5 Lower Back Stretches to Keep you Moving

Every day your spine experiences heavy loads of stress. When you do not stretch and perform exercises to help strengthen this area, you can develop muscular imbalances, tightness and pain. Below are some stretches that can be done to help relieve such pains and tightness. Remember, not all stretches may be right for you, so only do the ones that provide relief, not pain.

1. Lumbar Extension: Start lying on your stomach, forearms and palms of your hands flat at the floor. Keeping your hips on the floor, slowly raise your upper body off the floor, keeping your muscles relaxed. Only go as far as you can without pain. Hold for 10-20 seconds, then return to the original starting position.

2. Lumbar Flexion: Start sitting on your heels, knees on the floor. Keep your glutes on the heels, slowly walk the finger tips as far forward as you can. This is similiar to a “Childs Pose” in yoga. Hold for 10-30 seconds, then slowly walk your finger tips back up to a seated position.

3. Cat Stretch: Start with a neutral spine on your hands and knees. Slowly arch your back, letting your stomach move towards the floor. Once you are at your furthest point that feels good, stretch the opposite way pulling your spine and core up towards the ceiling. Slowly move through these two stretches 2-3 times.

4. Knee to Chest: Start lying on your back with both legs in front of you. Pull one knee in towards the chest, pressing the low back into the floor and trying to keep your straight leg on the floor. Hold for 10-30 seconds, then switch sides.

5. Hamstring Stretch: Start lying on your back with both legs straight on the floor in front of you. Slowly bring one leg up towards the ceiling as high as possible without bending the knee. You can use your hands or a band to help hold the leg up and add tension to the stretch. Hold for 10-30 seconds, then slowly lower down. Repeat on the other side.

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Personal Reflections on Coronary Artery Calcium Quantitation by CT: John A. Rumberger, PhD, MD, FACC

by John A. Rumberger, PhD, MD, FACC Director of Cardiovascular Imaging, the Princeton Longevity Center

Despite a number of controversies in the past 30 years regarding clinical cardiac [i.e. heart] imaging using x-ray computed tomography [CT], we have now settled an unbelievably simple matter – CAC [coronary artery calcification] quantified by CT is a validated means to estimate global coronary artery plaque burden; furthermore, the greater the burden or the more premature its development (for gender/age) the greater the personal cardiovascular risk. But this conclusion has not been easy for many in the Cardiovascular Disease community to accept and, as I reflect on personal issues and battles, I am reminded that we go through three stages of acceptance: First, “it is not true”; Second, “it is not important”; Third, “it is not new!”

My journey with CAC began in the early 1990’s. I had been using the exciting “new” technology of Electron Beam CT (EBT) for nearly a decade. We had successfully validated during 1985-87 the ability to quantify cardiac muscle mass and ventricular volumes and my Mayo Clinic laboratory had embarked upon studies of changes in heart size and shape after a first heart attack – called ventricular remodeling.
At that time I was approached by Mr. David King, the visionary and “father” of the CAC method, regarding whether I was interested in this ‘other’ application of the EBT technology. As a traditional cardiologist, I immediately launched a diatribe about how we already knew CAC did not tell us percent stenosis [i.e. percent narrowing of the heart artery as could be done using invasive angiography] and I could not possibly see how this would be of clinical benefit. I asked him to talk to a colleague, but I was simply “not interested”. I was moving through the first phase of acceptance (or maybe rejection): “it is not true” that CAC has any clinical value.

A year later I ran across one of the Mayo Internal Medicine residents who had measured CAC using EBT in autopsy hearts. He had raw data on a computer diskette and wondered if I could help him organize the information and point towards some analytical methods. Using a spreadsheet program we looked at the paired CT calcium areas and microscopic atherosclerotic plaque areas. In a perfunctory manner, I told him that we were going to graph these data and look at the potential for some sort of correlation. I recall this moment well; frankly it was an epiphany. I displayed the graph and saw what I did not think possible; these data, of course with scatter, showed a direct and linear correlation between coronary atherosclerotic plaque and the amount of coronary artery calcification [as measured by CT] in the same heart segments. I turned to him and said “Where the hell did you get this?” Three publications later I was still amazed at what had been “discovered”.(1-3) By that time, it had been nearly 5 years since Dr. Warren Janowitz and Dr. Arthur Agatston had published their paper demonstrating the prevalence of CAC by EBT paralleled the epidemiology of adult coronary disease across age and gender.(4) After re-reviewing their data in a new light I was hooked, and did not looked back.

David King had organized a fledgling group of researchers dubbed the “calcium club” (which formed the foundation for the future development of the Society of Atherosclerotic Imaging and for the Society of Cardiovascular Computed Tomography). We had early morning meetings before each major cardiology convention [twice per year]. During these one hour meetings we presented new research, shared concerns, formed bonds, and had arguments. Our little band grew in size at each meeting. More and more data had come forth, including early data on prognostication. We realized that guidelines on CAC use and interpretation in clinical practice should be devised. It was apparent to all that the greatest use was in the asymptomatic, intermediate risk subjects, in which traditional Framingham risk remains least predictive. By Fall 1996, we had CAC scoring categories and percentile rankings for age and gender. It was my job to put this together as a manuscript. The paper was ready for journal submission by Spring 1997. Each major cardiology and internal medicine journal we contacted was not interested or had other “opinions”. It took literally three years to get the “guidelines” paper published and it appeared in the Mayo Clinic Proceedings in 1999.(5) As an interesting aside, in 2003 the then Editor of the Mayo Clinic Proceedings told me that this paper was amongst their most requested reprints.

The general interest was clearly there, but the adult cardiology community remained skeptical. For instance, there was a review by the American College of Cardiology(6) on CAC that somewhat reversed a prior publication by the American Heart Association. These controversies and concerns focused on the second phase of acceptance: “it is not important” and most certainly the prevailing opinion was that CAC was not as “good” as established Framingham risk calculations.

In 2004 and 2005 there was literally a rapid fire of publications presenting new scientific data and consensus opinions regarding CAC, each now confirming older data and guidelines while expanding the database across populations. The research confirmed CAC as THE most powerful “risk factor” in asymptomatic patients as an individual providing data actually incremental to conventional risk assessments(7-9)– especially in those 40-50% of the population seen by the Internist or Family Practitioner who fall into the “intermediate” risk group. We had come full circle; in short, “it is not new!”

As cardiac CT has now come of age and EBT has been replaced with 64+-slice MDCT (multi-detector CT) devices, the issue of CAC is now center stage, along with the ability to visualize non-calcified (“soft”) plaque and segmental coronary stenoses using intravenous contrast enhancement.

Another milestone was reached just recently with the February 2015 release of a documentary film called ‘The Widowmaker’ [Oxford, Films, London, UK] detailing the difficulties of the ‘calcium club’ to get a foot hold in preventive cardiology and early diagnosis of coronary atherosclerotic plaque versus the much more profitable world of advanced coronary disease and use of stents. The film will soon undergo global release and can be found on iTunes and Amazon. The story is worth seeing!

Cited References:
1. Simons DB, Schwartz RS, Edwards WD, Sheedy PF, Breen JF, Rumberger JA: Non Invasive Definition of Anatomic Coronary Artery Disease by Ultrafast CT: A Quantitative Pathologic Study. J Am Coll Cardiol 1992; 20: 1118 26
2. Rumberger JA, Schwartz RS, Simons DB, Sheedy PF, Edwards WD, Fitzpatrick LA: Relations of Coronary Calcium Determined by Electron Beam Computed Tomography and Lumen Narrowing Determined at Autopsy. Am J Cardiol 1994;73:1169 1173
3. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS: Coronary Artery Calcium Areas by Electron Beam Computed Tomography and Coronary Atherosclerotic Plaque Area: A Histopathologic Correlative Study. Circulation 1995;92:2157-2162
4. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R: Quantification of coronary artery calcium suing Ultrafast computed tomography. J Am Coll Cardiol 1990:15:827-32
5. Rumberger JA, Brundage BH, Rader JD, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 1999;74:243-252
6. O’Rourke RA, Brundage BH, Froelicker VF et at. American College of Cardiology/American Heart Association Expert Consensus Document on Electron-Beam Computed tomography for the Diagnosis and Prognosis of Coronary Artery Disease. Circulation 2000;102;126-140
7. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD: Coronary Calcification, Coronary Disease Risk Factors, C-Reactive Protein, and Atherosclerotic Cardiovascular Disease Events: The St. Francis Heart Study. J Am Coll Cardiol 2005; 46:173-9
8. LaMonte MJ, FitzGerald SJ, Church TS, Barlow CD, Radford NB, Levine BD, Pippin JJ, Gibbons LW, Blair SN, Nichaman MZ. Coronary Artery Calcium Score and Coronary Heart Disease Events in a Large Cohort of Asymptomatic Men and Women. Am J Epidemiol 2005;162:1-9
9. Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG. Coronary Calcium Independently Predicts Incident Premature Coronary Disease Over Measured Cardiovascular Risk Factors: Mean Three-Year Outcomes in the Prospective Army Coronary Calcium (PACC) Project. J Am Coll Cardiol 2005;46:807-14

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What to eat when you have Psoriasis

Although you cannot cure psoriasis by following a specific diet, eating certain foods may make living with psoriasis easier.  Some foods may help to control inflammation in the body that is caused by this skin condition and therefore, may help to minimize flare ups. In addition, keeping your weight in a healthy range can help to minimize symptoms.

Here is what you should focus on eating:

  • Omega-3 rich fish like salmon, trout, tuna, etc.; aim for 2 fish meals a week. Talk to your physician or Registered Dietitian about taking a concentrated omega-3 supplement if your fish intake is limited.
  • Vegetarian protein sources like beans, nuts, seeds, and large portions of vegetables, etc. Animal protein sources that are low in saturated fats like skinless chicken or turkey breast, fish, and lean beef can be eaten in small portions.
  • Whole grains like brown rice, quinoa, whole grain bread, etc. If you suspect that gluten (in wheat products) makes your symptoms worse, talk to your physician or Registered Dietitian about further testing or about trying an elimination diet.
  • Antioxidant-rich foods to reduce free radicals and decrease inflammation; choose a variety of different colored fruits, vegetables and other plant foods daily and throughout the week.
  • Foods rich in folic acid like leafy green vegetables (spinach, broccoli, asparagus, etc), peas, beans, whole grains, strawberries, etc.
  • Probiotic rich foods like kefir, yogurt, kimchi, miso or take probiotic supplements to improve gut function, which is linked to inflammation and immunity.
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Beans & Greens Burritos; A Cancer-Fighting Meal for Saint Patrick’s Day!

This recipe from the American Institute for Cancer Research uses cancer-fighting collard greens as burrito shells making a tasty and healthy “green” meal for St. Patrick’s Day!

Beans and Greens Burritos

Makes 4 servings

4 large collard green leaves, rinsed

1/2 cup canned black beans, rinsed and drained

1/2 cup frozen whole kernel corn, thawed

1/2 cup cooked brown rice

1/3 cup hummus

1/4 cup chunky salsa, mild or medium

2 stalks celery, thinly sliced

4 cloves garlic, minced

1/2 tsp. oregano

1/4 tsp. cumin

1/4 tsp. red pepper flakes, or to taste

Salt and freshly ground black pepper

On cutting board, lay each collard green leaf with top up and gently smooth leaf. Slice 4-5 inches off bottom to remove large stem.

Bring large pot of water to boil. Drop leaves in and blanch 2-3 minutes. Carefully remove from pot and lay flat on kitchen towel to drain and cool. Lay leaves in assembly line manner with top end up and cut bottom down.

In mixing bowl, add remaining ingredients. Mix gently but thoroughly. Season to taste with salt and pepper. Place mixture, evenly divided, in center of leaf and shape thick line from top to bottom leaving two inches at top and bottom. Gently fold up bottom edge, then top edge down. Next, fold left edge toward center and roll to right to form a burrito. Serve whole or cut diagonally in half.

Per serving: 130 calories, 3 g total fat (<1 g saturated fat), 23 g carbohydrate, 6 g protein, 6 g dietary fiber, 201 mg sodium

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Mini Vegetable Quiche

This is a quick and easy recipe to help you incorporate more vegetables into your diet, starting at breakfast when this may be a challenge.  Eating this mini quiche – hot or cold – on a whole grain sandwich thin or with a piece of fruit will start your day off with protein,  vegetables, and either a serving of whole grains or fruit, making this an ideal breakfast choice.

Yields 12 mini quiches

INGREDIENTS

  • 8 ounces baby portabella mushrooms 
  • 1 medium leek
  • 12 medium red pepper
  • 12 medium green pepper
  • 3 garlic cloves
  • salt
  • pepper
  • 3 eggs
  • 7 egg whites
  • 1 cup 1% milk
  • 1 teaspoon paprika
  • 12 teaspoon hot sauce
  • ¼ cup parmesan cheese

DIRECTIONS

  1. Sauté mushrooms for 2-3 minutes in a pan sprayed with cooking spray over medium heat.
  2. Add leeks, peppers and garlic and sauté for another 5-7 minutes.
  3. Add salt and pepper to taste.
  4. Turn off heat and put aside to semi-cool.
  5. Beat together eggs, milk, paprika, and hot sauce.
  6. Spray a muffin pan and pour egg mixture in muffin tins filling them 3/4 of the way full.
  7. Then add the vegetable mixture to each one and top with Parmesan cheese.
  8. Bake at 350 for approximately 25 minutes until golden brown.
  9. Eat immediately or cool on cooling rack and store in the fridge.
  10. To re-heat put them on high in the microwave for 30 seconds to 1 minute or in the toaster oven on 400 degrees for 7-10 minutes.

Nutrition: Calories per serving:  58.3, Total fat: 2.2 g, Saturated fat: 0.9 g, Cholesterol: 49.4 mg, Total carbohydrate:  4 g, Protein: 5.8 g

Resource:  http://www.food.com

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Don’t Forget to Eat your Fruits & Vegetables!

by Staci O’Connor, MS, RD, CLC, CDN

Most Americans are not getting enough fruits and vegetables into their diet and they are so rich in vitamins, fiber, nutrients, antioxidants, and water!  Below you will find simple ways to increase the amount of fruits and vegetables that you consume on a daily basis.

  1. Add fresh or frozen berries, dried fruit, or banana slices to your plain Greek yogurt or hot/cold cereal.
  2. Make a smoothie. Combine low fat milk or yogurt with frozen berries and a couple of cups of dark leafy greens for a super easy breakfast on the go.
  3. Top a whole wheat sandwich thin with a colorful vegetable omelette. Add red, orange, yellow and green peppers, tomatoes, mushrooms, onions, and broccoli to your scrambled eggs.  Think of the color of the rainbow and pick as many colorful vegetables to incorporate as possible.
  4. In a hurry? Grab a piece of fruit, such as an apple, banana, or orange with a handful of nuts on your way out the door.
  5. Aim to fill half of your plate with colorful vegetables at meal time.
  6. When dining out order extra sides of steamed, grilled or sautéed (in olive oil or vegetable broth) vegetables. Even if you don’t see any vegetable sides on the menu, ask if they can be prepared for you.
  7. Pizza night? Ask for a vegetable pizza or make your own vegetable pizza with your children.  Pile colorful vegetables onto your pizza and even consider eating a salad before you dive in for a slice of pizza.
  8. Top sandwiches with lots of fresh vegetables, such as romaine lettuce or spinach, tomato, onions, sprouts, mushrooms, or fresh red pepper.
  9. Incorporate raw vegetables with natural peanut butter or hummus for your morning or afternoon snack.
  10. Make a large vegetable-based salad for lunch. Pick a few days each week that can be your “salad” days.  Try to take the extra time to make your own salad at a salad bar or look for a healthy salad option at a restaurant.
  11. Keep a bowl of fresh fruit on the table or counter at home and throw a piece of fruit or two in your suitcase/lunch box before you leave the house.
  12. Look for grocery stores or delis that have containers of mixed fruit or vegetables that are already cut up and ready to eat.
  13. Shred, puree or grate vegetables and see how creative you can get with your favorite recipes. Grated zucchini and carrots do wonders for turkey burgers and meatloaf. While pureed cauliflower, winter squash, or red peppers can be stirred into sauces, mashed potatoes, pot pies, or even mac and cheese.
  14. At dinner, add crushed pineapple to coleslaw, or include orange sections or grapes in a tossed salad.
  15. End your meal with dessert consisting of: a baked apple, pear or bowl of fruit salad.
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Strawberries-A Heart Healthy Treat!

By Debbie Jeffery, RD

Not only are strawberries an excellent way to satisfy the sweet tooth, they are also extremely nutrient dense.  One cup of strawberries contains more vitamin C than an orange, has 20% of your daily folic acid needs, and contains 4 grams fiber & 270 mg of potassium.  Strawberries also contain a variety of phytochemicals, including flavonoids, which may have anti-inflammatory properties.  The latest research also shows that the nutrients in strawberries may also help to maintain a healthy heart. Besides snacking on strawberries, you might enjoy sliced strawberries mixed with salad greens or a refreshing smoothie like the recipe below!

Strawberry Flax Smoothie        

1 cup fresh or frozen sliced strawberries

½ cup nonfat Greek vanilla yogurt

½ cup skim milk (soy, almond, rice, or coconut milk may be substituted)

3 tablespoons ground flax seed

½ teaspoon ground cinnamon

Place all ingredients in blender and blend on high speed until smooth.  Consume immediately or refrigerate up to 2 hours before serving.

Serves 2.  Per serving: 145 calories, 4g fiber, 7g protein, .5g saturated fat, 19g carbohydrates, 170 mg calcium.

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