses. How this research relates to humans isn’t clear. To be on the safe side, it is best to limit the amount of cured meats in the diet because they are generally high in fat and salt. Salt has also been associated with an increased risk of stomach cancer and should be consumed in limited amounts.

• Burnt or barbecued foods – a group of carcinogenic substances called polycyclic aromatic hydrocarbons (PAHs) can be produced if foods are overheated or burnt. Although charred or smoked foods could contain traces of PAHs, experts agree that the amount in the average UK diet is too low to be considered a significant cancer risk. However, when cooking, it’s best to use relatively low temperature methods wherever possible. These include steaming, boiling, poaching, stewing, casseroling, braising, baking, stir-frying, microwaving or roasting. Avoiding char-grilled meats and foods would also be smart.

• Peanuts – some laboratory animals can develop cancer after eating peanuts that are contaminated with toxin-producing moulds. However, peanuts sold in the UK are generally uncontaminated and contamination is routinely screened for.

• Alcohol – consuming alcohol increases the risk of cancers of the mouth, pharynx, larynx, oesophagus, breast and liver. The risk is even greater in those people who smoke. Alcohol has also been associated with colon, breast and rectal cancers. Men should drink less than two standard drinks a day and women less than one standard drink a day.

Treating cancer with food
While food plays an important role in preventing some cancers, the therapeutic value of food in treating existing cancer is less clear. It is true that a person with cancer needs excellent nutrition in order to better cope with the physical demands of the illness and the rigours of medical treatment. However, claims that particular foods, vitamins or micro nutrients can kill cancer cells should be viewed with scepticism To date, there is little scientific proof that a particular food or supplement can cure cancer or destroy cancer cells.

Recently some Japanese studies have found that green tea may delay the development and spread of certain cancers. Other studies have suggested that soy may also have a similar effect. Although this work is preliminary, it may suggest a more important role for food in the treatment of cancer in the future.

Nutrition for the person with cancer is important for many reasons, including:

• The immune system needs bolstering to fight at full strength.

• The diet may be adjusted to cope with various symptoms, such as constipation, diarrhoea or nausea.

• Loss of appetite or an increased metabolism means that high energy foods may need to be included in the daily diet.

• Extra protein may be needed to help prevent loss of muscle from weight loss.

Things to remember

• High fat, low fibre diets may increase the risk of many cancers, including bowel, lung, prostate and uterine cancers.

• You can reduce your risk of developing cancer by eating more fresh fruits, leafy green vegetables and wholegrain foods.

• Even though diet can influence your risk of developing cancer, there is little evidence that special foods can be used to cure existing cancers.

Osteoporosis means ‘bones with holes’. Bones lose their strength and density, become fragile and break (fracture) more easily because of calcium loss. Breaks are most common in the spine, hip and wrist and often occur after only a minor fall or knock. Osteoporosis particularly affects women in their middle and later years, although some men are also affected.

Most people show no signs of developing osteoporosis until a fracture occurs. Both men and women can take steps from a young age to avoid developing the condition in later life. Reduce your risk of fractures by taking steps to prevent and treat osteoporosis (or brittle bones) and avoid falls wherever possible. Activity and a healthy diet rich in calcium and vitamin D are both important.

Osteoporosis and bone growth
Bone is formed by specialised cells. Like the rest of the body, bone is constantly being broken down and renewed. It is living tissue that needs exercise to gain strength, just like muscle. In the early years of life, more bone is made than is broken down, resulting in bone growth. By the end of your teens, bone growth has been completed and ‘peak bone mass’ is achieved.

Sex hormones, such as oestrogen and testosterone, have a fundamental role in maintaining bone strength in men and women. The fall in oestrogen blood levels that occurs during menopause results in accelerated bone loss. During the first five years after menopause, the average woman loses up to 10 per cent of her total body bone.

Fractures of the spine caused by osteoporosis can lead to loss of height, pain and changes in posture such as the ‘Dowager’s hump’. This hump is caused when spinal fractures are compressed due to the force of gravity, resulting in an abnormal bending of the spine (kyphosis).

Symptoms
Osteoporosis causes no specific pain or symptoms. However, it does increase the risk of serious or debilitating fractures. If you think you may be at risk of developing osteoporosis, see your doctor.

Risk factors for osteoporosis
Several factors can place a person at risk of osteoporosis. Risk factors include:

• Family history of osteoporosis (mother, sister or grandmother)

• Inadequate amounts of dietary calcium

• Low vitamin D levels

• Cigarette smoking

• Alcohol intake of more than two standard drinks per day

• Caffeine intake of more than three cups of tea, coffee or equivalent per day

• Lack of physical activity

• Early menopause before the age of 45

• Loss of menstrual period if it is associated with reduced production of oestrogen, which is vital for healthy bones (the menstrual cycle can cease following excessive dieting and exercise)

• Long-term use of medications such as corticosteroids for rheumatoid arthritis and asthma.

Some conditions place people at a higher risk of osteoporosis. These conditions include:

• Thyroid disease or an over active thyroid gland

• Rheumatoid arthritis

• Chronic liver and kidney disease

• Conditions that affect the body’s ability to absorb nutrients, such as Crown’s disease, coeliac disease and other inflammatory bowel conditions.

Preventing osteoporosis
Both men and women can take steps from a young age to prevent osteoporosis by making sure that they:

• Have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains

• Eat calcium rich foods

• Absorb enough Vitamin D

• Avoid smoking

• Limit alcohol consumption

• Limit caffeine

• Do regular weight bearing and strength training activities.

A varied and calcium rich diet is the key
We need calcium to build and maintain strong and healthy bones, help our muscles work and support our nervous system. Good sources of calcium include:

• Dairy foods – low fat varieties are available to reduce the risk of weight gain or raised cholesterol levels

• Canned fish with edible bones – for example, sardines.

The minimum recommended daily intake of dietary calcium is:

• Infants (under 12 months) – 210–270mg calcium per day

• Children (over four years) – 700–1,000mg calcium per day

• Adolescents – 1,300mg calcium per day

• Women under 50 and men under 70 – 1,000mg calcium per day

• Post menopausal women and men over 70 – 1,300mg calcium per day.

Adequate vitamin D
Vitamin D levels are increased with sun exposure. People who are housebound or who dress with most of their body covered are at risk of vitamin D deficiency. The majority of women have inadequate levels of vitamin D during winter months. All that is needed is 10–20 minutes of sun exposure to the arms and face daily, without sunscreen and not through glass. Sun exposure is safest before 11am or after 3pm.

Avoid smoking
Evidence has shown that smokers have a lower bone density. Nicotine is known to be toxic to bone cells.

Limit alcohol intake
Excessive alcohol consumption is associated with the development of osteoporosis. Restrict your alcohol intake to no more than two standard drinks on any one day for both men and women to reduce your risk. Everyone should have at least two alcohol-free days each week.

Reduce caffeine intake
A large amount of caffeine (more than two to three cups per day of cola, tea or coffee) has also been associated with an increased risk of osteoporosis.

Do regular weight bearing and strength training activities
You should exercise at least 30 minutes three to four times a week to maintain healthy bones. Recommended activities are:

• Walking

• Jogging

• Tennis

• Dancing

• Using weights.

This helps maintain bone strength and balance so falls are reduced.

Diagnosis
The most reliable way to diagnose osteoporosis is to measure bone density using a DEXA scan. This is done with x-ray technology that involves minimal radiation, is accurate and can be used to follow up treatment.

Ultrasound tests are available at many pharmacies and involve an ultrasound measurement of the heel. These tests are not as accurate in assessing for osteoporosis as a DEXA study and are not recommended by doctors.

It’s never too late for treatment
If you have osteoporosis, it is never too late to seek treatment. Treatment can halt bone loss and significantly reduce the risk of fractures. It is important that your doctor excludes other medical conditions that can cause osteoporosis, including vitamin D deficiency.

Medications and treatments are available to strengthen bones and prevent fractures by slowing down bone loss. They may improve bone density in women with osteoporosis after the menopause.

Available medical treatments include:

• Bisphosphonates – such as alendronate, risedronate and zolindrinic acid, which can be combined with vitamin D and calcium

• Strontium ranelate – also called Protelos

• Selective oestrogen receptor modulators (SERMs) – in the form of raloxifene

• Vitamin D derivatives and calcium supplements

• Hormone replacement therapy (HRT) – short-term use of oestrogen and progestogen at menopause.

Other potential therapies that may be used as treatment include parathyroid hormone.

Hormone replacement therapy
All treatments for osteoporosis aim to prevent fractures. Oestrogen replacement at menopause prevents bone loss and fractures, but the effect lasts only as long as oestrogen is used.

Oestrogen can be is used to prevent fractures mainly for younger women with premature menopause. This is because most fractures do not occur until after the age of 65 and long-term oestrogen use is not recommended.

Falls are a risk for people with osteoporosis
For people with osteoporosis, even minor trauma – such as coughing, knocks on the limbs and simple falls – can lead to fractures. Falls are a particular problem in the elderly as they are often more likely to result in fractures, particularly of the hip. Any fracture occurring from minimal trauma should be investigated as it may indicate underlying osteoporosis.

There are several ways to reduce your risk of falls. It may be necessary to see a physiotherapist and/or occupational therapist to provide assistance with walking aides and ensure your home environment is safe. Talk with your doctor or contact your community health centre to find the services you need.

Things to remember

• Osteoporosis occurs when bones lose their density and strength.

• A healthy lifestyle throughout life (adequate dietary calcium and regular physical activity) can help prevent osteoporosis.

• Oestrogen replacement helps maintain bone density in women with premature menopause.

Disability - fibre and constipation

Some people with disabilities suffer from constipation. Contributing factors can include the medications that they may take, low levels of physical activity, insufficient fluids and a diet that may be too low in fibre. Increasing the amount of fibre in the diet not only treats constipation but also lowers cholesterol, may reduce the risk of various cancers and bowel diseases, and improves general health and well-being

Two main types of fibre
The two broad categories of fibre include:

• Soluble fibre - softens the faeces by absorbing water and helps slow the rate of digestion and lower blood cholesterol and blood glucose. It is found in a range of foods including legumes, fruits, vegetables and oat bran

• Insoluble fibre - helps prevent constipation and other associated disorders, such as haemorrhoids, by adding bulk to the faeces and making the food products pass more quickly through the bowel. It is found in a range of foods including wheat bran and wholegrain cereals and breads.

Fibre keeps the digestive system healthy
Fibre:

• Encourages the passage of food and wastes through the digestive system (peristalsis).

• Reduces the risk of bowel diseases such as chronic constipation, diverticulitis and irritable bowel syndrome.

• May reduce the risk of various cancers, particularly those of the bowel.

Fluid is also important
Fibre can only help to relieve constipation if there is enough fluid in the diet for it to be able to do its work. Fibre absorbs water to produce a soft and bulky stool. Everyone should drink at least 2 litres of water each day, particularly in hot weather. Some people with a disability may need to be reminded to drink regularly. Water is the best drink.

Inactivity can cause constipation
Some people with a disability have conditions that affect their mobility, and this can also be a reason why a person is constipated. A person with a disability needs to be as active as possible each day, as every little bit of regular exercise helps.

Fibre can help with other health problems
A diet rich in fibre can help in many ways, including:

• Weight management - obesity increases the risk of a range of health problems, including diabetes and heart disease. Fibre is key to healthy weight management. Since it is indigestible, it provides a sensation of fullness without the kilojoules.

• Atherosclerosis - high blood cholesterol is a contributing factor in the development of atherosclerosis (narrowing of the arteries), which can cause a range of health problems including high blood pressure and heart disease. Soluble fibre (such as legumes, fruits and vegetables) helps to reduce blood cholesterol.

• Diabetes - a diet high in soluble fibre is digested and absorbed more slowly, which leads to lower blood glucose levels.

How much fibre?
Dietitians generally recommend about 30g of fibre every day. Packaged foods such as breads and cereals include nutrition information labels, which can help you to calculate your fibre intake, and nutrition books often include fibre charts. A dietitian can provide information to individuals on the type and quantities of foods that need to be eaten to achieve 30g of daily fibre in the diet each day. Examples of the fibre content in some foods include:

• Four slices of wholemeal bread - about 7g

• Half a cup of baked beans - about 7g

• Two medium pieces of fruit - about 6g.

General cautions
Changes to eating habits should be made with some care. For example:

• A sudden increase in dietary fibre can upset the digestive system and cause symptoms including flatulence (gas) and abdominal pain. It is better to slowly increase the amount of fibre in the diet over a period of several weeks.

• Diets that are too high in fibre can hinder the absorption of certain minerals including iron, zinc and calcium. Avoid consuming more than 35g of fibre per day.

• Do not use fibre supplements unless you have checked with your doctor or dietitian, since these products can aggravate or cause constipation, particularly if you don’t drink enough fluids. Some people with a disability have swallowing problems. Many fibre supplements thicken when added to fluid and this may cause a person with swallowing problems to choke.

• It is important to drink sufficient fluids. It may be helpful to always include a glass of water at each meal or snack.

Things to remember

• Some people with a disability suffer from constipation.

• Contributing factors can include medications, low levels of physical activity, insufficient fluids and a diet that is low in fibre.

• Dietitians generally recommend about 30g of fibre every day.

No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by avoiding or including certain foods or supplements. Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints. Everyone with arthritis can benefit from eating a healthy, well-balanced diet to maintain general good health.

Some conditions may be helped by dietary changes. For example, people with inflammatory conditions such as rheumatoid arthritis seem to benefit from an increased intake of omega-3 fats, found in oily fish such as sardines and salmon, while gout sufferers may benefit from avoiding foods high in purines, including offal, shellfish and beer and drinking plenty of water.
Always seek the advice of your doctor or dietitian before changing your diet. You may be restricting your food intake unnecessarily or taking too much of products (such as mineral supplements) that may have no impact on your condition at all. Some supplements can also interact with other medications.

General recommendations
General dietary recommendations for a person with arthritis include:

• Eat a well-balanced diet. This will help to maintain general good health, and a healthy weight.

• Avoid crash dieting or fasting.

• Increase dietary calcium to reduce the risk of osteoporosis in later life.

• Drink plenty of non-alcoholic fluids.

• Keep your weight within the normal range. Excess bodyweight increases the stress on joints, especially weight-bearing joints such as the knee and hips.

Dietary modification for gout
Uric acid is a waste product that is normally excreted from the body in urine. Gout is a type of arthritis characterised by the build-up of uric acid in the joints (such as the big toe), which causes inflammation and pain.
It is believed that lowering uric acid levels through small changes in your diet may help reduce the chance of future gout attacks. These changes include:

• Restrict or avoid alcohol.

• Avoid binge drinking.

• Restrict or avoid offal meats, such as liver, kidneys and brains.

• Restrict or avoid shellfish, such as prawns and scallops.

• Restrict or avoid some sea foods including sardines, herrings, mackerel and anchovies.

• Restrict or avoid products containing yeast, such as beer and Vegemite.

• Drink plenty of non-alcoholic fluids.

• Avoid fasting or ‘crash’dieting

• Make sure you don’t overeat on a regular basis.

• Take your time when eating.

Omega-3 fats and Inflammation
Foods that contain omega-3 fats have been found to help reduce the inflammation associated with some forms of arthritis, such as rheumatoid arthritis. These effects are modest compared with medications, however they do not have side effects, and may also have other health benefits, such as reduced heart disease.

Foods rich in omega-3 fats include:

• Fish – oily fish such as salmon and sardines, have greater amounts of omega-3 fats

• Linseeds and linseed (flaxseed) oil

• Canola (rapeseed) oil

• Walnuts

• Foods fortified with omega-3, such as margarines and eggs

• Some fish oil supplements.

It is important not to confuse fish oils with fish liver oils (such as cod liver oil and halibut liver oil). Fish liver oils also contain vitamin A. Large amounts of vitamin A can cause serious side effects. Ask your doctor before taking any supplements, to ensure the correct dosage.

Other supplements
The supplements glucosamine and chondroitin are popular – yet evidence about their success in treating arthritis is limited.

Studies show that glucosamine and chondroitin, taken either separately or in combination, may relieve pain for people with osteoarthritis where there has been a breakdown of cartilage. There is no evidence that these supplements are effective for any other forms of arthritis.

Glucosamine and chondroitin may interact with other medications, including warfarin, and should only be taken after consultation with your doctor.

Obesity may worsen arthritis symptoms
If you are overweight or obese, the extra load on your joints may be exacerbating your arthritis symptoms, especially if your affected joints include those of the hip, knee or spine. There is also a clear link between being overweight and an increased risk of developing osteoarthritis.

To lose excess weight you must be active, but this can be difficult for people with arthritis due to pain or stiffness. See your doctor, dietitian or health professional for information and advice.

Current evidence for dietary cures is sparse
Gout can be helped by avoiding some foods. However, there is no substantial scientific evidence that other forms of arthritis can be helped by avoiding particular foods, unless that person has specifically shown intolerance to them.
There is no evidence that acidic foods such as lemons, tomatoes, potatoes and eggplants or dairy foods trigger arthritis symptoms. These foods all contain important nutrients and avoiding them may be a health risk.

Tips for managing arthritis and diet
If you think a particular food may aggravate your arthritis, it can help to keep a diary of your food intake and symptoms. After a month, you may have some idea about which food could be provoking symptoms. Discuss these results with your doctor or a dietitian.
Don’t cut whole food groups from your diet – for example, all dairy products – without talking to your doctor, as you may miss out on important vitamins and minerals.

Remember that remission may be coincidental
The symptoms of arthritis, particularly the inflammatory types, can change for no apparent reason. Don’t assume any improvement in your symptoms is due to what you eat or avoid. Be guided by your health professional.

Things to remember

• Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints.

• No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by dietary changes.

• Fish oil can ease the symptoms of inflammatory types of arthritis, such as rheumatoid arthritis.

• The symptoms of gout can be eased by avoiding alcohol and offal meats, and by drinking plenty of water.