Our bodies can obtain vitamin D from diet and make it from sun exposure. Even with these two routes for obtaining vitamin D, however, inadequate vitamin D is common, and deficiencies can be found on all continents, in all ethnic groups, and across all ages—a major concern, given the many ways that vitamin D helps protect our health. (1) There are a number of factors that increase the risk of having inadequate vitamin D, among them, lifestyle, sunscreen use, geographic location, skin tone, age, and body weight.

• Lifestyle: People who spend less time outdoors, or who cover up with clothing when they are outdoors, get less exposure to the sun, so they make less vitamin D. (1)
• Sunscreen Use: Correctly-applied sunscreen blocks the harmful ultraviolet B rays that cause skin cancer, but it also blocks most of the skin’s production of vitamin D. So people who use sunscreen daily are more likely to be low in vitamin D. (1) But don’t ditch the sunscreen: The American Academy of Dermatologists says that sunlight exposure to unprotected skin increases the risk of skin cancer, and that there’s no safe level of sunlight exposure that allows you to make vitamin D without increasing skin cancer risk. Their advice? Use sunscreen or other sun protection daily, skip the tanning booths, and get your vitamin D from diet or supplements. (2) Some Vitamin D experts take issue with the American Academy of Dermatologists’ hard line on sun exposure, and they recommend a more moderate option: Put sunscreen on your face, and allow your arms and legs to get a small amount of unprotected sun exposure—say, 15 minutes max—before applying sunscreen or covering up. It’s still a matter of scientific debate.
• Geographic Location and Season: In the summer, if you sat out in a bathing suit on a sunny afternoon for long enough to turn your skin slightly pink, you could make plenty of vitamin D. Yet during the late autumn and winter, people who live at higher latitudes produce little or no vitamin D from the sun, because the sun is at too low an angle in the sky. In the northern hemisphere, people who live in Boston (U.S.), Edmonton (Canada), and Bergen (Norway) can’t make enough vitamin D from the sun for 4, 5, and 6 months out of the year. (3) In the southern hemisphere, residents of Buenos Aires (Argentina) and Cape Town (South Africa) can make far less vitamin D from the sun during their winter months (June through August) than they can during their spring and summer. (3) The body stores vitamin D from summer sun exposure, but it must last for many months. By late winter, many people in these higher-latitude locales are deficient. (1)
• Skin Tone: People who have a darker skin tone have more melanin in their skin, and this pigment is a “natural sunscreen” that slows down skin production of vitamin D. (3)  This the main reason why African Americans are more likely to be low in vitamin D. (4)
• Age: The ability to make vitamin D in the skin drops as we age, and is one of the reasons why older individuals are more likely to have low vitamin D levels. (1)
• Body Weight: People with excess body fat have lower vitamin D levels, so those who are overweight or obese have a higher risk of having inadequate vitamin D.  (1, 5, 6)

The bottom line: Low vitamin D can be found in all ethnic and age groups, around the world, for a host of reasons. Even if you are taking a standard multiple vitamin, the amount of vitamin D in most vitamins (400 IU) is not enough to prevent low blood levels. If you suspect that you are at risk of vitamin D deficiency, you can ask your physician to order a blood test for vitamin D.

Legumes play an important role in traditional diets in many parts of the world. They are low in fat, are good sources of protein and fiber, and contain a variety of micronutrients and phytoestrogens (plant estrogens). Phytoestrogens have received a lot of attention for their ability to fight not only cancer, but also heart disease and osteoporosis. They help balance hormones in the body and thus are thought to be particularly valuable for the hormone-dependent cancers: breast cancer and prostate cancer. It is well known that male hormones play a role in prostate cancer development.

Despite their advantages, legumes play a minor role in most Western diets. The typical Western based diet (lower in vegetables and legumes and higher in animal-based foods) can cause an increase in both male and female hormones (androgens and estrogens), while a plant-based diet tends to lower these hormones. This is the basis for the role of diet in the development of hormone-dependent cancers.

Soy foods, such as tofu, soy milk, soy beans, and vegetarian burgers, seem to be particularly rich in cancer-fighting properties. This is at least partially due to a form of phytoestrogen, called isoflavones, that is found primarily in soy. It appears to help prevent prostate cancer by binding to male hormone receptors in the prostate, thus reducing the stimulating effect of male hormones on prostate cell growth.

Epidemiological studies have shown that high levels of isoflavones are often associated with low rates of breast, colon, and prostate cancer. This has been used to explain why countries such as Japan and China that typically consume large amounts of soy have lower risks of these diseases.

The difficulty with consuming soy for reducing risk of prostate cancer is the lack of clinical trial evidence to support its use. As with any dietary component, it is difficult to isolate the effect of a particular food type to prove its effectiveness. One prospective study, including over 12,000 men, did evaluate consumption of soy milk. It found that those who drank soy milk regularly had a reduced risk of prostate cancer. The relationship held up after other factors were controlled for. Other studies need to be done to further establish the benefits of soy. In the meantime, getting more soy foods into your diet can be healthy for many reasons, and lowering your risk of prostate cancer may be one of these.

The prostate gland depends on testosterone for growth and development. Prostate cells, both noncancer and cancer, do too. This is why prostate cancer is sometimes referred to as a hormone-dependent cancer. Higher levels of circulating testosterone lead to higher concentrations in the prostate, and this appears to increase the risk of clinically significant prostate cancer. However, higher testosterone levels are not consistently found in prostate cancer patients, so there is more to the relationship.

A possible protective role of exercise has been proposed based on its ability to lower testosterone levels and to boost the immune system. Exercise causes a temporary reduction in testosterone, so regular exercise can reduce long-term exposure to testosterone. And chronic exercise has been shown to increase the number and activity of natural killer cells, which are part of the immune system that attack cancer cells.

Based on these effects, it seems that exercise should be beneficial, but the evidence concerning the impact of exercise on prostate cancer risk is inconclusive. In a review of 17 epidemiological studies of varying quality, 9 showed a beneficial effect, 5 no effect, and the other 3 actually showed an increased risk related to exercise or physical activity. None of the studies, however, provided conclusive proof, but taken together, they seem to support a weak beneficial effect of regular exercise on prostate cancer risk.

The challenge is proving that men who exercise regularly develop less prostate cancer when all other factors are the same. This requires a prospective long-term randomized study, and this probably will never be done. The best long-term prospective studies that looked at habitual physical activity in adulthood are encouraging, however.

A study of nearly 18,000 alumni of Harvard University showed that those who maintained a high level of physical activity were about half as likely to develop prostate cancer after the age of 70 as those who were least active. Another prospective study evaluated the level of physical fitness, as well as physical activity, on the risk of prostate cancer. Higher fitness levels were associated with lower risk in men under 60, but not in older men. And men who expended more than 1,000 kcal per week in exercise had lower risk than those who did not get this much exercise. The best long-term study of men's health is the Health Professionals Follow-up Study. It began in 1986 and has followed over 47,000 men in various health occupations since then. Data was collected in the beginning, and periodically through the study, on many factors including physical activity. The only positive result through 1994 was that at least 3 hours per week of vigorous physical activity was associated with a reduced risk of metastatic prostate cancer. But no relationship was observed between physical activity and the incidence of total or advanced prostate cancer. The same study, however, found an inverse relation between physical activity and BPH, more activity meant a lower likelihood of urinary symptoms or surgery for BPH. Walking 2–3 hours per week was enough to lower the risk of BPH.

The bottom line is that questions remain about the relation between exercise and prostate cancer, but there is no question that regular exercise is good for general health. So, it is wise to get some moderate exercise on most days of the week, and you may be protecting yourself from prostate problems, too.

Vitamin D Deficiency: A Global Concern

If you live north of the line connecting San Francisco to Philadelphia and Athens to Beijing, odds are that you don’t get enough vitamin D. The same holds true if you don’t get outside for at least a 15-minute daily walk in the sun. African-Americans and others with dark skin, as well as older individuals, tend to have much lower levels of vitamin D, as do people who are overweight or obese.

Worldwide, an estimated 1 billion people have inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. (1-3)  Indeed, in industrialized countries, doctors are even seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification. (4-6)

Why are these widespread vitamin D deficiencies of such great concern? Because research conducted over the past decade suggests that vitamin D plays a much broader disease-fighting role than once thought.

Being “D-ficient” may increase the risk of a host of chronic diseases, such as osteoporosis, heart disease, some cancers, and multiple sclerosis, as well as infectious diseases, such as tuberculosis and even the seasonal flu.

Currently, there’s scientific debate about how much vitamin D people need each day. The Institute of Medicine, in a long-awaited report released on November 30, 2010 recommends tripling the daily vitamin D intake for children and adults in the U.S. and Canada, to 600 IU per day. (7) The report also recognized the safety of vitamin D by increasing the upper limit from 2,000 to 4,000 IU per day, and acknowledged that even at 4,000 IU per day, there was no good evidence of harm. The new guidelines, however, are overly conservative about the recommended intake, and they do not give enough weight to some of the latest science on vitamin D and health. For bone health and chronic disease prevention, many people are likely to need more vitamin D than even these new government guidelines recommend.

Vitamin D Sources and Function

Vitamin D is both a nutrient we eat and a hormone our bodies make. Few foods are naturally rich in vitamin D, so the biggest dietary sources of vitamin D are fortified foods and vitamin supplements. Good sources include dairy products and breakfast cereals (both of which are fortified with vitamin D), and fatty fish such as salmon and tuna.

The body also manufactures vitamin D from cholesterol, through a process triggered by the action of sunlight on skin, hence its nickname, “the sunshine vitamin.”  Yet some people do not make enough vitamin D from the sun, among them, people who have a darker skin tone, who are overweight, who are older, and who cover up when they are in the sun. (1)

Correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent. (8) And not all sunlight is created equal: The sun’s ultraviolet B (UVB) rays—the so-called “tanning” rays, and the rays that trigger the skin to produce vitamin D—are stronger near the equator and weaker at higher latitudes. So in the fall and winter, people who live at higher latitudes (in the northern U.S. and Europe, for example) can’t make much if any vitamin D from the sun. (8)

Vitamin D helps ensure that the body absorbs and retains calcium and phosphorus, both critical for building bone. Laboratory studies show that vitamin D can reduce cancer cell growth and plays a critical role in controlling infections. Many of the body’s organs and tissues have receptors for vitamin D, and scientists are still teasing out its other possible functions.

New Vitamin D Research: Beyond Building Bones

Several promising areas of vitamin D research look far beyond vitamin D’s role in building bones. And, as you might expect, the news media release a flurry of reports every time another study links vitamin D to some new ailment. These reports can be confusing, however, because some studies are stronger than others, and any report needs to be interpreted in the light of all other evidence. More answers may come from randomized trials, such as the VITamin D and OmegA-3 TriaL (VITAL), which will enroll 20,000 healthy men and women to see if taking 2,000 IU of vitamin D or 1,000 mg of fish oil daily lowers the risk of cancer, heart disease, and stroke.

Here, we provide an overview of some of the more promising areas of vitamin D research, highlighting the complex role of vitamin D in disease prevention—and the many unanswered questions that remain.

Vitamin D and Bone and Muscle Strength

Several studies link low vitamin D levels with an increased risk of fractures in older adults, and they suggest that vitamin D supplementation may prevent such fractures—as long as it is taken in a high enough dose. (9-13)

A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit. (13)

Vitamin D may also help increase muscle strength, which in turn helps to prevent falls, a common problem that leads to substantial disability and death in older people. (14-16)  Once again, vitamin D dose matters: A combined analysis of multiple studies found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent, but taking 200 to 600 IU per day did not offer any such protection. (17)

A recent vitamin D trial drew headlines for its unexpected finding that a very high dose of vitamin D increased fracture and fall risk in older women. (18) The trial’s vitamin D dose—500,000 IU taken in a once-a-year pill—was much higher than previously tested in an annual regimen. After up to 5 years of treatment, women in the vitamin D group had a 15 percent higher fall risk and a 26 percent higher fracture risk than women who received the placebo.

It’s possible that giving the vitamin D in one large dose, rather than in several doses spread throughout the year, led to the increased risk. (18) The study authors note that only one other study—also a high-dose, once-a-year regimen—found vitamin D to increase fracture risk; no other studies have found vitamin D to increase the risk of falls. Furthermore, there’s strong evidence that more moderate doses of vitamin D taken daily or weekly protect against fractures and falls—and are safe.

So what is the significance of this study for people who want to take vitamin D supplements? A reasonable conclusion would be to continue taking moderate doses of vitamin D regularly, since these have a strong safety record, but to avoid extremely high single doses. This recent finding does present a challenge to scientists who will work to understand why the extreme single dose appears to have adverse effects.

Vitamin D and Heart Disease

The heart is basically a large muscle, and like skeletal muscle, it has receptors for vitamin D. (19) So perhaps it’s no surprise that studies are finding vitamin D deficiency may be linked to heart disease. The Health Professional Follow-Up Study checked the vitamin D blood levels in nearly 50,000 men who were healthy, and then followed them for 10 years. (20) They found that men who were deficient in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have found that low vitamin D levels were associated with higher risk of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. (21-24) How exactly might vitamin D help prevent heart disease? There’s evidence that vitamin D plays a role in controlling blood pressure and preventing artery damage, and this may explain these findings. (25) Still, more research is needed before we can be confident of these benefits.

Vitamin D and Cancer

Nearly 30 years ago, researchers noticed an intriguing relationship between colon cancer deaths and geographic location: People who lived at higher latitudes, such as in the northern U.S., had higher rates of death from colon cancer than people who live closer to the equator. (26) Many scientific hypotheses about vitamin D and disease stem from studies that have compared solar radiation and disease rates in different countries. These can be a good starting point for other research but don’t provide the most definitive information. The sun’s UVB rays are weaker at higher latitudes, and in turn, people’s vitamin D levels in these high latitude locales tend to be lower. This led to the hypothesis that low vitamin D levels might somehow increase colon cancer risk. (2)

Since then, dozens of studies suggest an association between low vitamin D levels and increased risks of colon and other cancers. (1,27)  The evidence is strongest for colorectal cancer, with most (but not all) observational studies finding that the lower the vitamin D levels, the higher the risk of these diseases. (28-38) Vitamin D levels may also predict cancer survival, but evidence for this is still limited. (27) Yet finding such associations does not necessarily mean that taking vitamin D supplements will lower cancer risk.

The VITAL trial will look specifically at whether vitamin D supplements lower cancer risk. It will be years, though, before it releases any results. It could also fail to detect a real benefit of vitamin D, for several reasons: If people in the placebo group decide on their own to take vitamin D supplements, that could minimize any differences between the placebo group and the supplement group; the study may not follow participants for a long enough time to show a cancer prevention benefit; or study participants may be starting supplements too late in life to lower their cancer risk. In the meantime, based on the evidence to date, 16 scientists have circulated a “call for action” on vitamin D and cancer prevention: (27) Given the high rates of vitamin D deficiency in North America, the strong evidence for reduction of osteoporosis and fractures, the potential cancer-fighting benefits of vitamin D, and the low risk of vitamin D supplementation, they recommend widespread vitamin D supplementation of 2000 IU per day. (27)

Vitamin D and Immune Function

Vitamin D’s role in regulating the immune system has led scientists to explore two parallel research paths: Does vitamin D deficiency contribute to the development of multiple sclerosis, type 1 diabetes, and other so-called “autoimmune” diseases, where the body’s immune system attacks its own organs and tissues? And could vitamin D supplements help boost our body’s defenses to fight infectious disease, such as tuberculosis and seasonal flu? This is a hot research area and more findings will be emerging.

Vitamin D and Multiple Sclerosis: Multiple sclerosis (MS) rates are much higher far north (or far south) of the equator than in sunnier climes, and researchers suspect that chronic vitamin D deficiencies may be one reason why. One prospective study to look at this question found that among white men and women, those with the highest vitamin D blood levels had a 62 percent lower risk of developing MS than those with the lowest vitamin D levels. (39) The study didn’t find this effect among black men and women, most likely because there were fewer black study participants and most of them had low vitamin D levels, making it harder to find any link between vitamin D and MS if one exists.

Vitamin D and Type 1 Diabetes: Type 1 diabetes is another disease that varies with geography—a child in Finland is about 400 times more likely to develop it than a child in Venezuela. (40) Evidence that vitamin D may play a role in preventing type 1 diabetes comes from a 30-year study that followed more than 10,000 Finnish children from birth: Children who regularly received vitamin D supplements during infancy had a nearly 90 percent lower risk of developing type 1 diabetes than those who did not receive supplements. (41)  Other European case-control studies, when analyzed together, also suggest that vitamin D may help protect against type 1 diabetes. (42) No randomized controlled trials have tested this notion, and it is not clear that they would be possible to conduct.

Vitamin D, the Flu, and the Common Cold: The flu virus wreaks the most havoc in the winter, abating in the summer months. This seasonality led a British doctor to hypothesize that a sunlight-related “seasonal stimulus” triggered influenza outbreaks. (43) More than 20 years after this initial hypothesis, several scientists published a paper suggesting that vitamin D may be the seasonal stimulus. (44) Among the evidence they cite:

• Vitamin D levels are lowest in the winter months. (44) 
• The active form of vitamin D tempers the damaging inflammatory response of some white blood cells, while it also boosts immune cells’ production of microbe-fighting proteins. (44) 
• Children who have vitamin D-deficiency rickets are more likely to get respiratory infections, while children exposed to sunlight seem to have fewer respiratory infections. (44) 
• Adults who have low vitamin D levels are more likely to report having had a recent cough, cold, or upper respiratory tract infection. (45)

A recent randomized controlled trial in Japanese school children tested whether taking daily vitamin D supplements would prevent seasonal flu. (46) The trial followed nearly 340 children for four months during the height of the winter flu season. Half of the study participants received pills that contained 1,200 IU of vitamin D; the other half received placebo pills. Researchers found that type A influenza rates in the vitamin D group were about 40 percent lower than in the placebo group; there was no significant difference in type B influenza rates. This was a small but promising study, and more research is needed before we can definitively say that vitamin D protects against the flu. But don’t skip your flu shot, even if vitamin D has some benefit.

Vitamin D and Tuberculosis: Before the advent of antibiotics, sunlight and sun lamps were part of the standard treatment for tuberculosis (TB). (47) More recent research suggests that the “sunshine vitamin” may be linked to TB risk. Several case-control studies, when analyzed together, suggest that people diagnosed with tuberculosis have lower vitamin D levels than healthy people of similar age and other characteristics. (48)   Such studies do not follow individuals over time, so they cannot tell us whether vitamin D deficiency led to the increased TB risk or whether taking vitamin D supplements would prevent TB. There are also genetic differences in the receptor that binds vitamin D, and these differences may influence TB risk. (49) Again, more research is needed. (49)

Vitamin D and Risk of Premature Death

A promising report in the Archives of Internal Medicine suggests that taking vitamin D supplements may even reduce overall mortality rates: A combined analysis of multiple studies found that taking modest levels of vitamin D supplements was associated with a statistically significant 7 percent reduction in mortality from any cause. (50) The analysis looked at the findings from 18 randomized controlled trials that enrolled a total of nearly 60,000 study participants; most of the study participants took between 400 and 800 IU of vitamin D per day for an average of five years. Keep in mind that this analysis has several limitations, chief among them the fact that the studies it included were not designed to explore mortality in general, or explore specific causes of death. More research is needed before any broad claims can be made about vitamin D and mortality. (51)

Remember when a total cholesterol reading of under 200 was the standard for judging cardiovascular health? Today, of course, we know that it's the components of cholesterol (LDL, HDL, the size of those cholesterol particles, and triglycerides) that are much more predictive of heart health. Well, our understanding of total weight and its effects upon your heart has evolved in similar fashion. It's not your total weight but the characteristics of that weight—how much is fat and where it's deposited—that matter most.

Surprised? Thank the scientists at the Mayo Clinic, who are behind this recent discovery. After comparing various health markers with the weights and body mass index numbers of thousands of adults, they found that more than half of those with normal weights and BMIs actually had "high body-fat percentages as well as heart and metabolic disturbances." In other words, they had the same risks of coronary disease, diabetes, and other chronic illness as people who weighed much more.

This research, and its sobering implications for millions of Americans, led to the establishment of a new condition called normal weight obesity (NWO). This is more than just the latest fat phobia. It's worth paying attention to because the accumulation of fat in the body, especially in the belly and around internal organs, causes low-level inflammation that gradually damages tissue and blood vessels. (Think of it as metabolic rust.) So even though your weight or BMI may be within acceptable limits for your height and age, don't be lulled into a false sense of security. Do your own analysis, starting with these steps:

1. Stop being preoccupied with pounds. As with total cholesterol, total weight is just one general assessment of your health. Yes, people who are trying to lose weight are more likely to succeed if they weigh themselves often. But seeing numbers that are within a healthy BMI range may actually disguise your heart disease risk. Keep them in perspective.

2. Measure your body fat. For a quick estimate of this key factor, wrap a cloth measuring tape around your naked waist just above your belly button. If your weight is fairly normal but the number you see above your navel is 35 inches or more (40+ inches for men), you may have NWO. For a more exact reading, ask your doctor (or health club) to measure your body fat. This can be done using a variety of noninvasive methods. If it's higher than 30 percent (20 percent for men), you likely have NWO.

3. Get a blood test. Ask your doctor to order a thorough blood analysis at your next physical. Warning signs of NWO include low HDL (total cholesterol and LDL may be normal), along with elevated triglycerides, blood sugar, and blood pressure.

4. Target belly fat. If you're diagnosed with NWO, take aim at visceral fat. Despite how entrenched it may seem, you can lose it. The keys are: Avoid the white stuff (white bread, rice, pasta, and other refined carbohydrates). Add monounsaturated fats, which target belly fat, to your diet. And do interval exercises to burn more fat and strength-training to build lean body mass.

5. Keep tracking fat. Just as you hop on the scale to keep tabs on your weight, do the same with your body fat. Have it measured periodically at your doctor's office or health club. Or just observe the notches where your belt buckles.

Conversely, if you're considered overweight by current standards, there may be some good news here. If your body-fat percentage is lower than 30 percent (20 percent for men) and your blood chemistry is normal, then you are among the "fat and fit." (Many athletes are in this category.) Continue to eat smart and exercise, but accept your body for what it is and know you're not unhealthy because of it. Feeling fat and feeling healthy are no longer mutually exclusive.

More Heart-Healthy Advice

Staying hydrated is one simple way to keep blood pressure in the safe zone.

Boston, MA – Men who do weight training regularly—for example, for 30 minutes per day, five days per week—may be able to reduce their risk of type 2 diabetes by up to 34%, according to a new study by Harvard School of Public Health (HSPH) and University of Southern Denmark researchers. And if they combine weight training and aerobic exercise, such as brisk walking or running, they may be able to reduce their risk even further—up to 59%.

This is the first study to examine the role of weight training in the prevention of type 2 diabetes. The results suggest that, because weight training appears to confer significant benefits independent of aerobic exercise, it can be a valuable alternative for people who have difficulty with the latter.  

The study will be published online in Archives of Internal Medicine on August 6, 2012. 

“Until now, previous studies have reported that aerobic exercise is of major importance for type 2 diabetes prevention,” said lead author Anders Grøntved, visiting researcher in the Department of Nutrition at HSPH and a doctoral student in exercise epidemiology at the University of Southern Denmark. “But many people have difficulty engaging in or adhering to aerobic exercise. These new results suggest that weight training, to a large extent, can serve as an alternative to aerobic exercise for type 2 diabetes prevention.” 

Type 2 diabetes is a major public health concern and it’s on the rise. An estimated 346 million people worldwide have type 2 diabetes, and diabetes-related deaths are expected to double between 2005 and 2030, according to the World Health Organization. More than 80% of these deaths occur in low- and middle-income countries. 

The researchers, including senior author Frank Hu, professor of nutrition and epidemiology at HSPH, followed 32,002 men from the Health Professionals Follow-up Study from 1990 to 2008. Information on how much time the men spent each week on weight training and aerobic exercise came from questionnaires they filled out every two years. The researchers adjusted for other types of physical activity, television viewing, alcohol and coffee intake, smoking, ethnicity, family history of diabetes, and a number of dietary factors. During the study period, there were 2,278 new cases of diabetes among the men followed. 

The findings showed that even a modest amount of weight training may help reduce type 2 diabetes risk. The researchers categorized the men according to how much weight training they did per week—between 1 and 59 minutes, between 60 and 149 minutes, and at least 150 minutes—and found that the training reduced their type 2 diabetes risk by 12%, 25%, and 34%, respectively, compared with no weight training. Aerobic exercise is associated with significant benefits as well, the researchers found—it reduced the risk of type 2 diabetes by 7%, 31%, and 52%, respectively, for the three categories above. 

The researchers also found that the combination of weight training and aerobic exercise confers the greatest benefits: Men who did more than 150 minutes of aerobics as well as at least 150 minutes of weight training per week had a 59% reduced risk of type 2 diabetes. 

Grøntved said that further research is needed to confirm the results of the study as well as to analyze whether or not the findings can be generalized to women. 

“This study provides clear evidence that weight training has beneficial effects on diabetes risk over and above aerobic exercise, which are likely to be mediated through increased muscle mass and improved insulin sensitivity,” said Hu. “To achieve the best results for diabetes prevention, resistance training can be incorporated with aerobic exercise.” 

Other HSPH authors included Eric Rimm, associate professor in the Departments of Epidemiology and Nutrition, and Walter Willett, Frederick John Stare Professor of Epidemiology and Nutrition and chair of the Department of Nutrition. 

Support for the study was provided by the National Institutes of Health (DK58845 and CA55075). 

“A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men,” Anders Grøntved, Eric B. Rimm, Walter C. Willett, Lars B. Andersen, Frank B. Hu, Archives of Internal Medicine, online August 6, 2012.

Sports massage is a form of massage therapy that is tailored to treat the needs of athletes. The use and application of specific techniques is the foundation of sports massage, yet what distinguishes it from other modalities is the intention behind the therapy. Many of us might think of massage as relaxing and holistic. Sports massage, in contrast, is designed to achieve specific goals, such as increasing performance or treating or preventing injury. The purpose of a sports massage session can vary, depending upon numerous factors that are unique to each athlete. For instance, sports massage can be used effectively to treat conditions such as tendonitis, strains, sprains, and adhesions. It can also be used in conjunction with training schedules and conditioning programs to enhance performance, aid in recovery and reduce the potential for injuries.

The major applications of sports massage are recovery, remedial (to improve a debilitating condition), maintenance, and event (pre, inter, and post). An athlete can enhance his or her performance by knowing when to incorporate sports massage into a training routine. Healthy, injury-free muscles perform better, longer, and with less chance of injury.

Sports massage can help to optimize the positive factors that affect performance, such as healthy muscle and connective tissues, normal range of motion, high energy and fluid and pain-free movement, as well as inducing mental calm and improving alertness, and concentration. It also can help minimize negative factors such as dysfunctional muscle and connective tissue, restricted range of motion, low energy, staleness, pain, and high anxiety^(1a).

Sports massage decreases injury potential by helping to prevent acute injuries (muscle tears) as well as chronic injuries stemming from wear and tear (tendonitis). Regular massage allows the muscles and soft tissue to stay supple and healthy, lengthened and flexible and free from adhesions, thereby reducing the potential for injury. By increasing circulation and assisting the body’s healing processes and breaking down scar tissue and adhesions, sports massage can help chronic injuries get better.

Important Primary and Secondary Effects of Sports Massage^(1b)

Primary effects refer to the physiological and psychological condition of the athlete and include:

• Improved fluid circulation (blood, lymph),
• Muscular relaxation,
• General relaxation,
• Functional separation of muscle and connective tissue (i.e., breaking up adhesions),
• Connective tissue normalization (releasing areas of tension, etc.),
• Increased mental alertness and clarity, and
• Deactivation of trigger points. (A trigger point is a nodule of tight muscle tissue that can refer pain locally or to other areas of the body.)

Secondary effects refer to performance-related outcomes and include:

• Greater energy,
• Greater flexibility and range of motion,
• More fluid movement (i.e., referring to the quality of the range of motion),
• Faster recovery, and
• Pain reduction.

If you decide that sports massage is the right treatment for you, it is important to find a well-trained therapist. Check out if a practitioner has had training in sports massage from an accredited school. Currently, there is no national credentialing that signifies a person who has passed a test demonstrating a solid understanding of the foundations and techniques of sports massage, so you will have to ask a few questions. How many hours of training (in general) did they have? Was their school accredited by the American Massage Therapy Association? How many hours of training in sports massage did they receive? What kind of athletes have they worked with? Were the athletes training or competing at the time? Is your therapist an athlete (on any level)?

Many sports massage practitioners participate in races or competitive events, which increases their understanding not only of the uses and benefits of sports massage, but of other factors that go into being an athlete. For example, the length of time between the massage session and the athletic event directly relates to the depth of pressure a therapist should use. A knowledgeable therapist will know that a pre-event massage, which is meant to encourage general looseness, calls for less deep work than a regular “maintenance” massage. It is important that your therapist always errs on the side of caution when using deep pressure, and that they have an understanding of the psychology of an athlete and the physical demands of training.

One of the benefits of working regularly with the same sports massage therapist is that he or she can learn to feel what is “normal” for your tissue and body type and can keep a watchful eye on any changes that may signal the need to head off potential trouble spots. If an injury does occur, the therapist can join the team of health care practitioners helping you to recover. Here, the focus is on healing the injury quickly and effectively, minimizing the side effects of the injury and decreasing the chance of re-occurrence.

The use of sports massage in training routines varies depending on the athlete, the sport being trained for and the level of competition. It is important to mention that every athlete and every situation is going to be different, and that each person should research and find a plan that is most suitable for them. With that in mind, let’s take a look at how two different athletes used sports massage in conjunction with their training.

When Uta was competing in 5K to 10K races, or preparing for a marathon, she received sports massage twice a week. Usually, she scheduled her massages the day after one of her harder training sessions for the week. If that wasn’t possible, she would allow herself a treatment session on the same day as her hard workout, but she would wait at least 3 to 4 hours to let her body recover some from the training before addressing soft tissue needs. Getting regular massage during her intense training periods also helped Uta psychologically, by allowing her to give back to her body and take some time for herself.

Training for my first triathlon, I used sports massage regularly. I noticed that I could identify potential problems and head them off before they became an impediment in my training. I also felt, during the most intense training periods, that taking the time to give back to my body really helped me to feel like I was rounding out my training program. Having time to recover, making the effort to work my muscles and being in tune with my body, all played integral roles in my ability to train as hard as I did, without hurting myself.

Getting regular massages during training is a great way to generate feedback for yourself about how you are doing. The more feedback you can gather about performance and training, and how your body is responding to it all, the better informed you will be about how you can compete and recover from competition. Sports massage, therefore, can be a great tool for athletes in their training. It provides myriad benefits, including increasing performance potential, speeding recovery time, and reducing the prevalence of injuries. And let’s not forget the wonderful relaxation, stress relief, and whole body integration that everyone—not just the athlete—can obtain from massage!

About A.B.C.D.E.

Every child needs to learn the ABC’s of life. When it comes to establishing healthy habits, you can teach them how to “ABCDE” (Act Boldly to Change Diet and Exercise).

Why is this important?

• Good nutrition and plenty of exercise are the building blocks for strong growth, healthy development, and lifelong wellbeing for children.

• These days, too many children are not receiving the proper nutrition or enough exercise:

  • - They are not eating enough - an estimated 16 to 17 million children live in homes where they are at risk of going hungry (approx. 1 in 6 households).

  • - They are not eating enough healthy food – an estimated 1 in 3 children are overweight and about 1 in 6 (ages 6-17) are obese.

  • - They are not getting enough exercise – only 30% of children (aged 6 to 17) participated in 20 minutes plus of vigorous physical activity on a daily basis. Children need to get 60 minutes of exercise on a daily basis.

What are the benefits of good nutrition and daily exercise for kids?

Mental and behavioral benefits

• Good nutrition is essential to healthy brain development in children which is, of course, critical to learning.

• Children who exercise regularly and eat healthily are likely to:

  • - perform better academically 

  • - feel better about themselves, their bodies, and their abilities

  • - cope with stress and regulate their emotions better

  • - avoid feelings of low self-esteem, anxiety, and depression.

• Establishing healthy eating and exercise habits early in life can lead to long term healthy behavior in adulthood.

Physical benefits

• Children need a wide variety of nutrients (e.g., protein, complex carbohydrates, healthy fats, minerals, vitamins) to assist in their daily growth and development and to protect them from childhood illnesses.

• Daily exercise also helps children to build stronger muscles and bones and limit excess body fat.

• Healthy eating also cuts down on risk for cavities, eating disorders and unhealthy weight control behaviors (i.e., fasting, skipping meals, eating very little food, vomiting, using diet pills, laxatives, or diuretics), malnutrition, and iron deficiency.

• Healthy eating and consistent physical activity help to prevent chronic illnesses that appear in adulthood associated with obesity, e.g., heart disease, diabetes, high blood pressure, and several forms of cancer.

What are the effects of different settings on the eating and exercise habits of kids?

In the home:

• Lack of access to healthy, wholesome foods and inadequate physical activity - contributes to kids becoming overweight and not getting adequate nutrition for their growth and development. Children need at least 60 minutes of daily physical activity in the form of physical play or sports.

• Hunger – kids who do not get enough to eat are at risk of developing chronic health conditions, behavioral problems, academic struggles, anxiety, depression, and even obesity especially if they only have access to poor quality processed food.

• Unhealthy weight control behaviors - have been found to co-occur with obesity. Many adolescents, particularly teenage girls, have body image concerns and engage in these behaviors threatening both their physical and mental health. 

• Media effects –

  • - Food advertising - targeted at children is dominated by commercials for unhealthy food (e.g., candy, sugary cereals, sugary beverages, processed snack foods, fast food restaurants). Food advertising is pervasive and can be found on multiple media platforms (TV, web, and even embedded in computer games).

  • - Advertising by other industries - often objectifies girls and women, contributing to body dissatisfaction, eating disorders, low self-esteem, and depression.

  • - TV watching – television viewing is linked to childhood obesity because it displaces physical activity, increases snacking behavior while watching, exposes kids to potentially harmful advertising, and reduces their resting metabolism.

At school:

• Risks to academic achievement - result from children not getting adequate nutrition and physical activity. Hunger can be particularly damaging to children’s progress in school and cognitive development overall.

• Overabundance of unhealthy foods - too many schools offer poor nutritional choices in the form of unhealthy school lunches or even vending machines filled with candy, processed snacks, and sugary beverages.

• Lack of opportunities for physical activity - many schools have scaled back requirements for a daily recess and do not prioritize physical education opportunities for children at every age.

• Peer behaviors – peers can serve as remarkably powerful role models for children and may share their unhealthy eating or exercise habits with them.

• Stigma of being overweight – can lead to social and psychological distress (e.g., depression, low self esteem). Bullying and teasing from peers can be particularly damaging and teachers and school staff may attribute less desirable personality characteristics to obese youth and their families.

In the neighborhood:

• Overabundance of unhealthy foods – there are a growing number of communities called “food deserts” where supermarkets and grocery stores are scarce or charge higher prices for healthy foods than processed foods. In addition, many underserved communities are populated with fast food restaurants that are often located near schools and playgrounds.

• The built environment – lack of adequate and safe parks, bike lanes, playgrounds, recreational facilities, or walkways can restrict opportunities for children and teens to get exercise.

Why are you critical to establishing healthy behaviors in your kids?

• You are role models

  • - Children are instinctively primed to imitate their parents and caregivers. They are incredibly sensitive to the messages that are sent about eating and exercise. You exert the most influence on your children’s behavior and can model healthy attitudes and habits toward food and physical activity that persist as they grow up.

• You are gatekeepers

  • - Parents and caregivers control the types of food children have access to in the home and can maximize access to healthy, wholesome foods (fruits, vegetables, lean proteins, whole grains, and low-fat dairy).

  • - You can also monitor children’s diet, exercise, and limit media consumption (TV/video watching, web surfing, and videogames).

•  You are taste-setters

  • - Parents and caregivers significantly influence the likes and dislikes that children attach to certain foods. These influences can last a lifetime. Each of us can probably remember a favorite home cooked meal from our childhood. There is even research that suggests that this begins in infancy; children who are breastfed may be exposed to different flavors in their mother’s breast milk than the sugars and fats in infant formula. Breastfeeding may provide protection from the development of obesity.

  • - Eating with your children at regular family mealtimes can help establish positive nutrition habits and healthy weights for children.
    

• You are advocates

  • - Parents and caregivers can push local leaders to introduce affordable transportation (e.g., bus or shuttle lines) to supermarkets or grocery stores if there are none in their communities.

  • - You can call for the construction of parks or playgrounds and restriction of fast food places in your neighborhood.

  • - You can push school administrators to introduce after-school programs that incorporate physical activity or nutrition education, healthier school lunches, and policies that eliminate the use of vending machines on school grounds.

  • - You along with members of your community can volunteer to coach afterschool sports.

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.

When you decide on your favorite summer workouts—we discussed a few fun options in Part I—you can move on to organize everything so you stay healthy and well-hydrated during your fitness routine.

First of all, add extra care to how you prepare for your workouts. Make sure you are properly hydrated beforehand. Drink small amounts of water frequently, beginning two hours before you go out. I would not necessarily drink too much for 20 to 30 minutes prior to your start, though, because it can make you need to “go” while working out.

If you plan to work out for more than one hour, you might want to run with a water bottle belt, as many athletes do. You also could leave one or more water bottles on the course. If you decide on that strategy, it is best to stay on a loop course. This gives you a chance to replenish every few miles. And, if you want to be absolutely safe, ask a friend to join you on a bike. For bikers, use both your water bottles, and stay ahead of the game by stopping at any convenience store or gasoline station to fill-up your bottles before you need them again.

Listen to Your Body, Stay Healthy

Nothing is more important than listening to your body. If you do not feel well, please be very cautious. Before, during, and after your workouts, the first signs of a possible problem might be heavier breathing, an elevated heart rate, or losing concentration. Consider wearing a heart rate monitor—it can caution you before you run into trouble.

When you feel unwell, admit it to yourself early on and get out of the heat right away. Cool off with a cold towel, use ice cubes, and hydrate! Please, do not wait to see a physician if you do not feel better immediately. Be familiar with some of the early warning signs of overheating: dizziness, fainting, fatigue, hot skin and followed by chills, lack of perspiration, feeling thirsty, and elevated heart rate. If you stop sweating, you most likely are very dehydrated⁽¹⁾.

Also be careful after your workout. Take a dry shirt to put on after your run, and always take some fluid to drink. If you feel cold—even in summer, for example when you come from outside into an air-conditioned room while still wearing your wet workout clothes—change immediately into dry clothes. It may be summer, but you need to stay “warm” after your workouts to avoid weakening your immune system and maybe getting a cold.

For adequate protection, sunscreen, glasses, a summer hat, and a rain jacket are always good to have close by.

Hydrate Well Throughout the Day

It can be very warm and dry during the summer, so make sure you stay cool and hydrated at all times. There are some guidelines I would suggest, and one of my favorite is to keep a bottle of water or a sports drink close by. This will remind you to drink and get replenished with small amounts continuously and evenly spread out throughout the day.

Hydration is critical for many body functions, such as digestion, regulation of body temperature, and the circulatory processes that bring nutrients to the cells and transport waste from them. This is even more understandable when considering that our bodies are up to 75% water in total, depending on age and build, with blood being 83% water and the brain being 75 to 78% water. These are the levels when each of those organs work best⁽²⁾.

When you get dehydrated, every cell in your body suffers, causing you to feel less fit and fatigued⁽³⁾. This puts more stress on your body and makes you more prone to illness and disease. And you can be at risk of overheating, which can have terribly serious consequences—including being life-threatening.

For proper hydration, start with juice from a fresh squeezed lemon with lots of water first thing in the morning. It is good for re-hydration after your night’s sleep and also will help your body to detoxify.

And as mentioned earlier, drink enough before, if possible during, and right after your training. It is best to replenish within 30 minutes of finishing your workout—the so-called “recovery window.” I like to eat a big slice of water melon right after my training, it is a great source of water, antioxidants, and easily digested carbohydrates. In the following article “General Guidelines,” you can find more information on this topic.

A Few Thoughts on Summer Nutrition

Many people like to adjust their nutrition and take advantage of everything that is fresh and more available in the summer, like tasty fruits and vegetables. It is berry season—maybe you are lucky enough to be able to pick your own on a berry farm. Eat food that has high water content like melon, citrus fruits, berries, and vegetables.

Diluted fruit juices with 1 part juice and up to 2 parts water can help you to stay hydrated. The juice from sour cherries, for example, has many health benefits and can even support faster strength recovery for runners.

You also can try the many different kinds of unsweetened iced teas. My favorite flavor is mango.

Enjoy what you eat and make it tasty. Add some cool summer nutrition like different kinds of smoothies. Depending on the amount you make, they even can be served as an entire meal. Just add water, berries (like raspberries and blueberries), banana, whey protein, and some ice cubes into a blender. Mix it and enjoy. Or try a variation with mango or pineapple. And for more health benefits, add a teaspoon of ground flaxseeds.

There also are many delicious salad creations with great dressings. You could try a variety of citrus dressings. Other choices of salads include my favorites—fresh cucumber salad with dill and onions or a tomato salad with olives, feta, and basil.

Sashimi and sushi can be delightful lighter dinner fare when well-portioned. And when you prepare your meals, add more vegetables than pasta or potatoes. And how about cold summer soups like water cress and gazpacho?

And for all you BBQ lovers, here are some thoughts on “Healthier Grilling.” I hope you can enjoy many relaxing summer evenings with your family and friends.

Good luck for your summertime fitness!

Food safety outdoors
Food poisoning is a real risk when taking food outside the home. Taking food out of its regular environment such as the fridge, freezer, pantry or clean kitchen for long periods of time can mean a greater risk of contamination. Take extra care with packed lunches for work and school, picnics and eating outdoors, especially in warm weather.

Eating outdoors and the risk of food poisoning
Eating outdoors is a great way to enjoy the hot weather, but it can bring added risks because:
• Bacteria grow more easily when food is stored in the ‘temperature danger zone’ of between 5 °C and 60 °C.
• Facilities for cleaning and hand washing may be inadequate, and clean water is not always available.
• Food can be exposed to contamination from insects, pests, animals and dust.
High-risk foods Food poisoning bacteria grow more easily on some foods than others.
These high-risk foods include:
• Meat
• Poultry such as chicken and turkey
• Dairy products
• Eggs
• Smallgoods such as hams and salamis
• Seafood
• Cooked rice
• Cooked pasta
• Prepared salads like coleslaws, pasta salads and rice salads
• Prepared fruit salads.

Some people are more at risk
Some people are more at risk of getting food poisoning than others. Special care should be taken with their food. Vulnerable groups include:
• Pregnant women
• The elderly
• Young children
• People with chronic disease.

Home barbeques and outdoor cooking
Some practical hints for keeping food safe to eat when you have a barbeque at home are:
• Keep the meat in the fridge until you are ready to start cooking.
• Store raw meats and poultry separate from cooked items, and underneath other food so that raw juices do not contaminate other food.
• Cook food to at least 75 °C. Use a meat thermometer to check the final temperature. Using
a thermometer is the best way to ensure that meats are properly cooked. If you don’t have
one, you should cook poultry until the meat is white – there should be no pink flesh.
Similarly, if there is no thermometer, cook hamburgers, mince, sausages and other meats
right through until any juices run clear.
• Never buy cracked or dirty eggs and always thoroughly cook any food made from eggs.
• Use a clean plate for all cooked meats – don’t re-use the same plate or container that held
raw meats. Don’t use the same equipment used to cook raw food (such as tongs or forks)
to handle cooked food.
• Take salads, pates, dips and other perishables outside only when required, and return
them to the fridge when that part of the meal is finished.
• Throw out any high-risk food left in the temperature danger zone for more than four hours.
Don’t put it in the fridge and don’t leave it for later.
• Cover food and keep birds, insects and animals away from it.
Preparing food for outdoors
When planning a picnic, making packed lunches or preparing for any other occasion where you are
eating away from home, be aware of the basic food safety rule – keep hot foods hot and cold foods
cold. You should also:
• Store any raw meat in an insulated cooler, away from other food.
• Cut and prepare all meats and salads beforehand to reduce the need to handle foods when
you are outdoors.
• Place containers with raw meat or other high-risk foods into separate leak-proof containers
and then into a cooler.
• Make sure all cooked foods are completely cooled before you pack them in the cooler.
• Use plenty of ice or cold packs around the food. Frozen drinks can serve as icepacks,
especially in packed school lunches.
• Travel with the cooler on the floor of the car, out of sunlight. Cover the cooler with a
blanket for extra insulation.
Camping food safety tips
Perishable foods are generally unsuitable for camping unless you have access to a fridge. It is best
to take dry, UHT and canned products. Other tips for camping include:
• If you want to take some meat with you, frozen meats can be stored in a cooler with ice
bricks for up to two days and pre-cooked meals, such as frozen stews, for up to one day.
• Cover the cooler with a wet bag to promote evaporative cooling.
• Divide the food into meal-size portions and pack it according to when you plan to eat it so
that you can get what you need quickly.
• Make sure you cook or heat all food well, to at least 75 °C.
• Boil drinking water before use, or use disinfecting tablets.

General cleanliness tips
Cleanliness is always important, but it’s especially important when you’re preparing food outside the home.
Remember to:
• Wash your hands before and after handling raw foods. Wash your hands with clean water and soap, and dry them with clean towels or disposable towels.
• Consider using disposable wipes or a hand sanitiser if there is no safe water.
• Keep the outdoor area or campsite as clean as possible.
• Keep food sealed and covered – birds, insects and animals can be a source of food poisoning bacteria.

After years of denying the health benefits of sunlight, conventional researchers are finally starting to recognize the important role that ultraviolet light plays in human health. Getting sunlight on your skin, research now shows, is extremely important for preventing and even reversing chronic diseases. I'm talking about prostate cancer, breast cancer, cervical cancer, mental depression, osteoporosis and even, to some extent, type 2 diabetes. The interactions between sunlight and body chemistry for these diseases are quite complex, and I'm not going to go into them all here, but let me give you the highlights.

Vitamin D is essential for calcium absorption

First, you most likely already know the importance of calcium for your health. If you don't have enough calcium circulating through your blood, you're going to have cardiovascular problems and you will probably end up with heart disease. Calcium is crucial for healthy nervous system function, as well.

If you've read any of the promotional material about coral calcium and all the different diseases that calcium can prevent or even help cure, then you have a pretty good idea about some of the practical applications of calcium. Now, I don't think that calcium all by itself is going to reverse many chronic diseases, but without calcium, there's no question that you will be accelerating those diseases and reducing your lifespan.

Here's the kicker: Without vitamin D in your small intestine, your body will not absorb calcium even if you take an excess of supplements. This is the single most important point, and I don't think I've ever been able to get this point across with enough emphasis. You must have vitamin D in your body in order to use calcium. So if you're out there taking coral calcium supplements or eating a lot of green leafy vegetables, but not getting sunlight or ultraviolet radiation on your skin, then you are probably not absorbing the calcium you are going to such great trouble to ingest.

Reversing osteoporosis with sunlight

Sunlight can actually reverse osteoporosis. A lot of senior citizens are taking calcium supplements but not getting sunlight, so the calcium is passing right through their bodies. As a result, they're losing bone mineral density. However, by adding vitamin D to the equation through sunlight (remember, your skin generates vitamin D in response to sunlight exposure), senior citizens can start assimilating calcium and rebuilding their bones.

This is information that doesn't get told to senior citizens, and modern doctors don't even understand it. They think that you treat osteoporosis with drugs, which is ridiculous. The only thing you need in order to treat osteoporosis is sunlight, calcium and a little bit of physical exercise. You will rebuild bone mineral density very rapidly on that kind of program.

The bottom line: Get some sun on your skin

Make sure that you're getting sunlight on your skin. If you do this one thing, and do it consistently, it will create such a positive health outcome. Sunlight will make a world of difference in your life. It will change your mood. It will change your biochemistry. It will enhance your bone mineral density, and it will help your body beat or prevent various forms of cancer.

In fact, vitamin D is a key compound in the regulation of cancer cell growth. Researchers are just now figuring out that people who are chronically deficient in vitamin D, which includes most Americans, are at far greater risk of a variety of different cancers. Vitamin D has been shown to be the single most powerful chemical compound known to medical science for preventing hormone-related cancers such as breast cancer and prostate cancer.

Why antioxidants are important before exposing yourself to UV light

Now, you might ask, "What if I can't get sunlight? What if I live in a northern climate or a cloudy climate and I just can't get sunlight?" First, as I said before, you can go visit a tanning salon. This is only the second-best choice. Personally, I don't like artificial light even if it is ultraviolet -- sunlight is far healthier for you because it has a full spectrum of energy that's not found in a tanning bed. But a tanning salon is your best alternative. If you can't get out in the sunlight, go sign up with a tanning salon.

If you do that, it is crucial that you supplement with superfoods and high levels of antioxidants. If you don't have high levels of antioxidants in your tissues, you may suffer skin damage from excessive ultraviolet radiation. By taking high levels of antioxidants, however, you will build up an internal sunscreen, and your skin's response to sun exposure will be very different. It will be healthy and adaptive, meaning that you won't burn. Instead, you will tan. This is true even if you've never tanned in your life.

I know exactly what I'm talking about here -- I used to be one of the most fair-skinned people around. I would sunburn very easily. I grew up in the Midwest, and after just half an hour in the summer sun I would be burned beet red. My skin would peel, and I would be in pain for days. Now, thanks to the antioxidants I'm taking, I can go out in the desert in Arizona, in the middle of the summer, and spend three hours under the sun with no sunscreen whatsoever and not burn at all. What's the difference? Do I have new skin and new genetics? Of course not. I just have better nutrition.

This is one of those truths about health that medical science currently considered heresy, but will eventually acknowledge as true in the years ahead.

Protect your skin with outstanding internal nutrition

Nutrition makes all the difference when it comes to sun exposure. Keep in mind that it takes a little bit of time for this nutrition to work its way into the tissues of your skin. So if you haven't been engaging in good nutrition but you want sunlight, don't make the mistake of jumping out into the sun right away. Give yourself a couple of weeks following high-density nutritional supplementation first (and use whole food-based supplements, not the cheap chemical multivitamins sold at retail).

One of the best products you can get to assist with this is called astaxanthin. Astaxanthin will greatly boost the antioxidant count in your tissues, protect you from sunlight, and function as an internal sunscreen. It will also reduce inflammation and protect your nervous system, including your eyes, from damage from a variety of sources, including oxidative damage, free radical damage, and damage from ultraviolet radiation. Getting astaxanthin into your diet is very wise.

You should also add superfood supplements to your diet. If you're not already taking a green foods product, I strongly urge you to order one and make it part of your daily diet. If you don't like the taste of it at first, keep in mind that you will get used to it, and you can start small. Blend half a teaspoonful into your favorite drink. I recommend bananas and either milk or soymilk. That makes a delicious milkshake. You can blend in a little supergreen powder and start increasing your dosage until you're putting in a couple of heaping tablespoonfuls each morning. Believe me, you'll not only get used to the taste, you'll come to like it.

You can also buy a variety of other nutritional supplements. There's a product available at health food stores called Berry Green. It's a whole food concentrate. It's important that you don't make the mistake of relying on isolated vitamins; eat whole food concentrates if you want to boost your antioxidant count, which will help protect you from sunburn.

Alternative food sources of vitamin D

If you can't get into a tanning booth, or don't want to, another alternative to sunlight is to find other sources of vitamin D. The best way to do that is to drink cod liver oil on a daily basis. A tablespoonful of cod liver oil would go a long way toward boosting your vitamin D count and protecting you from chronic disease.

Don't assume that this tastes unpleasant just because it's from fish. Cod liver oil is actually close to tasteless. It's sort of like drinking olive oil or corn oil. Additionally, you can buy mint- or orange-flavored cod liver oil from health food stores and it won't taste objectionable at all. You can even mix it into your blended morning drink if you want. Either way, get vitamin D into your diet.

Don't believe for a second that vitamin-D-fortified milk is going to give you enough vitamin D. Most of the vitamin D in milk has been destroyed by excess exposure to light. It's a terrible way to get vitamin D. The most efficient vitamin D supplement is still fish oil, and cod liver oil is the best way to go.

There are four main points you should take from this:

1. You have to get sunlight into your life in order to be healthy and prevent or even reverse major chronic diseases. Start getting more sun.
2. Boost your antioxidant count, because antioxidants will protect you from the risk of overexposure to sunlight. Astaxanthin, green foods powder, Berry Green, and other green foods are all excellent sources. Get those supplements now and find ways to work them into your diet starting today.
3. If you can't get sunlight, visit a tanning booth to get ultraviolet radiation. It's a secondary choice, but it's better than doing nothing. Remember not to use tanning booths for too long, and be sure to have great nutrition for at least 30 days before tanning in a booth.
4. If you can't get sunlight or get to a tanning booth, find other sources of vitamin D. The best source is cod liver oil, which you can mix into a delicious shake the same as you would most whole food supplements.

If you do these things, you will simply amaze your doctor with your improved health. You will have healthier bones, tissues and blood. You'll help prevent cancer, depression and gum disease. You'll heal more quickly from injury, and your mood will markedly improve. This is the power of vitamin D, a nutrient so miraculous that if it could be patented and sold for profit, it would be among the top selling drugs in the world.

First off, this type of headache, prompted by exercise, is called an "exertional headache" or "exercise headache."  Running is known to cause exertional headaches, and lifting weights is another common cause.  Generally, exercise headaches cause pain (lasting from 5 minutes - 2 days) on both sides of the head.  They may even cause nausea.

What might be contributing factors?
-Hot weather
-High altitude
-Caffeine
-Alcohol
-Dehydration

How serious is this?
-You should know that, while they can be very irritating, these headaches are not medically serious. -However, these headaches still should be properly diagnosed, as they could possibly be a sign of something serious (potentially bleeding in the brain).  In fact, over 10% of people with exercise headaches may have a serious underlying condition, so you should talk to your doctor...especially if you've never had a headache like this before.
-It is probably nothing serious if the headache leaves within a few hours and there are no other neurological symptoms
-A doctor might recommend a MRI exam if your headaches do last longer than a few hours, if they begin very suddenly, if you are older than 40, and if you have accompanying symptoms (including nausea).  This MRI will help the doctor to verify that there is no serious underlying issue.

How can I treat this?
-Normally, these headaches leave on their own.
-If treatment is necessary, the medication "indomethacin" may be helpful.
-Aspirin and ibuprofen may also be effective.
-Actually exercising regularly can help to prevent exercise headaches (funny as that sounds!), although it may be best to avoid the specific circumstances in which your headaches tend to arise.

What is dehydration? Dehydration is the excessive loss of water from the body, as from illness or fluid deprivation. Any person who exercises on a regular basis is susceptible to the effects of even mild fluid loss. The value of the body's most important nutrient, water, cannot be underestimated. Exercise produces body heat, and too much body heat reduces exercise capacity. As the core body temperature rises, blood flow to the skin increases, and the body attempts to cool itself by sweating. During intense exercise, the body temperature rises as high as 39 degrees Celsius (105 degrees Fahrenheit) and the muscle temperature can rise as high as 40 degrees Celsius (108 degrees Fahrenheit). These temperatures make exercise difficult because the body and muscles are competing for blood. As the body temperature rises, oxygen becomes more of a commodity due to increased circulatory demands. Oxygen is needed to help with the cooling process, and reduces the amount of oxygen available for vital organs, which can lead to severe health risks as well as a drop in athletic performance. When you start exercising, as much as two percent of the body water is lost. Although this amount is considered a "normal" range for humans, it is certainly not an optimum level for athletic performance. Below is a table that summarizes the effects of minimal fluid loss during exercise.
		PHYSICAL SYMPTOMS AND EFFECTS OF DEHYDRATION
Body Water Lost Symptoms     1 % Few symptoms or signs of any thirst present; however, there is a marked reduction in VO2 max. 2% Beginning to feel thirsty; loss of endurance capacity and appetite. 3% Dry mouth; performance impaired. 4% Increased effort for exercise, impatience, apathy, vague discomfort, loss of appetite. 5% Difficulty concentrating, increased pulse and breathing, slowing of pace. 6-7% Further impairment of temperature regulation, higher pulse and breathing, flushed skin, sleepiness, tingling, stumbling, headache. 8-9% Dizziness, labored breathing, mental confusion, further weakness. 10% Muscle spasms, loss of balance, swelling of tongue. 11% Heat Exhaustion, delirium, stroke, difficulty swallowing; death can occur. Dehydration can cause any or all of the following: • Increased heart rate (beats per minute) • Increased lactate acid in muscles (increased blood acidity) • Increased body temperature • Decreased strength • Any of the following medical conditions: heat cramping, heat exhaustion & heat stroke The best way to avoid fluid loss is often the simplest: drink plenty of fluids. Water is sufficient to replenish the fluids that are lost during exercise. However, water cannot replace the minerals that are lost during exercise-induced sweating. Sweating releases potassium, sodium and calcium, which are vital for survival. These minerals, also known as electrolytes, are not found in water. It is therefore advisable to consume a supplement, which contains these added minerals, before any strenuous exercise. One such supplement that contains these electrolytes is a “sports drink.” Although these sports drinks can contain a combination of vitamins and minerals, they also contain simple and complex carbohydrates, predominantly simple sugars, which provide the athlete with an added amount of glucose. This glucose, which is converted by the body into fuel, can later be used to power working muscles. The carbohydrates that are found in sports drinks are designed, when used as directed, to help in performance, but do not play a direct role in hydration. The added nutrients, potassium, sodium, and calcium, along with the water content of the sports drink, are the determining factors in hydration. Exercise scientists, along with savvy marketers, have designed the newest product to conquer dehydration - fitness water. This new product has taken regular water and added minerals and vitamins, including those vital electrolytes, potassium, sodium and calcium. This new product targets fitness enthusiasts that want to protect against dehydration, but who are looking to keep their calorie count and sugar intake to a minimum, which can help with weight loss goals. Caffeinated drinks should typically be avoided before and during exercise. Caffeinated products increase urine output, which raises the amount of fluid loss. This fluid loss is exactly what we are trying to avoid. Many people drink caffeinated drinks before exercise to obtain extra energy. A suggestion to those who need “the extra energy”— avoid the caffeine and take a vitamin B tablet instead. The vitamin B tablet will give the extra energy desired, without the increased fluid loss. Another product to avoid, especially in relation to hydration, is alcohol. Alcohol, like caffeine, increases urine output, which increases fluid loss. Although most people will not consume alcohol just before exercising, it should be noted that a few drinks the night before a morning workout could have a large negative effect on hydration levels. If you’re planning on exercising the morning after consuming alcohol, drink plenty of fluids, including those necessary electrolytes. Taking in the required electrolytes, as well as satisfactory levels of fluids, will determine your hydration level. It is vital to monitor the body and to continually take in fluids. By the time thirst sets in, the body has already lost at least two percent of its fluid, and dehydration occurs. At any chance possible before and during exercise consume fluids to avoid the harmful consequences of dehydration.

Many people do not realise that alcohol can be viewed as a nutrient, just like protein, carbs and fat. Would you ever have thought of it that way?. When consuming alcohol the following is to be remembered:

• Alcohol contains kilojoules and therefore adds extra kilojoules to your daily intake, which can jeopardise your weight management programme
• The human body prefers to use alcohol as an energy source rather than fat. Consuming too much alcohol will therefore diminish fat loss which is counter productive if your'e wanting to reduce weight
• It is better to have an alcoholic drink with a meal or a snack as alcohol is absorbed directly from the stomach and may cause hyperglycaemia if taken on an empty stomach
• Consuming too much alcohol late at night may lead to high blood glucose levels in the morning, especially if you have diabetes. Always take alcohol in moderation and with food.
• Give preference to the following drinks, as they are lower in kilojoules and/or alcohol:
  • Dry or "lite" white wine
  • Dry red wine
  • Wine "spritzer" - wine mixed with soda water
  • Dry sherry
  • "Lite" Beer
  • Spirits such as whisky, brandy, vodka (have asingle tota and top it up again and again with soda water)
• If you are trying to maintain weight, do not consume more than 1-2 units of alcohol for female and 2-3 units for males. This is also a good guide for general health as over consumption predisposes high blood pressure, high cholestrol levels, many types of cancer and osteoporosis amongst others.
• Remember that 1 unit of alcohol is equal to:
  • 125 ml wine or champagne
  • 60 ml sherry
  • 340 ml can or bottle "lite" beer
  • 170 ml regular beer
  • 25 ml of spirits
  • 250 ml "spritzer" at least half should be soda water or ice
  • 170 ml apple cider
  • 80 ml spirit coolers such as Smirnoff Ice

                                  

Along with a balanced diet and regular exercise, multivitamins are a good way to stay in good health. For just pennies a day, they may help lower your risk of cancer, heart disease and osteoporosis as well as prevent some birth defects. When undertaking body weight management, taking a multi-vitamin will keep you strong and healthy. Since you are changing your eating habits in one way or another, you want to make sure you are getting in a good amount of your essential vitamins and minerals. Look to include vitamins: A, D, E & B-Complex (B1, B2, B6, B12), minerals: calcium, magnesium, potassium, copper, manganese, chromium, zinc, iodine, boron, iron & selenium in addition to an anti-oxidant. There are many misconceptions about vitamins and the health benefits they offer.
Vitamins play an important role in keeping the body healthy. However, taking large doses of certain vitamins can actually be harmful. For most people, it is best to get the vitamins our bodies need from eating a variety of healthy, unprocessed foods rather than by taking supplements. Vitamin supplements are frequently misused and taken as a form of medicine to treat ailments such as colds or to counteract lifestyle issues such as stress. Contrary to popular belief, vitamins aren’t drugs or miracle cures. They are organic compounds that participate in various metabolic functions. High-dose supplements should not be taken unless recommended under medical advice. Isolating the ‘active ingredient’ is not the answer Proper balance and adequate levels of essential nutrients is important for a range of complex processes in our body. When vitamins are taken as supplements, they are introduced into the body at levels that could never be achieved by eating even the healthiest of diets. They are also sent in ‘alone’. When they occur in food, vitamins have many other companions to help them along the way. For instance, provitamin A (beta-carotene) in food is accompanied by hundreds of its carotenoid relatives. Simply taking a vitamin pill is not an instant fix for feeling run down or lacking in energy. It is the combination of a whole range of compounds (most of which we probably don’t even know about) in plant foods that gives us the protection. When you artificially remove one of them and provide it completely out of context, it may not be as effective and, in the case of some vitamins, can have negative effects
Recommended dietary intakes
 Many people mistakenly believe that since small amounts of vitamins are good for you, then large amounts must be better. In the case of vitamins, it is better to follow the rule of ‘less is more’. The vitamins A, D, E and K are fat soluble, which means they can be stored in the body. Taking high doses of these vitamins, especially vitamin A, over a long period of time can result in harmful levels in the body unless you have a medically diagnosed deficiency. Some of the water soluble vitamins can also cause side effects in high doses. For instance, vitamin B6 has been linked with nerve damage when taken in large doses. For a healthy adult, if supplements are used, they should generally be taken at levels close to the recommended dietary intake (RDI). High-dose supplements should not be taken unless recommended under medical advice. Deficiencies and illness
The human body is able to store vitamins. The fat soluble vitamins A, D, E and K can be locked away in the liver and body fat and stored for a long time. The water soluble vitamins, including B-complex and vitamin C, are mostly only stored for a shorter period of time. A vitamin deficiency takes weeks or months before it will affect your health. For instance, it would take months of no vitamin C before you developed scurvy. An occasional lapse in good eating will not harm you if your usual diet consists of a wide variety of fresh foods.
Sometimes supplements are needed
 Supplements do have a role to play for some groups of people. For instance, people on long-term restrictive weight loss diets or people with malabsorption problems such as diarrhoea, coeliac disease, cystic fibrosis or pancreatitis can benefit from supplements. Folic acid supplements are strongly recommend for women planning a pregnancy to reduce the risk having a baby with neural tube defects, like spina bifida. People who are advised by their doctor that they need to take vitamin supplements are encouraged to consult an accredited dietitian, who can work with their doctor to provide dietary advice related to the person’s situation. If you need to take a supplement, it is best to take multivitamins at the recommended dietary level, rather than single nutrient supplements or high-dose multivitamins.
The common cold and vitamin C
Many people think that vitamin C helps prevent the common cold. Despite exhaustive research across the world, there is still no strong evidence to prove this. Some studies have shown that taking large doses of vitamin C (more than 1,000mg per day) continuously or at the start of a cold may ease some of the symptoms and the duration, on average, making it about half a day shorter. It does not prevent you catching a cold. You also need to consider the health risks associated with taking large doses of vitamin C. Large doses may cause nausea, abdominal cramps, headaches, fatigue, kidney stones and diarrhoea. It may also interfere with your body’s ability to process (metabolise) other nutrients – for example, it could lead to dangerously raised levels of iron. Excessive amounts of vitamin C in the body can also interfere with medical tests, such as diabetes tests, giving a false result. Adults need about 45mg of vitamin C per day and any excess amount is excreted. Stress, depression and anxiety Some vitamin and omega-3 fatty acid deficiencies can lead to emotional disturbances. However, if you are feeling run down, it is more likely to be due to stress, depression or unhealthy lifestyle habits (such as insufficient sleep or smoking) rather than a vitamin deficiency. Feeling under pressure doesn’t automatically lead to a vitamin deficiency, so taking a vitamin supplement won’t necessarily make the stressful feelings go away. More serious mental illnesses, such as schizophrenia and bipolar disorder, aren’t caused or prevented by vitamins, although a healthy diet and good nutrient intake can help support a person to better cope with their condition.
Vitamin E and heart disease
Vitamin E is widely promoted as a beneficial antioxidant that can help prevent heart disease. Unfortunately, several large-scale reviews have conclusively found no evidence that vitamin E supplements prevent death from heart disease. In fact, there may be greater risk of all-cause death from taking such supplements.
Cancer cures
Vitamin A in large doses does not cure cancer and can be toxic, particularly if taken as pills rather than food. There is some evidence that vitamin E could play a small role in preventing some cancers although, equally, there is evidence that it could hasten the onset of other types of cancer; however, this has not been conclusively proved or disproved. While it is argued by some that megadoses of antioxidants can help with the effectiveness of conventional cancer treatments, such as chemotherapy and radiotherapy, the evidence is far from supporting this. In fact, it has been shown that megadoses of antioxidants can actually interfere with some medical treatments of cancer by helping to protect the cancer cells that the therapies aim to eradicate.
Some research findings
A number of studies into supplement use have shown negative findings. For instance: Vitamin A (beta-carotene) was thought to reduce the risk of some cancers but has been linked to an increase in others, such as lung cancer in smokers, if taken in supplement form. Several long-term studies have shown that prostate, breast and lung cancer risk are not decreased by taking high-dose supplements containing vitamins E or C or selenium. People taking high-dose vitamin E supplements have been found to have higher rates of early death (mortality).
Anti-ageing vitamins
Vitamin E is often singled out as the potential fountain of youth. However, there is no evidence that taking large doses of any vitamin can either stall or reverse the effects of ageing. Neither can any one vitamin restore a flagging sex drive or cure infertility. Vitamins and chronic disease
In developed countries, vitamin deficiency is rare but the inadequate intake of some vitamins is not so rare and has been linked to a number of chronic diseases. These include cardiovascular disease, cancer and osteoporosis. There is ongoing research to study the effects of taking vitamin supplements to prevent chronic disease, and evidence around nutrition and diet is constantly changing. It is important you consult with your doctor before taking vitamin supplements in high doses.
Things to remember
Vitamins are not drugs or miracle cures. Taking large doses of vitamins can be harmful because your body only needs vitamins in very tiny amounts. Eating plenty of fruits, vegetables, whole grains and cereals will give your body most of the vitamins your body needs at the right level and in the right balance. Vitamin supplements can’t replace a healthy diet, but a general multivitamin may help if your diet is inadequate.
People who may need vitamin supplements include pregnant and breastfeeding women, people who consume alcohol in amounts over the recommended level, drug users and the elderly.

Eating disorders are a mental illness. They can affect women and men of all age groups, from a range of backgrounds and from different cultures. Despite an increase in the incidence and understanding of eating disorders, many people live with these disorders for a long time without treatment or a clinical diagnosis.

Female adolescents and young women are most commonly affected, but men can be also be affected by eating disorders. Anorexia nervosa is most likely to strike during the mid-teenage years. In the UK anorexia affects approximately 1 in 150 fifteen-year-old females, and 1 in 1000 fifteen-year-old males. Approximately 1 percent of 16 to 18 year olds have anorexia. About 40 percent of people with anorexia recover completely. Around 30 percent of anorexia sufferers continue to experience the illness long-term

Signs and symptoms
Some habits and behaviours are common to people with eating disorders. They include:

• Weight loss or weight change, usually due to dieting, but sometimes from an illness or stressful situation.

• Preoccupation with body appearance or weight.

• Loss or disturbance of menstrual periods in females.

• Sensitivity to cold.

• Faintness, dizziness and fatigue.

• Increased mood changes and irritability.

• Social withdrawal.

• Anxiety and depression.

• Inability to think rationally or concentrate.

• Increased interest in preparing food for others.

• Obsessive rituals, like only drinking out of a certain cup.

• Wearing baggy clothes or changes in clothing style.

• Excessive or fluctuating exercise patterns.

• Avoidance of social situations involving food.

• Frequent excuses not to eat.

• Disappearance of large amounts of food.

• Trips to the bathroom after meals.

• Dieting.

Dieting, depression and body dissatisfaction are the most common risk factors for the onset of an eating disorder.

Causes
There is no single cause of eating disorders. It is currently agreed that eating disorders are multifactorial – that is, social, psychological and biological factors all play a part, in varying degrees, for different people.

Contributing factors may include:

Social factors

• Media and other presentations of the ‘ideal’ shape as slim and fit.

• Mixed messages about health and fast food.

• Pressure to achieve and succeed.

• Occupations or pursuits with an emphasis on body shape and size – for example, modeling or gymnastics.

Psychological factors

• Major life changes or events such as adolescence, relationship breakdowns, childbirth, the death of a loved one, or the accumulation of many minor stressors.

• Fear of the responsibilities of adulthood.

• A belief that love is dependent on high achievement.

• Poor communication between family members.

Biological factors

• Adolescence and its associated physical changes.

• Genetic or familial factors.

If you think you have an eating disorder
Many people have problems with their eating. If you do have an eating disorder, you have the right to get help. Remember that these disorders can be overcome.

Getting professional help and support from others is important. Recovery may be slow as you learn to approach food in a more positive way and understand the reasons for your behaviour, but the effort will be worthwhile.

Family and friends
Parents, siblings, partners, friends, extended family, work colleagues and others often experience many different feelings as they learn to cope with the effects of an eating disorder on the person, and on their own lives.

The strain of living with an eating disorder can create tensions and divisions within a family. There may be feelings of confusion, grief, anger, guilt and fear.

Family and friends can remind their loved one that the effort associated with recovery will be worthwhile for everyone. The most important thing is to show love, care and faith in the person, and seek advice at the earliest possible time.

Some suggestions for family and friends include:

• Be honest and open about your concerns.

• Use ‘I’ statements rather than ‘you’ statements. For example, ‘I am concerned for you because I have noticed you are not so happy at the moment’ rather than, ‘You aren’t happy at the moment’.

• Focus on the person’s behavioural changes, rather than their weight, food consumption or physical appearance.

• Try to take the focus off food and weight. The person with the eating disorder is already likely to be excessively focused on food and weight issues.

• Mealtimes should not be a battleground. Frustrations and emotions need to be expressed but not at mealtimes, which are already likely to be difficult.

• Do things as you usually would. The person with the eating disorder needs to learn to co-exist with food and other people, rather than others learning to co-exist with the eating disorder.

Treatment and recovery
Many different forms of therapy are available and it is important to remember that different approaches work for different people. Once the right approach is found, prospects of recovery are excellent. Professional help and support from others is important.

Because the disorders affect people physically and mentally, a range of health practitioners might be involved in treatment including psychiatrists, psychologists, doctors, dietitians, social workers, nurses and dentists.

Things to remember

• There is no single cause of eating disorders.

• Dieting, depression and body dissatisfaction are common risk factors for the onset of an eating disorder.

• Eating disorders can be overcome with professional help and support from others.

Stroke is the interruption of blood to the brain. This may be due to blockage of a blood vessel in the brain or rupture of a blood vessel, causing bleeding in the brain or into the space surrounding the brain. The most common type of stroke is ischaemic, caused by a blood clot blocking an artery or blood vessel. The brain cells in the immediate area die and those in the surrounding areas are affected by the reduced blood flow. Once brain cells die, their functions die with them.

An estimated 150,000 people have a stroke in the UK each year.Stroke accounts for around 53,000 deaths each year in the UK. Stroke is the third most common cause of death in England and Wales, after heart disease and cancer. Stroke accounts for 9 per cent of all deaths in men and 13 per cent of deaths in women in the UK. Stroke has a greater disability impact than any other chronic disease. Over 300,000 people are living with moderate to severe disabilities as a result of stroke. The direct cost of stroke to the NHS is estimated to be £2.8 billion. The cost to the wider economy is £1.8 billion. The informal care cost is £2.4 billion. Stroke patients occupy around 20 per cent of all acute hospital beds and 25 per cent of long term beds. Stroke units save lives: for stroke patients general wards have a 14% to 25% higher mortality rate than stroke units. Each year over 130,000 people in England and Wales have a stroke. About 10,000 of these are under retirement age.

Stroke is influenced by different risk factors. Some of these – age, gender and family history – are beyond your control. However, you can substantially reduce your overall risk by making healthy changes to your diet and lifestyle.

TIA or transient ischaemic attack
A transient ischaemic attack (TIA) is often called a ‘mini stroke’. It is a powerful warning that a severe stroke may follow. The symptoms are identical to those of a full stroke, but disappear in a few minutes and last no longer than 24 hours. A TIA can appear hours, days, weeks or months before a full stroke but is more common within days or a few weeks. Just like full strokes, TIAs need emergency treatment and should not be ignored.

Warning signs
Stroke is a medical emergency. The longer a stroke remains untreated, the greater the degree of stroke-related brain damage. The warning signs of both stroke and TIA include:

• Sudden blurred or decreased vision in one or both eyes

• Numbness, weakness or paralysis of the face, arm or leg

• Difficulty speaking or understanding

• Dizziness, loss of balance

• Difficulty swallowing

• Severe headache.

High blood pressure
Blood pressure is a measurement of the force your blood puts on blood vessel walls as it travels through your body. High blood pressure is medically known as ‘hypertension’ and is one of the most important risk factors in stroke.

Normal blood pressure is around 120/80. High-normal blood pressure is between 120/80 and 140/90. If your blood pressure is consistently over 140/90, you have high blood pressure. The levels for normal blood pressure are a guide only. In general the lower your blood pressure, the lower your risk of stroke. Your doctor can talk to you about your blood pressure and risk of stroke and may recommend treatment if required.

You can control hypertension by reducing your weight, exercising regularly, eating a low salt, low fat and high fibre diet, and taking antihypertensive medication (if necessary).

Cigarette smoking
Smoking can increase your risk of stroke by increasing blood pressure and reducing oxygen in the blood. Seek advice on how to quit smoking by calling the NHS Free Smoking Helpline: 0800 022 4 332 Monday to Friday 9am to 8pm, Saturday and Sunday 11am to 5pm for guidance and support.

Diabetes
Diabetes can damage your entire circulatory system and is a risk factor for stroke. Type 1 usually occurs from a young age and is treated with insulin injections. Type 2 usually occurs from 30 years of age onwards and is treated with either tablets or, in some cases, insulin. Talk to your doctor about controlling diabetes if you are diabetic.

Other important risk factors
Other factors that can increase your risk of stroke include:

High cholesterol
High cholesterol is a contributing factor to blood vessel disease, which often leads to stroke. To reduce cholesterol in your blood, eat foods low in saturated fat. Choose lean meats and low fat dairy products. Your doctor may prescribe medication to lower your cholesterol but diet changes and exercise are still important.

Obesity
Being overweight or obese can increase the risk of stroke. Too much body fat can contribute to high blood pressure and high cholesterol and may lead to heart disease and type 2 diabetes. If you are unable to maintain your weight within recommended levels, ask a doctor or nutritionist for help.

Alcohol
Your risk of stroke may be reduced with moderate alcohol intake (one to two glasses a day). Excessive amounts of alcohol can raise blood pressure and increase your risk of stroke.
Diet and exercise
A diet low in fat and salt will reduce your risk of stroke. Eating a balanced diet of fresh foods (wherever possible) is recommended. Avoid processed or canned foods as they can be high in sodium, or salt. Check a food’s sodium content in the list of ingredients on the label (low salt food has a level of less than 120mg/100g).

A good balance between exercise and food intake is important to maintain a healthy body weight. People who participate in moderate activity are less likely to have a stroke. Try to build up to at least 30 minutes of moderate physical activity most days of the week. Talk to your doctor about an exercise program – people with high blood pressure should avoid some types of exercises.

Irregular pulse (atrial fibrillation)
You are more at risk of stroke if you have an irregular pulse due to the condition atrial fibrillation (AF). Your doctor can diagnose this condition and advise you on how best to manage this if it happens. If you experience symptoms such as palpitations, weakness, faintness or breathlessness, it is important to see a doctor for diagnosis and treatment.

Risk factors beyond your control
Stroke is influenced by some risk factors that are outside a person’s control. These include:

• Age – the majority of people who suffer from stroke are 65 years or older.

• Gender – men are at higher risk than women.

• Family history – a family history of cerebrovascular disease may make you more susceptible to stroke.

Statistics on stroke
Each year over 130,000 people in England and Wales have a stroke:

• One in three people die within a year of having a stroke.

• Stroke kills more women than breast cancer.

• Almost one in five people who experience a stroke are under the age of 55.

• Men are more likely to suffer a stroke and at a younger age.

Things to remember

• Stroke may occur due to blockage of a blood vessel in the brain or rupture of a blood vessel, causing bleeding in the brain or into the space surrounding the brain.

• Many strokes are avoidable and can be caused by unhealthy diet and lifestyle choices.

• Some of the major risk factors for stroke include high blood pressure, cigarette smoking and diabetes.

Stroke prevention

Strokes can be fatal but the risk can be reduced. Many stroke risk factors are lifestyle related, so everyone has the power to reduce their risk of having a stroke. Some stroke risk factors, such as gender, age and family history, can’t be controlled.

Lifestyle factors that increase your risk of stroke include high blood pressure, smoking, diabetes, high blood cholesterol levels, heavy drinking, a diet high in salt and fat and lack of exercise. You can reduce your risk of having a stroke by making a few simple lifestyle changes.

Causes of stroke
‘Stroke’ is a term used to describe the interruption of blood flow to an area of the brain. This can occur in the following ways:

• Haemorrhagic stroke – an artery may rupture and cause bleeding into the brain tissue.

• Ischaemic stroke caused by atherosclerosis – an artery may become blocked by progressive thickening of its walls.

• Ischaemic stroke caused by embolism – a clot blocks an artery and prevents blood getting to part of the brain.

The brain cells in the immediate area are killed because they are deprived of oxygen. The dead area that results from stroke is known as an infarct. Without prompt medical treatment, the area of brain cells surrounding the infarct will also die.

Risk factors
Some stroke risk factors can’t be controlled. These include gender, age and family history. However, many stroke risk factors are lifestyle related. Everyone can reduce their risk of having a stroke by making a few simple lifestyle changes.

Lifestyle-related factors that increase your risk of stroke include:

• High blood pressure

• Cigarette smoking

• Diabetes

• High blood cholesterol levels

• Heavy drinking

• High fat, low fibre diet

• Lack of exercise.

It has been reported that the use of some birth control pills may increase a woman’s risk of stroke, but the evidence is limited.

Reduce high blood pressure
High blood pressure (hypertension) is the most significant risk factor for stroke. Blood pressure refers to the pressure inside the arteries. Hypertension means that the blood is exerting more pressure than is normal or healthy. Over time, this weakens and damages blood vessel walls, which can lead to cerebral haemorrhage.
Hypertension may also cause thickening of the artery walls, resulting in narrowing and eventual blockage of the vessel (ischaemic stroke). In atherosclerosis (hardening of the arteries), the pressure of your pumping blood could ‘hose off’ debris from damaged artery walls. The circulating debris (embolism) can cause a stroke by lodging in and blocking a blood vessel of the brain.

Strategies to reduce high blood pressure include:

• Check your blood pressure regularly and know your numbers.

• Maintain a healthy weight for your height.

• Exercise regularly.

• Choose a low fat, high fibre diet.

• Reduce or eliminate salt from your diet.

• Limit your alcohol intake to two or less standard drinks per day.

• Stop smoking.

• Take antihypertensive medications to help control high blood pressure.

Quit smoking
Smoking can double or even quadruple your risk of stroke. Some of the chemical ingredients in cigarette smoke (such as nicotine and carbon monoxide) accelerate the process of atherosclerosis. Clots are more likely to form because smoking thickens the blood and makes clotting factors, such as platelets, much more ‘sticky’. Cigarette smoke forces arteries to constrict – a narrowed diameter makes it harder for the thickened blood to move through the vessels.

Strategies to quit smoking include:

• Seek advice on how to quit smoking by calling the NHS Free Smoking Helpline: 0800 022 4 332 Monday to Friday 9am to 8pm, Saturday and Sunday 11am to 5pm for guidance and support or see your doctor for information and advice.

• Decide on a strategy, such as ‘cold turkey’ or using nicotine replacement therapy.

• Keep a smoking diary so that you are aware of your smoking triggers (such as stress or boredom).

• Decide on a quit date.

• Ask your family and friends for support.

• Don’t be discouraged by a slip-up. If you smoke a cigarette, put it behind you and keep going.

Manage your diabetes
Diabetes is a chronic condition in which the body is unable to utilise blood sugar. A person with diabetes is around twice as likely to have a stroke as someone of the same gender and age who doesn’t have diabetes. This is because the high blood sugar levels contribute to the development of atherosclerosis. It is very important that diabetes be kept under control.

Strategies to reduce the effects of diabetes include:

• See your doctor regularly for check-ups.

• Monitor your blood sugar levels regularly.

• Maintain a healthy weight for your height.

• Exercise regularly.

• Choose a low fat, high fibre diet.

• If you are on medication, make sure you are taking it correctly.

Keep cholesterol levels in check
Cholesterol is a fat-like substance that is made by the human body. It has many essential roles to play, but it becomes a problem if levels in the blood are too high. Blood cholesterol contributes to the formation of a substance called atheroma, which sticks to artery walls and leads to atherosclerosis.

Strategies to lower blood cholesterol levels include:

• Have your blood cholesterol levels checked regularly by your doctor.

• Switch to a high fibre diet.

• Reduce your intake of saturated fats (commonly found in animal products).

• See your doctor for information and advice. Medications may be recommended.

Avoid heavy drinking
Some studies have indicated that drinking moderate amounts of alcohol (such as one or two standard drinks per day) can actually reduce the risk of stroke. However, people who drink heavily are three times more likely to have a stroke, regardless of their age. It is important to limit your alcohol intake.

Suggestions include:

• Limit your consumption to no more than two standard drinks per day.

• Have at least two alcohol-free days every week.

• See your doctor for information and referral if you are finding it difficult to limit your alcohol intake.

Eat a healthy diet
Various studies show that diet is an important risk factor in the development of stroke. Suggestions include:

• Limit or moderate salt intake.

• Choose fresh rather than processed foods.

• Increase your intake of vegetables, fruit and whole grains.

• Cut out or reduce sugary and fatty foods like cakes, lollies and junk food.

• See a dietitian who can help you plan a well-balanced low fat, high fibre diet.

Exercise regularly
A sedentary lifestyle increases the likelihood of obesity, high blood pressure and high blood cholesterol levels. These are all important risk factors for stroke.

Suggestions include:

• See your doctor for a check-up if you haven’t exercised for a while.

• Choose a range of activities you enjoy.

• Start your new exercise program slowly and only increase the intensity and duration as you become fitter.

• Exercise with a friend or join a team sport to add a fun social element to the activity.

• Remember to warm up and cool down.

• Contact a physiotherapist or gymnasium instructor for advice and information regarding appropriate exercise.

• Try to get moderate exercise for at least 30 minutes on (at least) five days of the week.

Things to remember

• A stroke interrupts blood flow to an area of the brain.

• Most stroke risk factors are lifestyle related, so everyone has the power to reduce their risk of having a stroke.

• Some stroke risk factors, such as gender, age and family history, can’t be controlled.

• Lifestyle factors that increase your risk of stroke include high blood pressure, smoking, diabetes, high blood cholesterol levels, heavy drinking, high salt and high fat diet and lack of exercise.

At any UK supermarket, health shop or chemists, you will find a wide range of dietary supplements.  When faced with different brands of various minerals, one asks oneself “which one?”.

Which ones to take indeed?  Let’s face it, all the vitamins and minerals one requires can be found in a healthy, balanced diet, which is varied with protein (in the form of meat and dairy products) and fresh fruit and vegetables.  However, peoples’ busy lives can be so pressurised and busy, that some days we don’t get a “healthy balance”.  This means that we miss out on the essential vitamins and minerals, including zinc, l’arginine, vitamins A – D and K.

Some supplements are enhanced with prebiotics and probiotics, which encourage the growth of “friendly bacteria”.  Prebiotics are supplements which provide the bacteria with essential nutrients, encouraging them to grow.  Probiotics are the actual friendly bacterial cultures.  When ingested, the bacteria from the probiotic supplements help increase the numbers of friendly bacteria already in your gut.

Extra vitamins and minerals to a healthy diet aren’t “essential”, however they can boost our lives emotionally by encouraging vigour and zest.  Natural minerals can even help enliven our sex lives.  Zinc and potassium are minerals which boost sperm count, and can be found readily in the form of multivitamin tablets, or they can be bought and taken individually.

Natural aphrodisiacs are widely available in the form of herbal supplements.  These tablets are crammed full of all the good stuff:  L-Arginine, an essential protein; zinc, to enhance sperm count and testosterone; gingko, a natural stimulant to increase energy levels and enhance performance.

So, when choosing the mineral for you, consider the following:

1.  What are you lacking?  If your diet is unbalanced at the moment, consider taking on board the essential vitamins and minerals.  i.e. the ones that you need to be healthy.  So, vitamins A-D.

2.  If you have a balanced diet, but lack zest and vigour, consider natural stimulants such as gingko and guarana.

3.  If you want to boost and enliven your sexual performance, why not consider a supplement which encompasses lots of different minerals and stimulants?  Search for herbal supplements for men and blue pill, to see what’s on offer.

4.  Price – is it really affordable?  As we can get all the vitamins and minerals we need from just eating a healthy, balanced diet, supplements can only be seen as a luxury.  Check out the prices carefully.  Examine product ingredients and compare the big brands with the smaller brands.

5.  Is the company you’re about to purchase from reputable?  Does the company have a good offline presence as well as online?