How to Garden without Breaking Your Back

Now that the weather is starting to warm up, a lot of our patients are heading out into the garden. Who can resist the allure of fresh air, sunshine, the feel of dirt in their hands, and the promise of delicious, homegrown fruits and vegetables? It's a wonderful thing to grow some of your own food. But gardening is an inherently challenging activity for people who have any kind of weakness in the back, so it's important to take precautions while in the garden.


Why does gardening cause back problems?
Part of the reason gardening causes back problems is that it's a weekend warrior activity. You go for months and months without gardening, and then you end up doing a physically demanding activity for an extended period of time that your body isn't used to doing. In particular, gardening involves a lot of forward bending, which loads a tremendous amount of pressure on the discs and joints. The Oklahoma State University website does a good job of explaining this phenomenon:

Think of your back as a lever. With the fulcrum in the center of the lever, it only takes ten pounds of pressure to lift a ten pound object. However, if you shift the fulcrum to the side, it takes much more force to lift the same object. Your waist actually acts like the fulcrum in a lever system, and it is not centered. In fact, it operates on a 10:1 ratio. Lifting a ten pound object actually puts 100 pounds of pressure on your lower back. When you add in the 105 pounds of the average human upper torso, you see that lifting a ten pound object actually puts 1,150 pounds of pressure on your lower back.[i]

Oftentimes, not only are you bent forward when you're gardening, but you're attaching something to the end of your hand, like a shovel with a mound of dirt, which makes the lever even longer and thus puts even more pressure on your back.

[1] Oklahoma State University. Back Safety. http://ehs.okstate.edu/kopykit/Back%20Safety.pdf

Tips for pain-free gardening

1. Be careful of forward bending for too long
Don't bend over in an uncontrolled position for hours and hours. Either kneel, sit on a little stool, or figure out what the best posture position is for you.

2. Take frequent breaks
Every 30 minutes, get up and stretch your back. Even short breaks can prevent back injuries.

3. Do backward bending exercises
To counteract all that forward bending, do some backward bending exercises if they work for you.

4. Hire out the hard stuff
If you need to do some digging, and digging is really hard on your back, hire someone to dig for an hour for you. The rest will be easy!

5. Quit when your back feels tired
If you feel your back starting to get tired or painful, stop. Frequently injuries happen when the back is tired.

Remember, a lot of chronic back problems start with either minor tears in the discs or strains to the ligaments, and those things can easily occur with gardening. That doesn't mean you shouldn't garden. Gardening gives you an opportunity to connect to the earth in a very profound and deep way. So do it, just take care of yourself while doing it!

Sincerely,

Marc Heller Matt Terreri

What you eat can improve your health, mind, and appearance

For many, springtime means revamping exercise regimens, improving appearance, reading more books, taking on a new hobby, and improving dietary habits.

Great news is that following good-for-you food goals will help your whole body -- from your skin to your brain -- so you can tackle those other resolutions with ease.

"The best way to have healthy hair, eyes, and skin is to take good overall care of yourself. That means eating well," said Dr. David L. Katz, director of the Yale Prevention Research Center at Yale University. So whether it's your heart, brain, bones, eyes, skin, or hair you seek to nurture, there are foods up to the task.

"The more colors you get into your diet, the better," Katz said. A variety of fruits and vegetables supplies antioxidants and vitamins that are most powerful when working together. Daily servings of whole grains, lean protein, and dairy round out your body's needs. A diet rich in fresh, whole foods, full of colors and rich textures, satisfies with abundant flavor, and nourishes every part of your body.

For Silky Skin and Hair

Antioxidants like lycopene and vitamin C, as well as soy protein and omega-3 fatty acids, help keep skin glowing. Antioxidants have long been the rage in topical skin care, but those same nutrients work even better from the inside out. When skin (the body's largest organ) is exposed to the sun's rays, free radicals can develop, Katz explained. "These free radicals attack the skin and impair blood flow to the area, causing premature aging. Antioxidants fight that process."

Vitamin C, found in citrus fruits, facilitates collagen production, a critical component for vibrant skin. Another antioxidant, lycopene, found in foods like canned tomatoes and red grapefruit juice, also promotes skin health. Tofu is a good option since its omega-3 fatty acids help regenerate new skin cells and reduce inflammation, while its soy protein has been shown to boost collagen.

Shiny, healthy hair starts with the vitality of cells in the hair follicle, where hair is manufactured, says Katz. Eat foods high in calcium and quality protein like eggs, dairy, or fish. Eggs also provide biotin, a structural component of both bone and hair. Vitamins B6, B12, and folate nourish follicle cells, too.

Eat For Your Eyes

According to a study published in the Archives of Ophthalmology, people who ate two servings of fish weekly benefited from an almost 50 percent decrease in the risk of age-related macular degeneration (AMD), said Dr. Emily Chew, deputy director of the division of epidemiology and clinical research at the National Eye Institute. Eggs, leafy greens, broccoli, winter squash, and Brussels sprouts all contain the antioxidants lutein and zeaxanthin (both associated with eye health), as well as vitamins C and E, zinc, and beta-carotene.

Scientists are still investigating how these foods promote eye health. Observational studies show they likely reduce the risk of AMD, Chew said. No one knows exactly what lutein and zeaxanthin do for the eye, but it's thought they filter damaging light and support cell structure. Expect more answers in 2012, when Chew and colleagues hope to publish research on the effects of lutein, zeaxanthin, and omega-3 fatty acids from a study following 4,000 patients for five years.

Build Better Bones

Calcium, vitamin D, and phosphorus work together to build strong bones. Even though green leafy and cruciferous vegetables (like spinach and broccoli) contain calcium, the body absorbs it best from dairy products, said Joan Lappe, a bone health researcher and professor at Creighton University in Omaha, Nebraska.

Dairy products offer a package deal: they are abundant in phosphorous, and vitamin D added to milk and dairy products aids in calcium absorption. Some nondairy foods high in calcium include canned salmon, sardines, and calcium-fortified firm tofu.

Greens are still good bone foods, however. Broccoli, kale, and bok choy may provide little calcium, but they offer plenty of vitamin K. Research is showing promise that vitamin K -- or some antioxidant or phytochemical in foods high in the vitamin -- boosts bone mineralization. Research published last year in Osteoporosis International followed postmenopausal women for three years, and found that those taking supplemental vitamin K maintained or enhanced bone strength, compared to those on a placebo.

Heart Helpers

Whole grains, fatty fish, and fresh fruits and vegetables are the keys to keeping your heart in prime condition.

A recent review of seven studies showed that two and a half servings of whole grains per day reduced heart attack and stroke risk by 21 percent, said lead author Dr. Philip Mellen, then an assistant professor at the Wake Forest School of Medicine in Winston-Salem, North Carolina. Whole grains are rich in antioxidants, especially vitamin E (also found in almonds, peanuts, and green leafy vegetables), which helps maintain healthy blood vessels. And soluble fiber from fruits, vegetables, and nuts helps lower harmful LDL cholesterol and control weight, both of which have a positive impact on heart health.

Further cut your risk of a heart attack by eating fish, especially those high in the omega-3 polyunsaturated fats like salmon, mackerel, or rainbow trout. Omega-3s make platelets in the blood less sticky, reducing clotting and the likelihood of a heart attack.

Brain Boosters

Omega-3 fatty acids and whole grains are good for your heart -- and they're good for your brain and mental health, too. "People who are heart healthy are brain healthy," said Dr. Joseph S. Kass, assistant professor of neurology at Baylor College of Medicine in Houston, Texas.

Kristen E. D'Anci, a research psychologist in the Nutrition and Neurocognition Laboratory at Tufts University and professor of psychology, noted, "Diets rich in vitamins C and E are consistently associated with lower levels of cognitive impairment in aging." Abundant in fruits, vitamin C may also reduce the risk of stroke.

Additionally, vitamins B12, C, E, and folate may play a direct role in keeping your mind sharp. Research shows that B12 (found in lean protein like turkey) and folate (found in many grains fortified with the vitamin) help improve memory and lower the risk of Alzheimer's. They may also help people over age 60 with learning, attention, and response speed, according to study results from Tufts University.

The pleasure of posture awareness

By Julie Duck

Maybe it is a childhood thing to slouch. Or simple laziness on the part of anyone, young or old, who finds themselves slumped in their seat. However you look at it, good posture plays an important role in overall wellness, including spine health. When your patient is not standing up straight, it is time to educate him on the reasons why he should, and guide him toward simple solutions to help raise his posture awareness.

The slump
Have you ever been told to sit up straight or stop slouching? There is more to it than manners, because good posture helps the body to stay in alignment, and contributes to everything from walking and running, to sitting and sleeping. Unfortunately, bad habits can lead to poor posture, and subsequent problems with the back, shoulders and neck.

Where does bad posture begin? It starts with being unaware of the body’s position. Slouching is simple and easy to revert to unless one is paying attention to their posture. Additionally, people with depression, spinal issues and those who are obese are at greater risk for poor posture because they tend to hunch down. Have you ever tried to “hide” yourself with a slouch?

To help your patients become more aware of their posture, point out the little things – the everyday occurrences – that can contribute to slouching, and show them how little changes can make big differences in their posture.

Bag the bag
Some of the biggest contributors to bad posture are the millions of heavy briefcases, handbags and backpacks that are lugged around by men, women and children every day. Stuffed to the gills, and generally oversized for fashion reasons, many of today’s bags are just too big to carry and get away with it. Slinging heavy objects, such as an overloaded backpack or humongous purse, over one’s shoulders puts a disproportionate amount of weight across one side of the body, leading to slumping shoulders, hunched backs and strain. The result is painfully poor posture.

Ideally, the weight of any backpack, bag or briefcase should be dispersed via two straps, but because most purses and messenger bags are not made that way, the next best thing is a bag with a wide, padded shoulder strap that allows one to pull it over the head and sling it across the body. There are several ergonomically correct bags available on the market that address the issue of posture, of which you can provide to patients who need to put more effort into their awareness. Or, suggest that the patient carry only what they need for the day in their bag, instead of the whole kit and caboodle, to promote good posture habits.

The super six-pack
Core strength can make a difference when it comes to bad posture and back pain. Without strong abdominal muscles, the back becomes weak and unable to optimally support the spine. Additionally, the muscles that reside closer and deeper to the spine have a greater overall effect on posture and, subsequently, a healthy back. By exercising on a regular basis, the stomach muscles can become strong, holding the spine correctly and allowing for naturally good posture. This knowledge alone, however, might not be the trick to getting your patients to do their crunches.

Let them know that good posture that is supported by regular exercise, can contribute to a more slender-looking body and reduce the appearance of a potbelly. This alone could motivate many patients who want to appear slimmer to stand up straight.

Healthy posture, healthy spine
Of paramount importance is spine health. Poor posture can be the culprit for spinal pain and problems with the shoulders and neck, as well as contribute to the worsening of pain that is already present. And because many people spend large chunks of time at their desks, slouching in their chairs, or performing repetitive lifting without good form, there is quite a bit of back pain all around. For these patients, teaching them about the benefits of good posture can help them to begin to utilize posture awareness to prevent possible future injury and additional pain. By simply keeping a neutral spine, your patients may finally realize just how superior good posture can feel

Fiber supplements lay foundation for health

In the world of wellness, the benefits of fiber may be too easily forgotten. After all, there is nothing flashy about fiber. In comparison to dietary stars such as “super foods” and antioxidants, fiber may appear downright pedestrian.

Years of solid research and scientific investigation, however, prove that fiber is no flash in the pan. In fact, this food staple helps lay a strong foundation for good health, as fiber has been linked to a number of physical benefits.

According to the Mayo Clinic, a diet high in fiber can decrease cholesterol, help with regularity, aid in the prevention of constipation and speed up the passage of material through the GI tract. It also may decrease your risk of digestive conditions, such as irritable bowel syndrome and hemmorhoids. Experts report that the consumption of fiber can slow the absorption of sugar as well, which is good news for diabetics and for the prevention of type 2 diabetes.

Added on to the list of benefits associated with fiber is the fact that it can help you feel full for a longer period of time, which may lead to weight loss. Plus, as people choose foods that are high in fiber, they usually are choosing foods that happen to be lower in fat, sodium and other unhealthy components as well. For example, good choices for high-fiber foods include grains, whole-grain products, fruits, vegetables, beans, peas, legumes, nuts and seeds.

However, not everyone may be able to meet their daily fiber needs through food intake. In this case, it is important to look toward fiber supplements to do the trick. Health experts recommend that men to get 30 to 38 grams of fiber per day, and that women get 20 to 25 grams per day. Study your diet, and figure out whether a fiber supplement would contribute to overall wellness.

In order to understand the importance of consuming adequate amounts of fiber, it’s important to know the definition of fiber. The Mayo Clinic defines it as “all parts of plant foods that your body can't digest or absorb.”

“Unlike other food components such as fats, proteins or carbohydrates — which your body breaks down and absorbs — fiber isn't digested by your body,” the Mayo Clinic reports. “Therefore, it passes virtually unchanged through your stomach and small intestine and into your colon.”

Fiber frequently is classified into two types: soluble and insoluble. Soluble fiber, found in foods such as oats, peas, beans, apples, citrus fruits, carrots and barley, dissolves in water to form a gel-like substance.

Insoluble fiber, on the other hand, does not dissolve in water. This type of fiber, found most often in foods such as whole-wheat flour, wheat bran, nuts and many different vegetables, promotes the movement of material through your digestive tract. It also increases stool bulk, which can be beneficial for those who have irregular stools or constipation.

The benefits of fiber are many, especially as it addresses the risk factors tied to so many diseases, including heart disease, diabetes, diverticular disease, constipation and metabolic syndrome.

If you do decide to up your fiber intake, be sure to choose a broad-spectrum dietary fiber supplement, which contains both soluble and insoluble fiber.

Study: Fruit and vegetable consumption inadequate worldwide

A new study that looks at the fruit and vegetable consumption of nearly 200,000 people finds that the prevalence of inadequate diet is “remarkably high” across the globe.

Overall, 77.6 percent of men and 78.4 percent of women consumed less than the suggested five daily servings of produce.

“Low fruit and vegetable consumption is a risk factor for overweight and obesity, and adequate consumption decreases risk for developing several chronic diseases,” said lead author Spencer Moore. “The release of the 2002-2003 World Health Survey data provided a unique opportunity to examine global differences in low fruit and vegetable consumption in a way that has until now simply not been possible.”

Moore is an assistant professor in the School of Kinesiology and Health Studies at Queen’s University in Ontario, Canada. He and his colleagues looked at data from 196,373 adults in 52 mainly low- and middle-income countries.

The study appears in the May issue of the American Journal of Preventive Medicine.

There were wide variations among nations, ranging from 37 percent of men in Ghana who did not meet that standard — to 99 percent of Pakistani men. The researchers saw similar findings in women with the same two countries at the high and low ends

The prevalence of low fruit and vegetable intake increased with age and decreased with income. These results surprised Moore, as surveys from the United States and other developed countries consistently show that fruit and vegetable intake increases with age.

“Most people regardless of the country that they live in simply do not meet the recommended guidelines for adequate fruit and vegetable consumption,” said co-author Justin Hall, a graduate student at Queen’s University. “Some countries appear to be better off than others in relative terms, but the overall prevalence of low fruit and vegetable consumption is remarkably high across the globe.”

Tim Byers, M.D., interim director of the University of Colorado Cancer Center at Denver, said that this study argues against the stereotype that those in tropical climates have better diets because fruits and vegetables surround them.

“Although the survey deals mainly with developing countries, their results are not substantially different from those we have seen in other surveys done in Europe or the United States,” said Byers, who was not involved in the study. “This is telling us that dietary quality is a global problem.”

Hall JN, et al. Global variability in fruit and vegetable consumption. Am J Prev Med. 36(5), 2009.

Cubicle stretches

By Jeannine Stein
March 2, 2009

If you don't move around nearly enough during the workday, you might need to compensate with these flexibility-enhancing moves. Some require minimal equipment such as dumbbells; others can be done at one's desk or against an unoccupied bit of wall space. Sure, the moves may raise a few eyebrows in the office, but while everyone else is reaching for pain relievers, you'll be sprinting out the door ready for after-hours socializing.

Pete McCall exercise physiologist with the American Council on Exercise, and a San Diego-based personal trainer:

For clients who sit all day, I like to do three different exercises.

* The first is a bridge, where you lie on your back with your feet on the floor, legs bent and push your hips up to the ceiling while squeezing the glutes. The activation of the glute muscles sends a signal to the hip flexors to relax, and it allows them to lengthen. Push the hips up on a one-two count, hold for about a second, and take about three to four seconds to come down. Do that about 12 to 15 times, and really emphasize the contraction of the glutes.

* The next one is a quadruped, or a bird dog. Begin on hands and knees, making sure your wrists are under your shoulders, knees are under your hips and your head and neck are aligned with your spine. Extend your right arm and left leg straight out at the same time. While you're doing this, contract your ab muscles and feel the stretch through the upper chest muscles and the hip flexor. Do this about 10 to 12 times on each side, either alternating, or staying on the same side and then switching.

* The third one is a plank. The body is supported on the forearms and the toes, and you should try to keep the hips and the shoulders at the same height. Contract the core muscles, and the glutes and the quadriceps. As with the bridge, as the glutes contract the hip flexors relax and lengthen. Do these about two to three times and hold for about 15 seconds. To modify this, drop down to your knees, but watch the hip position and avoid bending the body at the hips. You should still feel the extension in the hip flexors.

Then, for a great stretch for the neck and shoulders, let your left arm hang down at your side, and look over your right shoulder. Press your right hand into your chin. Do the other side as well. That gets the levator scapulae and the scalene muscles -- smaller muscles in the neck that get tensed up a lot.

For help with rounded shoulders, stand two to three feet in front of a wall, with your back toward the wall. Rotate the body to the right side and reach up and touch the wall with your right hand as if reaching for something on a shelf. Do the same on the left. This opens up the pectoral muscles and the obliques in the abdomen. It's also a good stretch for the hip flexors.

Tasha Turner

Personal trainer, t:

* The hip flexors tend to get tight if you sit all day, so you want to release that tension and stretch and strengthen them as much as possible. Before you do strengthening exercises, you want to stretch them out with something like a bridge.

* I love squats for strengthening the hips, and you can do them with just your body weight. Three sets of 20 reps is good, or you can try doing them continuously for one minute. If you want definition in your legs, do them with weights for three to four sets of eight to 10 reps. As you progress, increase the weight to shock the system and avoid plateaus.

* I'm a die-hard fan of lateral raises to strengthen the shoulders, but doing them with bent elbows really isolates the shoulder muscle and takes the strain off the neck. Start by holding light dumbbells (about 3 to 5 pounds) by your side, with elbows bent. Raise the arms, making sure the elbows and shoulders are in a straight line -- never go any higher than that. Hold that position for two seconds, then take the arms down slowly. Do three sets of 15 to 20 reps. You can do this standing or sitting, but sitting may be a little more challenging because you're less likely to use momentum to move the weights. This will take the pressure off the neck, especially if you sit at a computer all day and strain your neck trying to read the screen.

* In general, it's a good idea to work on core exercises. You move through your core, and you need a strong core for everything -- walking, standing, even sitting.

Eric Fleishman

, Powerhouse Gym, Burbank:

* One good quick stretch is putting your leg up on a desk or a chair and, keeping the knee slightly bent, reaching down and trying to grab your toe. This allows your hamstrings to get a stretch, which is good if you've been sitting all day. You'll really feel it in the back of your leg, and it has a great effect on the lower back because it promotes blood flow to the region. Then do the other leg. * You should pay attention to your posture, which is incredibly important for body alignment and feeling good, and how you're sitting. We do an exercise at the gym where we take a small bottle of water that's about one-third full and place it on someone's head and have them walk around, which is very "My Fair Lady," but it teaches you what proper posture feels like. You can do the same thing sitting at a desk.

* There's almost nothing better to stretch your shoulders, your trapezius muscles and your back by finding a chin-up bar and allowing yourself to hang. It's almost like picking up a necklace from a table -- it allows the spine and vertebrae to fall into place. It's important not to hold your breath, and you can hang anywhere from eight to 15 seconds. For a more advanced move, swing a little bit back and forth.

Next up on Ask the Trainers: exercises for people always on the move.

Getting health benefits from chocolate

Joe Graedon, Teresa Graedon, The People's Pharmacy
March 30, 2009

A column described health benefits from chocolate. Would high-quality chocolate include Snickers bars? What would be a moderate amount, to get the health benefits?

High-quality chocolate is dark chocolate (at least 70% cocoa solids, and not alkali processed). A good "dose" is 5 to 15 grams daily, which should be just under 100 calories. This is not a large piece of chocolate.

A traditional Snickers bar contains milk chocolate, weighs 58.7 grams and has 280 calories. Milk chocolate does not have the same benefits as dark chocolate.

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I have been taking Protonix for heartburn. After I learned that long-term use might lead to complications, I tried to stop taking it. After about a week, I had to start taking it again due to severe heartburn. I asked my pharmacist how to discontinue acid-suppressing drugs, but she was unable to find out.

Rebound heartburn may make it difficult to stop medications such as Aciphex, Nexium, Prevacid, Prilosec and Protonix. As a result, people sometimes end up taking such drugs for years. The consequences might include an increased risk of pneumonia, hip fractures and vitamin B-12 deficiency.

Dr. Tieraona Low Dog, director of education for the Arizona Center for Integrative Medicine, recommends a gradual approach for discontinuing acid suppressors. She suggests taking ginger capsules and chewing DGL (deglycyrrhizinated licorice) tablets as you phase out Protonix. Probiotics also may be helpful.

Joe Graedon is a pharmacologist and Teresa Graedon is an expert in medical anthropology and nutrition. www.peoplespharmacy.com