Caution! Holiday Eating Ahead

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at the new Penn Medicine Washington Square building, discusses some healthy eating tips for the holiday season.

With the holiday season upon us, if you're anything like me, you just can't wait to get into the festive spirit by puting on that cozy, bulky sweater to keep warm. It also helps to camouflage those few extra holiday pounds the sweet potato casserole and stuffing are likely to leave behind.

But, have no fear; this season can still be enjoyed without needing to buy a new wardrobe when it's over. With a few simple tips and some pre-meal planning, you can still eat the foods you love without the fear of adding the "festive 15."

Keep Your Plate Green

This is actually a great tip for any meal, not just around the holidays! If you dedicate half of your plate to healthy veggies, you've already won half the battle. You can’t give in though. If you go back for seconds, remember the half-plate rule. Veggies are high in fiber, so they will keep you feeling fuller longer and help to prevent over-indulging on some of the less healthy options.

If you intend on bringing a dish to someone’s home, volunteer to bring roasted veggies or a big salad. This way, you know you will like the healthy option.

Don't Leave the House Hungry

One of the most common mistakes individuals make during the holidays is skipping breakfast in an attempt to "save up" calories for big meals. This tactic actually slows your metabolism to a halt. When you do eat, your body wants to hold onto every last calorie it can. Plus, when all that delicious food is put in front of an empty, growling stomach, it becomes an irresistible temptation to overeat. Be sure to eat a healthy, satisfying breakfast, such as oatmeal with a handful of dried fruits and nuts or egg whites with veggies and low-fat cheese.

Pick your "Poison"

We all have our "Achilles heels" when it comes to holiday meals - mine happens to be...well, anything on the dessert table. If you know what you're likely to over-indulge in, you can make a plan to keep yourself on track. For instance, if you're a sweets or carbohydrate-lover like me, you might avoid the "pre-dinner" snack foods and limit the stuffing and sweet potatoes at dinner to one serving each (~1/2 cup). This allows you to have that nice piece of pie for dessert without any guilt!

Keep the Food off the Table

This is a sneaky trick that I have used for years. If the food isn't kept on the table, grazing isn't nearly as easy. In order to get seconds, you have to make the conscious effort to get up from the table, get more food and maybe even heat it up if it's gotten cold. You'll be forced to ask yourself, "do I really want to get up from the table?" rather than just picking at whatever tasty treat is casually left in front of you.

Don’t Forget about Liquid Calories 

Holiday cocktails and wine with friends add up to a lot of empty calories. For example:

• One cup of eggnog – without added liquor – has about 350 calories and 19 grams of fat.
• One cup of champagne has about 182 calories.
• One, four-ounce serving of red wine has about 100 calories.

Try to stick to water or unsweetened tea. If you do choose to have “a drink”, stick to wine, low-carb beer or spirits.

So, enjoy your holidays. Just remember, a little preparation and a modest amount of self-control can go a long way. What better way to start the New Year than with a positive resolution.

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Halloween Safety Tips for Parents

Halloween is fast approaching. Soon, the streets will be filled with ghosts, goblins, princesses and cowboys. To help make this year's festivities a trick-free treat, follow these simple safety tips:

For the Young Ones

• Spotted in the dark. Bright-colored costumes are more likely to be seen after dark. Add reflective tape to your child’s costume or to the trick-or-treat bag so you and cars can keep an eye out. 
• See and breathe easy. If the costume has wigs or beards, make sure they don’t cover your child’s eyes, noses, or mouths. Same goes for wearing a mask.
• Toxic makeup. Consider using nontoxic face paint or makeup. Test the face paint or makeup on your child's arm or hand before applying; ensuring the paint doesn't irritate the skin.
• Don’t trip. Try to avoid oversized and high-heeled shoes and costumes that have long fabric that can cause children to trip.
• Home safe. Check all treats to make sure they are sealed. Throw out any candy with holes in the packages, spoiled items and any homemade foods from strangers.

For Parents with Older Kids

• Be aware. If your child is trick-or-treating on their own, find out the route they'll be taking.
• Safer in groups. Make sure they go in a group and stress that they stay together.
• Welcome in. Advise them to only go to houses with porch lights on and walk on sidewalks on lit streets. 
• Don’t play with fire. Steer clear from candles and other flames. 
• Light it up. Equip your child with a flashlight with new batteries.

Finally, make sure trick-or-treaters will be safe when visiting your home as well. Remove anything that could cause kids to trip or fall on your walkway or lawn. Double check to see if the lights are on outside your house and light the walkway to your door, if possible.

Have a safe and fun Halloween! To help get started, download our Halloween Safety Tips for Parents.

click here to enlarge and download.

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Tips To Stay Active This Fall

It seems as though everything is just a bit easier during the summer. People tend to be a little more laid back at work, there are less people on the road because many are on vacation and, with the added sunlight and warm temperatures, being active seems to be much less of a hassle.

Autumn, though, is here. Say goodbye to the warm temperatures and hello to shorter days and cooler weather. Perhaps it’s the fewer hours of sunlight, but this time of the year seems to be when many go into hibernation and ease up on their active summer lifestyles.

This doesn’t have to be the case as there are many fun things to do to stay fit during the cooler months.

“The change of seasons is a good time to focus on health and wellness goals," said Ngozi Onuoha, MD, FACP, of Penn Internal Medicine Mayfair. "Autumn is a great season to walk. Walking is a great form of exercise that does not require much preparation."

Here are some other tips to keep you moving and feeling healthy this fall.

• Make exercise fun: Autumn is synonymous with harvest season. What better way to stay active than to go pumpkin or apple picking with your family or friends? For the younger ones (or those simply young at heart, take part in physical activities such as corn mazes and haunted trails.
• Sign up for a holiday run: Fall is the season in which many fun runs and events occur. Participate in Halloween runs, turkey trots, reindeer romps, etc. Setting a specific goal, such as a race to train for, increases adherence to an exercise program. Signing up with friends or family will motivate you even more.
• Enjoy the colors: Grab a friend, and find a local park that has great trails to walk, run, or ride a bike on.
• Go to a farmer’s market: Many of the root vegetables are in season and are inexpensive. Grab some apples while you’re at it as they’re rich in antioxidants and flavanoids, both of which can reduce cholesterol.
• Take advantage of the cooler weather: Play catch, walk the dog, get a group of friends together to play ultimate Frisbee or touch football.
•  Make fall chores fun: Raking your lawn can be a real workout. Have fun with it (perhaps by jumping in the leaves??).

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Create Healthy Habits Through Strength in Numbers

R. Aimee Ando, DO, a family medicine physician at Penn Family Medicine University City, discusses how a “partner in health” can help you achieve your goals.

Working in primary care, I have the privilege of learning a person’s most intimate hopes and challenges on a daily basis. Conversations with my patients often revolve around healthy lifestyle changes - eating sensible portions and more fruits and vegetables, exercising, quitting smoking - and the seemingly insurmountable barriers to achieving such goals.

I believe there is a better way to tackle these challenges. And that is by not doing it alone. Changing habits often works best when done with someone else, whether it be your spouse or significant other, a workout “buddy,” or with a group of like-minded individuals.

These four tips will help you and your partner get on the road to good health:

• No more excuses: We are social beings and at our core do not want to let others down. We often thrive on the support that a “partner in health” can provide. Having someone to whom one feels accountable keeps us motivated and committed.
• Choose wisely: Find someone who you like and who has an upbeat attitude. If you are single or if your spouse/significant other is not up for the challenge, broaden your scope. Look to friends or work colleagues with similar exercise schedules to go walk the neighborhood or hit the gym. Working out together can push you to keep moving and dig deeper than when solo. A little healthy competition can go a long way! And don’t give up hope on that spouse at home still sitting on the couch. The positive changes that you make in your own life often inspire those closest to you.
• Create fun incentives: Establishing rewards for your hard work can be a great motivator. If you are committed to quit smoking with your partner, make a separate fund with the money saved from cigarettes and use the funds for a getaway or something special for the house. The reward can even be psychological: sign up and train for a 5K run/walk a few months ahead and set a schedule that you both will stick to. Setting tangible markers of success helps you to keep your eye on the prize.
• Make it fit your reality: What works for some does not always work for others. As parents of two very young children, my husband and I rarely have time to do anything together, much less go off to the gym. Nonetheless, we block off time and space during the week when each of us gets to have her/his own time to be active while the other one watches the kids. And we don’t let the other one back out of it either. It can be so “easy” to make excuses, but when you make your own health a priority, those you love may make their health a priority too!

You never have to go it alone. We have learned time and again that when we partner with people who are more active, think positively, and eat well, we are more likely to do the same. So go ahead and be contagious!

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Health in Your 20s: Good Health Starts With Healthy Habits

As a 20-something, you’re excited to start a career, move out on your own and meet new people. But what about developing or maintaining good health habits? Probably not so much. But being mindful at a young age can have a lifelong impact on your wellbeing.

Cultivate these nine healthy habits in your 20s to get on the road to good health!

1. Exercise Regularly. Daily exercise is essential for good health. It can help decrease blood pressure, improve blood sugar and cholesterol, and independently reduce your risk of heart disease later in life. And it’s not only good for your body, but also for your mind.

2. Get Enough Sleep. Adults need seven to nine hours of quality sleep every night. Lack of sleep not only leaves you groggy, but can lead to serious health concerns, such as obesity, heart disease, diabetes, kidney disease and stroke. If you find yourself tossing and turning at night, consider putting away your electronics and establishing a bedtime routine. Daily exercise can also help you rest easy, as can cutting back on caffeine after noon and alcohol after 6 pm.

3. Eat Right. Keeping track of everything you eat can help you make healthy diet changes. Some simple rules for healthier eating:

• If you don’t recognize the ingredients on the label, don’t eat it.
• If the package crinkles when you open it, don’t eat it.
• Shop the perimeter of the grocery store and focus on produce and fresh meats.
• Limit white carbohydrates (white bread, pasta, etc.).

4. Don’t Smoke. Smoking causes many health problems, including heart disease and emphysema, as well as lung, oral and other cancers. It can also lead to yellow teeth, bad breath and skin damage.

5. Wear Sunscreen. Be sure to apply a broad spectrum sunscreen with at least SPF 15 when you go outside. And remember to reapply every two hours. There is no such thing as a “healthy tan”!

6. Have Safe Sex Every Time. Using condoms with all sexual encounters will not completely eliminate the risk of sexually transmitted infections (STI's), but it will significantly decrease your chances of picking one up.

7. Drink Only in Moderation. If you do drink alcohol, drink in moderation and beware of oversized servings! Remember:
 One drink= 12 ounces of beer (one bottle) OR 5 ounces of wine OR 1 to 1.5 ounces of liquor

8. Treat Mental Illness. If you feel depressed, have lost interest in things you used to love, or are struggling with stress or anger, reach out for help. Your physician can recommend coping strategies and treatment options.

9. Have a Positive Social Network. Studies have shown that people with quality friendships live longer, healthier lives. Your 20s are a great time to think about who you are and who you want to be and to cultivate positive relationships that help you be the best you possible.

These are just a few tips to get you on the right track to a healthy adulthood.

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Ticked About Lyme Disease?

Awareness and Prevention are Key.

The weather is warmer, the days are longer and all you and your family want to do is spend time outside. It really doesn’t matter if it’s hiking, camping, or playing sports -- as long as you are outdoors-- you are happy. It is important to remember that higher temperatures and the more time you spend outside increases the risks of being bitten by a tick and contracting Lyme disease.

Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted to humans from the bite of the deer tick. Most Lyme disease in the northeastern United States occurs during summer or fall, when the small nymphal ticks are most prevalent.

The early stage of Lyme disease is usually marked by one or more of these signs and symptoms:

• Tiredness
• Chills and fever
• Headache
• Muscle and/or joint pain
• Swollen lymph glands
• A characteristic skin rash (erythema migrans)

When caught early, Lyme disease is highly treatable and curable with a single course of oral antibiotics. If the disease is left untreated, it can cause neurologic complications, including facial palsy, numbness, tingling and headaches, abnormal heart rhythm and large-joint arthritis.

Tips to avoid ticks

• Wear light-colored clothing. You’ll have a better chance of spotting a dark tick crawling around.
• Wear high socks, sneakers and long pants. Tuck your pant legs into your socks, your shirt into your pants and avoid wearing open-toed shoes to minimize areas where ticks can find its way to your skin.
• Use insect repellents. Apply repellent to any skin that is unprotected. You may need to apply every few hours. Make sure to avoid contact with your eyes!
• Shower or bathe within two hours. If possible, always wash off within a couple hours after being outdoors to wash away loose ticks. Do a daily tick check. Search all the places ticks love to hide: your hair, under your arms, between your legs, behind your knees and in your belly button.
• Don’t forget about the kids and pets. Be sure to check any children and pets before they enter the house. Ticks can easily drop off on carpets and furniture.
• Check all gear. Thoroughly examine all items you brought with you on your trek.
• Wash and dry your clothes. It is possible for ticks to survive the washing machine, even if hot water is used. Always dry your clothes in a dryer on high heat for an hour as well.
• Create a tick-free zone at home. Mow your lawn frequently, stack wood neatly and in a dry area and discourage animals by putting up fences. It is also good to keep playground equipment, decks, lawn chairs, etc. away from yard edges and trees.

“While Lyme disease can seem frightening, it is preventable! If you are vigilant about looking for ticks, and can pull the tick off the skin within 48 hours of the exposure, you can't get Lyme disease from that tick. If you're not sure how long the tick was on your body before you were able to remove it, contact your doctor to discuss a one-time dose of an antibiotic to help prevent the symptoms of Lyme disease from developing,” says Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine.

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7 Tips to Eating Healthy on a Budget

Tina McGroarty, CRNP, a nurse practitioner at Penn Family and Internal Medicine Lincoln, offers tips on how you and your family can eat healthy - on a budget. 

Tina McGroarty, CRNP

We are all aware that eating healthy is an essential part of maintaining health and wellness, and we see and hear these phrases often:
“Eat more fruits and vegetables.”
“Go organic.”

“Avoid processed foods.”

“Incorporate whole grains, legumes and nuts.”

While most know what is recommended, many find it hard to make these dietary changes without significantly increasing the bottom line at the grocery checkout.

Although processed food is more accessible and less expensive, there are ways to incorporate healthier choices into your diet and stay within your budget. Here are just a few suggestions I have found helpful:

Plan ahead. Check out your supermarket’s weekly ads, or circulars, to be aware of any specials. By preparing your list beforehand, you can plan your meals around sale items.

Eat seasonal produce. Fruits and vegetables are fresher and less expensive when in season, so choose meals that incorporate those items. You can also stock up and freeze or can fruits and vegetables to use later. Berries, green beans, corn and tomatoes all freeze/can well and are sure to be enjoyed in the winter months.

Buy local. Most communities have local farmer’s markets or produce stands that offer seasonal fruits and vegetables at reasonable costs. The prices tend to be much cheaper than supermarkets and provide a wider variety of fresher produce.

Grow your own. There is nothing better than freshly picked vegetables from your backyard. Starting a family garden is a great way to add healthy foods at a low cost.

Eat less meat. Most of us eat more meat than necessary. Substituting beans, legumes and other herbivorous proteins in place of meat is much healthier and less expensive. If you are buying less meat, it may make it affordable to buy grass-fed and free-range options, which can be more nutritious.

Buy organic wisely. In an ideal world, we would all love to consume only organic foods, but that is not realistic for most of us. Knowing the most and least contaminated foods can help you decide where to invest your money when buying produce.

• 12 most contaminated foods: peaches, apples, bell peppers, celery, nectarines, strawberries, cherries, pears, imported grapes, spinach, lettuce, potatoes
• 12 least contaminated foods: onions, avocado, sweet corn (frozen), pineapple, mango, asparagus, peas (frozen), kiwi, bananas, cabbage, broccoli, papaya.

Prepare meals at home. Home-cooked meals tend to always be healthier and less expensive. Taking a few hours on the weekend to cook/prep a few meals for the week will go a long way. Soups and stews are a great option as they can be loaded with vegetables and proteins, they freeze well and are delicious! Packaging leftovers and individual salads for lunch is also a great way to ensure a healthy meal during your busy work week.

Eating healthy doesn’t have to be expensive. I hope these ideas help you incorporate some healthier meals into your diet.

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How Much Water Do You Need Each Day?

Raza Ahmad, MD, discusses the question of how much water to drink on a given day. Dr. Ahmad practices at Delancey Internal Medicine, located at Penn Medicine Washington Square.

Raza Ahmad, MD

We all know the human body is predominantly made up of water. We also know that the body thrives when it is properly hydrated. But what is "proper hydration?" Do we really need to be running to the water cooler every 15 minutes to fill up our water bottle? And, do we really need to drink so much water? Can we drink other liquids instead? The answer is…well, a bit fluid.

Why Water is So Important

Water is a vital part of your body’s overall health — because it affects every cell of your body. It is a huge component of muscle and helps you produce energy. This is why you’ll often get a cramp when you work out without proper hydration.

Water also helps the body to maintain its temperature, remove waste and lubricate joints.

“Hydration has the greatest impact on training, performance and recovery," says Dr. Ahmad. "Dehydration, even at the lowest level, can result in impaired performance.”

How Do I know I am Hydrated Enough?

Dehydration occurs when your body loses more fluids, mostly water, than it is taking in. With dehydration, more water is moving out of our cells and body than what we take in through drinking.

The signs and symptoms of dehydration range from minor to severe. Increased thirst, dry mouth, weakness, dizziness, confusion and fatigue are all signs that an individual may be lacking the proper amount of water.

Many think that dry mouth is one of the first signs of dehydration. If you are experiencing dry mouth, though, your body is likely already craving water. If you are concerned that you may be dehydrated, a good way to check is to check the color of your urine.

If your urine is anything but clear, you are lacking the water your body needs. Yellow and orange are not the colors of healthy urine. If your urine is brown, you need to speak with your physician.

Should I Only Drink Water?

It is rare, but you can actually drink too much water.

As much as you need water, too much in your system can create an imbalance between water and electrolytes. When you sweat or lose water through other ways, you lose electrolytes. Replenishing your body with just water can dilute the electrolytes that are already low in your system. This could lead to your sodium levels becoming very low. When this occurs, you could become very ill. Although this is rare, it does occur.

During intense physical activity where you are sweating quite a bit, you may want to grab a sports drink or coconut water rather than plain water. This will help to better replace sodium lost in sweat.

"For slower athletes, it is recommend to drink according to thirst," said Dr. Ahmad. "Elite level athletes should follow a recovery plan, which includes drinking water and carbohydrate-electrolyte drinks."

How Much Water Do I Need Each Day?

This is last for a reason. Although the question is rather simple, the answer is much more complicated.

Unfortunately, there really is no one-size-fits-all approach to the amount of water you should consume on a daily basis.

As a general rule of thumb, you should try to drink between half an ounce and an ounce of water for each pound you weigh, every day. For example, if you weigh 200 pounds, it is recommended you drink 100 ounces of water if you are performing non-strenuous activities.

If you are going to be working out or hiking, you definitely should add to those 100 ounces. It is recommended that you drink 12 ounces of water a couple hours before your activity and then another 12 ounces about 30 minutes prior to the start. Be sure to also drink throughout the activity.

Other factors to keep in mind when thinking about your daily water consumption include the environment and any illnesses or health conditions. Hot or humid air makes you sweat more and will require additional intake of fluid. If you are sick and vomiting or have a fever, you will again be losing fluid more quickly and need to replenish.

As you can tell, being properly hydrated is important but not a perfect science. The best approach is to listen to your body and look for the feedback signs.

"I can not emphasize enough the importance of hydration," says Dr. Ahmad. "It has the greatest impact on training performance and recovery. Lack of hydration can lead to severe problems, including muscle breakdown, kidney injury and electrolyte imbalances."

Keep Calm and Hydrate on!

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If The Shoe Fits…Run!

Daniel C. Farber, MD, Foot and Ankle Surgeon, discusses the importance of picking the proper running shoe and offers advice while going through the selection process. 

To avid runners, there is much more to the sport than simply lacing up any type of running shoe. They know that selecting the proper shoe is an incredibly important part of preparing for any type of competition.

Daniel C. Farber, MD

If you're wearing a shoe that doesn't fit your feet properly, you have a better chance of developing an improper gait or poor biomechanics. This added pressure on the heel or ball of the foot could lead to pain, plantar fasciitis, stress fractures, hallux valgus, (bunions) and lesser toe deformities.

When you're standing in the shoe store, most running shoes feel comfortable. Still, the true test doesn't come until you've pounded the pavement for several miles.

"Not all shoes are the same. Make sure you choose a shoe that fits your foot shape and running style," Dr. Farber recommends. "Remember that the most expensive shoe is not necessarily the best. The midrange shoes often have the more proven technology without the trendy price."

So, how do you sift through the many different brands and styles to ensure your feet stay happy and you stay pain-free?

• Try on all shoes. Sizes among shoe brands and styles tend to vary. Don’t select shoes by the size marked inside the shoe. Judge the shoe by how it fits on your foot.
• Select a shoe that conforms as nearly as possible to the shape of your foot.
• Have your feet measured regularly. The size of your feet changes with age. For women, it may change during pregnancy.
• Have BOTH feet measured. Most people have one foot larger than the other. Always fit to the larger foot.
• Get fitted at the end of the day. The best time to measure your feet is at the end of the day when your feet are largest.
• Stand during the fitting process. Standing allows you to check that there is adequate space (3/8" to 1/2") for your longest toe at the end of each shoe.
• Comfort is important. Make sure the ball of the foot fits comfortably into the widest part (ball pocket) of the shoe.
• Don’t expect them to stretch. Avoid purchasing shoes that feel too tight, expecting them to “stretch” to fit.
• Minimize slippage. Your heel should fit comfortably in the shoe with a minimum amount of slippage.
• Take a stroll. Walk in the shoes to make sure they fit and feel right.

Finally, remember that knowing when to replace your running shoes is just as important as picking the proper pair. Dr. Farber recommends that running shoes should be replaced every 3-6 months (or 300-500 miles) as they show signs of wear.

"With less activity, once a year is adequate Dr. Farber said. "If a shoe is in good condition, but has lost the cushioning of its insole, you can oftentimes simply rehab it with an over-the-counter insert."

"However, if the shoe looks and feels worn and doesn't support your foot well, replace it no matter what the age."

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Fight the Winter Workout Woes

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at the new Penn Medicine Washington Square building, discusses ways to keep active during the colder months.

Lori M. Noble, MD

When it’s cold and blustery outside, your warm and fluffy slippers have a tendency to look much more enticing than your running shoes. Before you know it, one day off turns into two and, eventually, that short exercise break has turned into an outright sabbatical.

This doesn’t have to be the case, though. Some simple tips to help stay active this winter:

1. Switch it up: Who says you have to exercise the same way throughout the year? If you enjoy jogging or biking, there are great indoor alternatives to these activities.
   
   Try an exercise DVD series, sign up for an up-tempo Zoomba class, or try honing your swimming skills at the local YMCA. If you want to continue biking, get a stand that allows you to turn your road bike into a stationary one.


2. Squeeze it in when and where you can: You can burn calories by making small changes to your daily routine. Did you know that an individual weighing 200 pounds can burn up to 12 calories an hour simply by choosing to stand rather than sit? That adds up to about 100 calories in an 8-hour workday, which is about the same as running a mile!
   
   And we often forget that there is a built-in gym in every office building - the stairs. Take them whenever you need to go between floors. Take it a “step” farther and carve out part of your lunch break to walk or run a few flights.


3. Dress the part: If you know you won’t be able to get past the distractions at home or work to make exercising indoors possible, make exercising outside easier.
   
   You’ll need breathable, but fitted attire to keep warm and help reduce sweat. Because the body is mainly focused on warming your core, a hat, gloves, and warm socks are critical to feeling comfortable when the cold really hits.



4. There’s power in numbers: When motivation is lacking, nothing is more powerful than the support of a friend. Try organizing a neighborhood walking club, or reach out to that person with whom you just never have enough time to catch up. Time flies when you’re having fun, so that 30-minute jog will inevitably feel much shorter in the company of friends.


5. Track your progress: Setting goals is a great way to keep yourself motivated. Jot down your exercise plan for the month while keeping in mind the progress you hope to make. Keep the goals attainable, like increasing your workout by a few minutes each day. It's also nice to have a little reward planned once you've met your goal, like buying that new pair of sneakers you've had your eye on.

This winter, don’t let workout woes slow you down. Keep it interesting, and you’ll find it easier to keep moving.

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The Benefits of Physical Activity

Risha Hertz, APNC, discusses the numerous health benefits of keeping an active lifestyle. Risha practices at Penn Family Medicine Gibbsboro.

Risha Hertz, APNC

Just because there’s been a dip in the temperature, doesn’t mean it’s time to hibernate until next spring. It’s important for you and your family to stay active throughout the year.

For many of us, as kids, our parents probably sounded like a broken record: Go outside and play! Sitting inside and watching television is not good for your health.

As it turns out, they were right. Being sedentary or not really engaging in any physical exertion, can take a toll:

“Regular physical activity greatly helps many of the body’s systems function better,” said Risha Hertz, APNC. “For those that aren’t very active, they face increased chances of becoming overweight and developing a number of chronic diseases.”

“For my patients that are just becoming more active, it is a joy to see the positive effects just days into their individualized activity program.”

Below are just a few of the benefits of regular exercise and living a healthy lifestyle.

Controls weight and improves appearance. Perhaps most important, exercise can help prevent excess weight gain or help you to maintain weight loss. Adding muscle also helps your body look lean and toned. Exercise also makes you sweat, which purges the body of toxins that can clog pores and plague your skin with pimples and blemishes.

Strengthens mental acuity. According to the Centers for Disease Control and Prevention, research has shown that doing aerobics or a mix of aerobics and muscle-strengthening activities three to five times a week gives you numerous mental health benefits. Regular physical activity can help improve your thinking, learning, concentration and reaction time as you age. It can also reduce the risk of depression and may help you sleep better.

Gives you an energy boost. Exercise and physical activity transport oxygen and nutrients to your tissues and help your cardiovascular system work more efficiently. When your lungs and heart are working more efficiently, you have more energy.

Reduces risk of injury. Exercise is critical for strong muscles and bones. As you age, muscle strength declines, but studies show that people who exercise on a regular basis are stronger and leaner than others in their age group. Because muscles act as both cushions and shock absorbers for your joints, strong muscles help to protect joints, improve balance and can help reduce the pain of arthritis.

Reduce risk of disease. Two of the leading causes of death in the United States are heart disease and stroke. Living an active lifestyle increases your high-density lipoprotein (HDL), or "good," cholesterol and decreases unhealthy triglycerides. This combination, which helps blood flow, decreases the risk of cardiovascular disease. Regular activity can also help prevent a number of other health concerns, including stroke, metabolic syndrome, type 2 diabetes, depression, some types of cancer and arthritis.

Now that you know the positive effects of living an active lifestyle, how do you get started?

“At Penn Medicine, we partner with our patients to develop individualized activity programs that will work for them,” said Hertz. “Many think that they have to go to the gym for half an hour to an hour and perform weight lifting and cardio. Formal activity is great, but is not for everyone. My patients and I explore ways in which they can become more active throughout the day as much as possible.”

If you haven’t exercised consistently in some time, you might want to talk to your primary care doctor first.

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How to Have Your “Cake” and Eat It, Too

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at the new Penn Medicine Washington Square building, offers tips on how to satisfy your sweet tooth and do so in a healthy way.

Lori M. Noble, MD

For those that don’t know me, I have a bit of a sweet tooth. Ok, I'm a dessert-a-holic. But, throughout my medical training, I became more aware of the potential detriment this habit of mine could have on my health. It is estimated that diabetes affects 382 million people worldwide and the prevalence continues to increase in every country.

Among adults in the United States, the estimated overall prevalence of diabetes ranges from 5.8 to 12.9 percent. One very large, well-respected study - the community-based Framingham Heart Study- has found that the incidence of type 2 diabetes doubled from the 1970's to the 1990's. Diabetes is one of our country's leading health problems, and as I learned more, I decided I didn't want to become a statistic.

So, over the years, I've found creative ways to satisfy my craving for sweets without breaking the sugar bank. Here are some of the tasty tricks I've developed to make dessert both delicious and healthy:

• Fruit crisp/cobbler: Slice up a banana or an apple and brown it in a sauté pan that has been sprayed with some non-stick cooking spray. Sprinkle with cinnamon and put the warm fruit over ½ cup of granola. Add two tablespoons of low-fat whipped topping – delicious!
• "Ice cream": Freeze the older, brown bananas that you would normally wind up throwing out. Once frozen, grind them up in a food processor until they are smooth and creamy. You now have what tastes and looks like ice cream without the added sugar and fat! Mix in whatever you'd like – berries, some crushed graham crackers, a tablespoon of chocolate chips…the possibilities are endless!
• Oatmeal truffles: Mix one cup of instant oats with ½ cup of dried figs, dates or raisins, two tablespoons of skim milk, one tablespoon of honey and cinnamon in a food processor. Once well mixed, form into balls, roll into coconut flakes (optional) and chill in the fridge for 30 minutes.
• Bread pudding: Take two pieces of whole wheat bread (stale or fresh) and break them into small pieces, set aside. Mix ¼ cup of egg whites, two tablespoons of raisins, ½ teaspoon of salt, cinnamon to taste and one tablespoon of melted butter. Pour the mixture over the bread, transfer to an oven-safe dish and bake at 350 degrees until warm, about 15-20 minutes.

For those looking for store bought options that don't require preparation, here are two of my favorites:

• Skinny Cow: Skinny Cow ice cream sandwiches or ice cream popsicles. They typically run between 100-150 calories and are very satisfying.
• Weight Watchers muffins: Add a side of fresh fruit and you've got a high fiber, cake-like dessert.

So next time you are looking for something sweet, try one of these healthy, satisfying options that have earned high praise in my house and should do the trick in yours.

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The Importance of Primary Care Physicians

Generally speaking, people in good health rarely need medications or have the need to see a specialist. So it’s probably natural that most give little thought to selecting a Primary Care Physician (PCP).

Ngozi Onuoha, MD

At some point, though, everyone is going to feel under the weather, which might call for a medical opinion. This is where and when it makes sense to have a Primary Care Physician you can trust and who can act as the first point of contact into a health care system. A PCP can provide preventive care, teach healthy lifestyle choices, identify and treat common medical conditions and make referrals to medical specialists, when needed.

In fact, many patients, once they find a PCP they really like, stay with that physician for decades. With this kind of long-term relationship, PCPs develop a baseline for your wellbeing and really get to know you and your family, allowing for optimal management of your total health. The relationship you build with your primary care doctor is one of the most important you’ll ever have.

“A Primary Care Physician is essential to help an individual navigate to good health and stay healthy; preventing disease by identifying risk factors; coordinating and managing chronic disease care for longevity and a better quality of life,” says Ngozi Onuoha, MD, a primary care physician at Penn Internal Medicine Mayfair.

What Makes Penn Unique?

From childhood through the rest of your life, Penn primary care physicians and staff listen to your special concerns and help you make informed decisions about maintaining your health. Penn providers partner with patients to develop personalized goals and wellness plans to meet each individual’s specific health needs.

With a comprehensive approach and broad knowledge of each organ system and disease type, Penn PCPs emphasize health education, appropriate screenings and prevention and care of chronic diseases. When the time comes for you to choose a primary care physician, you should consider your specific needs as well as those of your family.

At Penn, you can choose from several different types of primary care:

• Family Medicine: Caring for the whole family in a variety of areas including obstetrics and gynecology, pediatrics and internal medicine.
• Internal Medicine: Generally caring for adults, treating a wide variety of general and chronic conditions.
• Pediatrics: Compassionate and personal care for children from birth to age 18.
• Adolescent Care: A team of physicians focused on the specific needs of young men and women between the ages of 12 and 30.

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