Wellfie Wednesday Tip #107: Zucchini Time!

Happy Wellfie Wednesday! Welcome back! This week is brought to you by Diana (@DianaKlatt)!

     I don’t know about all of you home gardeners but my summer garden is overloaded with zucchini. So I decided to look a bit into what the health benefits of zucchini are and to make sure it’s not a problem if I eat it every day for the next month…

     So what are the health benefits? Well first things first, let’s talk about the major reason for an increasing trend in zucchini as “zoodles.” Notably for the replacement of pasta and reduction in calories for weight loss. Zucchini is high in fiber and water content, which helps you feel fuller for longer! 

     What else does zucchini have? Well, zucchini is high in vitamin C, vitamin B6, vitamin A, vitamin K, vitamin B5, manganese, potassium, sodium, calcium, folate, iron, zinc, and even a bit of protein… daaang that is so many nutrients! Zucchini is an excellent source for optimal health maintenance and also so versatile.

     Some studies even suggestion that zucchini can help prevent certain types of diseases when consumed regularly because typically foods that are fiber-rich and antioxidant-abundant can help aid in reducing cancerous cells.

PRO-TIP: Zucchini is 95% water so before you do anything, salt the zucchini first to get the excess water out and drain it! Also, keep the skin ON the zucchini to get maximum nutrients (ie. beta-carotene, antioxidants…).

Things I’ve tried so far:

  • Zucchini noodles/"zoodles"
  • Zucchini fritters
  • Zucchini tempura
  • Zucchini bread (with and without chocolate chips!)
  • Zucchini boats (this one is life changing, I was recommended this and looked some recipes up on pinterest)

     If you’ve got any suggestions, send them my way! Thanks for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

-WW Crew

Wellfie Wednesday Tip #106: Appreciate and Share Skills

Happy Wellfie Wednesday! Welcome back! This week is brought to you by Patrick  (@TheFuelPhysio). This week's tip is simple... appreciate the skills that others have and if you have one yourself, share it!

     This idea got me thinking of a time I truly missed out on appreciation of a skill. And its unfortunately that it takes missing out on something to realize that. It has been about 5 years now since my grandfather past away. Though long before that, I spent time here and there in his workshop. And as I got older, I still only spent time here and there, possibly with the thought that building things out of wood was just a hobby of his. He was retired after all and I could of thought at the time that maybe his days just consisted of Gunsmoke and sawdust... 

     But, no.... My grandfather had a SKILL. He could build anything from the perfectly symmetrical bird house to an actual house. Everything was precise, down to the smallest detail. Carpentry was his skilled, and ironically a skill, maybe just a hobby, that I'm trying to develop now myself. But my point is, I didn't appreciate his skill when I should have.

     Appreciate the skills and talents of those in your life and of those you look up to. Learn everything you can no mater what, because there is a chance that it may one day be your own skill to share. 

     Thank you for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

-WW Crew

 

Wellfie Wednesday Tip #105: Our Patriotic Duty

Happy #WellfieWednesday! And Happy Fourth of July!! This week’s post is brought to you by Aaron (@AaronPerezPT). Enjoy! 

     Happy Fourth of July! On this day we often celebrate our Patriotism with brats, burgers, beers, and things that go BOOM! Today, I encourage us all to embrace another form of patriotism, Physical Activity. That’s right, #Activity4America, or if you’re a millennial you might prefer #Movement4Murica. It may seem strange to think of exercise in this way. But truth be told, being physically active and living a healthy lifestyle is incredibly patriotic. Our previous U.S. Surgeon General agrees. In a 2014 interview, Rear Admiral Dr. Boris Lushniak proclaimed, 

“I think we’re on the cusp of actually taking health and wellness seriously. I think for the longest time it’s been on the back burner. The time is right, right now. We have to treat health as a natural resource. We have to put it up on the same level as the economy. When the economy goes sour, all of a sudden there’s reaction. There’s the sense of somebody has to do something if the economy is bad. Guess what, folks? The economy doesn’t do anything without a healthy workforce. It doesn’t do anything without healthy people.”

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     Indeed, the health of any nation is only as great as the health of its people.  Health is our greatest natural resourceProtect it. Nurture it. If for no other reason, it is our patriotic duty to do so. Wishing us all a happy and healthy 4th of July! 

     Thank you for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

-WW Crew

Wellfie Wednesday Tip #104: Don't Wish for a Veggie Garden - Plant Your Own

     Happy Wellfie Wednesday! Welcome back! This week is brought to you by Patrick (@TheFuelPhysio). And I've got gardening on the mind! Not because I'm busy tending to garden, but because I'm getting bombarded at work with folks bringing in all their EXTRA vegetables.

     It's around this time of the year (if I didn't plant) that I start to regret not having planted any veggies, and wishing I was reaping the benefits of saving a few bucks and having the freshest of foods. Last year's garden was great. We had picked a small area of the yard, 8'x8', and planted a variety of things. We had some peppers (always the easiest if starting out), tomatoes (I always have better luck with roma), eggplant (surprising easy and delicious), brussels sprouts (never knew when to pick them), and zucchini/squash (which grow like wild fire!). But this year, I wasn't totally ready, nor had the time to set up a new garden at our new house. Mother nature played a small role as well. 

     But my point is, don't make excuses, you can always find a way to have a veggie garden. It doesn't have to be an elaborate, perfectly tilled landscape. It can simply be a plant within a pot. If you water it, it'll produce, most of the time. Though if you do get the feeling this time of year (probably just me), look into planting a veggie garden next spring, you won't regret it! (I normally start end of March/early April). 

     However, I did end up last minute planting some fruit plants, which have surprising taken off. My two blackberry bushes (growing more like vines) are already producing and my two blueberry bushes are well... being bushes. 

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     Let us see your garden if you planted this year! And Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

- WW Crew

 

Wellfie Wednesday Tip #103: Bike Sharing & Helmet Safety

Happy Wellfie Wednesday! Welcome back! This week is brought to you by Diana (@DianaKlatt). 

     Bicycle sharing has taken the world by storm.  They’re everywhere, quite literally every major city across the US and even abroad. Though if you look at the news of how people dock the bicycles in Australia…you may reconsider pushing for one in your hometown (from a population stand-point). Make sure to watch the satirical Facebook video within that link. But are they really increasing health? Well, yes and no.

     Yes, the implementation of bicycle sharing has made it so more people are using this method of transportation and is making a positive impact on their physical fitness as well as environmental health.  The benefits have improved public health immensely. However, there is something that is missing in most rental/sharing systems – H E L M E T S. Very few in fact provide helmets during a rental. 

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     Studies indicate that the prevalence of use of helmets in bike sharing users is low, which isn’t surprising when you look around and see that none of these bike share systems offer helmets.  But why? Well first of all it would be quite gross to share helmets with so many people… but that shouldn't stop YOU, as a consumer, to bring your own helmet!  The cost of sustaining a head injury (ie TBI) costs twice as much amongst those that do not wear a helmet versus those that do wear helmets.

     It’s completely up to you as to whether or not you wear a helmet (or your local law), but think about how easy it is to fall or collide with another person when you’re zig-zagging around a city.  A helmet could be the difference between some minor scratches and a major injury. 

     Be safe out there! And Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

- WW Crew

 

 

Resources:

 

 

Costa CK, Dagher JH, Lamoureux J, de Guise E, Feyz M. (2015). Societal cost of traumatic brain injury: A comparison of cost-of-injuries related to biking with and without helmet use. Brain Injury. 29(7-8):843-7. doi: 10.3109/02699052.2015.1004758.

Zanotto M, Winters ML. (2017). Helmet Use Among Personal Bicycle Riders and Bike Share Users in Vancouver, BC. American Journal of Preventative Medicine. 53(4):465-472. doi: 10.1016/j.amepre.2017.04.013

Fischer, CM. (2012). Prevalence of Bicycle Helmet Use by Users of Public Bikeshare Programs. Annals of Emergency medicine. doi: 10.1016/j.annemergmed.2012.03.018.

Graves JM. (2014). Public Bicycle Share Programs and Head Injuries. American Journal of Public Health. doi: 10.2105/AJPH.2014.302012
 

Wellfie Wednesday Tip #102: Gear Up for #SummerOfMOVE

     Happy Wellfie Wednesday! Welcome back! This week serves as more of a public service announcement. There is a movement happening... for more... MOVEMENT! #SummerOfMOVE, an initiative that resides along #FreeTheYoke and APHPT.org. Instead of trying to recreate information, I'll share with you details from the "The Flying Oxen."

2018 #SummerOfMOVE Highlights are as follows

TEAMS

Once again, the 2018 #SummerOfMOVE will work to crown a team champion using a points based system. And it all starts with registration STEP 1 HERE

PRIZES

Once again, the 2018 #SummerOfMOVE will award a portion of the proceeds to the winning teams’ charity of choice. It’s bigger than any one of us….it always has been.

BUILD A HABIT

Once again, the 2018 #SummerOfMOVE will include an RPE based load calculation across a variety of activities to award points for effort and consistency. Teams with habitual movers will succeed.

SOCIAL

Once again, the 2018 #SummerOfMOVE will rely on a strong social game to generate broad awareness of the power of MOVE to prevent and reverse disease as well as facilitate total well-being….. HOWEVER, with the new wrinkles added, the winning formula will change significantly.

BUILD CAPACITY

NEW IN 2018, the #SummerOfMOVE will emphasize the benefits of building movement competence AND confidence and will award SUBSTANTIAL points for those who climb the challenge ladder.

GROW YOUR INFLUENCE

NEW IN 2018, the #SummerOfMOVE will emphasize outreach and inclusion. How you MOVE is more than just a health thing…..it’s an expression of who you are…..it’s time to celebrate that!

Look for more details soon…..but for now….build your team. **Content above originally posted at FreeTheYoke

There you have it folks! Make sure you register and jump on board. Great things are to come! And as an FYI, the #WellfieCrew has a team!

Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #101: Disrupting Healthcare and Delivering Hope

Happy Wellfie Wednesday! Welcome back! This week’s #WellfieWednesday post is brought to you by Aaron (@AaronPerezPT). Enjoy! 

     I recently had the privilege of co-interviewing Harris Rosen, Ashley Bacot, and Kenneth Aldridge from Rosen Hotels for the APHPT Healthcare Reboot Podcast. I’ve had a great deal of admiration for Harris since first learning about his company through Dave Chase’s excellent book, CEO’s Guide to Restoring the American Dream. It was a real honor to learn from the Rosen team and I’m grateful for the opportunity. Below is a summary of that discussion that I wanted to share with the #WellfieWednesday crowd. There is a healthcare crisis in our country, but the good news is solutions have already been created, implemented with success, and can be scaled. 

     To start, Harris shared some of his background and what motivated him to solve healthcare for his company, Rosen Hotels. Harris acknowledges his success not as miraculous, but rather pragmatic. Driven by a desire to take great care for his people, Harris and his team describe a highly proactive approach to healthcare. This is in stark contrast to the traditional reactive healthcare system we typically experience. The result is achievement of the quadruple aim: reduced cost, improved health outcomes, and much greater satisfaction amongst both patients and providers. Saving big on healthcare has allowed Rosen to invest in philanthropic efforts. Rosen has “adopted” a disadvantaged Florida neighborhood called Tangelo Park. Investment in education was a key component of this program, and the results have been astounding with significantly improved high school and college graduation rates, as well as reduced crime rates. Rosen is now scaling this program to a larger Parramore neighborhood facing similar challenges and disparities. These programs demonstrate the power of philanthropy and investing in social programs. Harris shares his dream to solve healthcare nationwide by scaling the strategies that have brought his company such great success. Imagine, a day when Americans are empowered to be true consumers of healthcare choosing among providers whom are incentivized to care greatly for improving their overall health. We share in your vision Harris!  

Key takeaways from the episode: 

  • Mindset shift: Viewing prevention and health promotion as a worthwhile investment to be leveraged, rather than a cost needing justification, is a key to success. 
  • Moreover, beyond any business metrics, investing in the health of your people is simply the right thing to do.  
  • The solutions to healthcare in the U.S. have already been discovered and are reasonably scalable. So why aren’t more companies replicating Rosen’s approach? That seems to be the 3 Trillion-dollar question.
  • While there are plenty of reasons to be cynical about the status of healthcare in the U.S., Rosen Care offers a great deal of hope. 

     Be on the lookout for the podcast to be released soon if it has not already by the time you’re reading this! I’d like to extend a HUGE THANK YOU to Harris, Kenneth, and Ashley for their time and sharing their insights and dreams! 

     Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #100: We Thank You!

Happy Wellfie Wednesday! Welcome back!

     Well... We've made it 100 WEEKS! And we want to say Thank You! Whether you've been with us every week since the beginning or just joining us, we appreciate the time you give to see what our team has to say. If you are in fact joining us for the first time, be sure to check out previous posts! We've been striving to provide weekly tips that make living a healthier life easier. As living healthier doesn't need to be a big elaborate change, it can be accomplished by simply adding up those small victories towards health, which in time make a big difference. We hope that our tips have given you the tools to make healthier choices or at least be informed, spreading that knowledge to your family, friends, and community. 

     As our 100th tip, we simply want you as a reader to enjoy the last 99 tips, and discover if anything applicable to your life had been missed. We hope you're inspired to live a healthier life! And be sure to check out #WellfieWednesday on both Twitter and Instagram for more inspiration that has been shared by others!

     Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #99: Age Well - Senior Rehab Project

Happy Wellfie Wednesday! Welcome back! This week is brought to you by Alyssa (@kuhnalyssa_dpt) and Senior Rehab Project (@seniorrehab). 

Want to be healthy well into old age? Time to start exercising now!

     It unfortunately appears to now be common knowledge that fall risk and rates tend to simultaneously climb with increasing age, primarily affecting a population aged 80+. Falls can lead to serious injury that can dramatically impact mobility and independence. Now research is turning to prevention to attempt to find variables that can curb fall risk. 

     The 90+ Study from Paganini-Hill et al. (2017) determined that there is a lower likelihood of falling in persons aged 90+ among individuals who reported 30+ minutes/day of active exercise in their 60–70s. Fall prevention doesn’t just start in the elderly population! With the continued push for health and wellness to combat chronic disease, we can now add in another variable to also combat fall risk. This is yet another reason to add to the laundry list of benefits of physical activity and exercise. It was deemed that “exercise appears to be the most cost-effective intervention in the elderly” as well which should perk the ears of so many people outside of those with direct involvement with healthcare including family members and caregivers!

     Promoting physical activity at all ages is extremely important in order to reap all health benefits and to sustain a healthy lifestyle well into old age. Many people still continue to think that as they age, it is normal for function to decline and independence to fade. From experience as a physical therapist, this is NOT the case. Age is simply a number, there are so many people out there well into their 90s and still living on their own and able to do some amazing things. 

     The Senior Rehab Project was created by Dustin Jones and is a large force of rehab professionals (primarily physical and occupational therapists), created to challenge these exact stereotypes. The main focus of the group is to combat ageism and prove that age does not have to be a limiting factor to function. They are attempting to create a wave to empower older adults and also address and promote evidenced based practice for clinicians when treating older patients. The baby boomer population is growing exponentially which creates a very large opportunity to continue to influence quality of life and promote maintained independence. If you’re looking to join in this movement and be a part of the tribe that is changing the face of geriatric rehab, go to www.seniorrehabproject.com or follow on twitter @seniorrehab, you won’t regret it. 

     Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #98: Enjoy the Benefits of Red Wine!

Happy Wellfie Wednesday! And welcome back! This week is brought to you by Diana (@DianaKlatt)! 

     May is wine month in Italy and I’ve been living in Tuscany for the past 6 months, at the heart of the chianti region, so I’ve made my focus for this month wine in the spirit of my home… red wine to be specific. So what's the deal with red wine? Research suggests that drinking a glass of red wine may be good for you(1)! Earlier this month I made a video explaining the process of fermentation and that grapes have all of these compounds living on the exterior skins that aid in the process of wine production. My last post focused on the process of fermentation and the function that yeasty saccharomyces cerevisiae plays in that process but this one will focus on a different compound that has some serious health benefits...

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Why does that sound familiar? Because a while back it was the trending anti-aging and acne fighting agent in face creams... But that's not all it does!

     Resveratrol (3,4',5-trihydroxystilbene) is a natural phenol, a polyphenol to be exact, and it acts as an antioxidant. Studies have shown that consumption of resveratrol can have anti-aging(2) and anti-cancer effects(3), protect mental and cognitive degradation(4), prevent obesity and diabetes(5), and protect against cardiovascular health issues(6).

How exactly does that work?

     Antioxidants literally reduce oxidation through preventing free radical chain reactions from occurring. The reason that antioxidants are considered to be such a powerful and rejuvenating superfood is for this specific function. During the metabolism of sugars, fatty acids, and amino acids (oxidation) an unstable by-product is created, free radicals, and they are potentially harmful if they are overly abundant in the body. Free radicals are unstable because they have unpaired electrons and they float around in search of a way to fix their instability by latching on to  a n y t h i n g ... even DNA. Essentially free radicals are incomplete and they spread their toxicity if they are not stabilized. Antioxidants have electrons to give away! They're extremely generous in nature and are the perfect donor to help out these free radicals and thus humans have come to desire all things antioxidant to help reduce the negative, damaging, and aging effects of free radicals in the body.

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     Sooooo, then why was it in face cream? What the heck does this have to do with your skin? Like I said earlier, free radicals can attach to any proteins, such as collagen, elastin fibers, and lipids which are major for the structural integrity and defensive barriers of the skin. When these break down and are attacked you end up with wrinkles and dryness... and this is frequently caused by excessive UV exposure.

     So let's get back to resveratrol. Where do we get it and how should we consume it? Resveratrol has been showing up more and more on the pharmacy shelves but that's not really the best way to get the nutrients into our system (it does work for some supplements but not that well for resveratrol). Consuming natural sources of resveratrol helps to actually get it into the system and working it's polyphenol, antioxidant magic. And what better way than to drink it in a glass of red wine? Don't drink? No worries, resveratrol can also be found in blueberries, cranberries, and peanuts!

Disclaimer: Please drink in moderation, the suggested portion is 1 glass for women and 2 glasses for men. Studies have been relatively inconclusive of the overall health benefits of wine consumption for resveratrol intake and efficacy. Resveratrol was discovered and recognized as an antioxidant in 1992 and is relatively new comparatively to other well known and studies sources of antioxidants.

Diana's piece originally appearing at www.klattalyst.com/resveratrol.

     Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt) and keep the wave of healthy change going!

- WW Crew

 

Resources

1. Mayo Clinic. (2016) Red wine and resveratrol: Good for your heart? https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/red-wine/art-20048281

2. Semba RD, et al. (2014) Resveratrol levels and all-cause mortality in older community-dwelling adults. JAMA Intern Med. 174(7):1077-84.

3. Tan L et al. (2016) Resveratrol inhibits ovarian tumor growth in an in vivo mouse model. Cancer. 122(5):722-9.

4. Catholic University Campobasso. (2008) A little wine boosts omega-3 in the body: Researchers find a novel mechanism for a healthier heart. https://www.eurekalert.org/pub_releases/2008-12/cu-alw120408.php

5. Koppes LLJ et al. (2005) Moderate Alcohol Consumption Lowers the Risk of Type 2 Diabetes. Diabetes Care. 28(3):719-25.

6. Liu Y et al. (2015) Effect of resveratrol on blood pressure: a meta-analysis of randomized controlled trials. Clin Nutr. 34(1):27-34.

 

Wellfie Wednesday Tip #97: Health Literacy 101

Happy Wellfie Wednesday and Welcome back! This week’s #WellfieWednesday post is brought to you by Aaron (@AaronPerezPT). Enjoy!

Deductible…What did you just call me?!

     Lately I’ve been trying to learn more about healthcare in the United States. I’d like to say it’s been an easy learning process, but I’d be lying. I find it strange and somewhat saddening that even I, as a healthcare provider, struggle navigating the insurance world. I’m certainly not alone; a 2014 study found many Americans struggle with health insurance literacy. Historically, we have paid a lot of money for healthcare. Trends show those numbers are continuing to sky rocket and much of what we spend is becoming more “visible” to us. There also seems to be support for transforming Americans into more traditional “consumers” of healthcare. In other words, there is a push for individuals to bear more up-front costs when purchasing healthcare. It seems unreasonable to place responsibility of purchasing healthcare services on individuals without at least educating them on the basics health insurance. So, I thought a post explaining some basic insurance terms may be helpful.

Before reading further, check your current knowledge by taking this short 10 question quiz on health insurance literacy and see how you compare to other Americans.

Premium

The amount you pay monthly for health insurance. You pay this even if you do not use healthcare services. 

Deductible

The amount you pay out-of-pocket for healthcare services before your insurance starts paying. This is separate from your premium contribution. For example, if you have a $1,000 deductible, you will need to pay for the first $1,000 of any healthcare services you receive. 

In-network

These are doctors who your insurance has negotiated lower rates with than they would otherwise charge in most cases. You will typically spend less if you go to an “in-network” provider, though this may not always be the case.

Out-of-network

These are doctors who your insurance has not agreed upon a negotiated price with. Typically, you’ll pay more if you receive services from an “out-of-network provider”, though this may not always be the case.

Out-of-pocket maximum

This is the most you’ll pay for any healthcare services you receive within a given year. For example, if your out-of-pocket maximum is $7,000, once you reach this amount insurance will pay for everything else except for co-pays.  

Co-pay

A fee that you pay each time you use a specific service. This fee does not count towards your deductible. Typically, office visits (i.e. family doctor visit) carry less costly co-pays while specialty care (i.e. cardiologist) and emergency room visits carry more costly co-pays.

Co-insurance

Your plan may have a co-insurance. This is a percentage of cost you share with your insurer after your deductible is met. For example, if you have a 30% co-insurance, you will pay for 30% for healthcare services while your insurance picks up 70%. This will happen until you reach your out-of-pocket maximum, in which case insurance will cover 100%.

Here is a great summary video of some of the above info: https://www.youtube.com/watch?v=sBxLmKBqa60

     Okay, clear as mud? Hopefully this post helps someone out there understand some insurance benefit lingo a little bit better. While I generally support the idea of transforming the healthcare industry into a more consumer-driven market, there is much work to do in empowering people to be able to be true consumers of healthcare.

     Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #96: Path of Resilience

Happy Wellfie Wednesday and welcome back! This week with is brought to you by Patrick (@TheFuelPhysio). And we hope the topic is something that is applicable to everyone.

     This week I want to talk Resilience and making sure you are aware of your ability to "bounce back" when faced with difficult experiences. "Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors." (1) So essentially how you react when unexpected or unwanted situations come your way. Do you get trapped behind new road blocks or roll with the punches and adapt to a new environment? 

     The American Psychological Association has some great resources on Resilience, including strategies and places to seek help. I'll go ahead and share with you their "10 ways to build resilience," (1) but be sure to check out their site for more in-depth information for each of these: 

  1. Make connections
  2. Avoid seeing crises as insurmountable problems
  3. Accept that change is a part of living
  4. Move toward your goals
  5. Take decisive actions
  6. Look for opportunities for self-discovery
  7. Nurture a positive view of yourself
  8. Keep things in perspective
  9. Maintain a hopeful outlook
  10. Take care of yourself

     I have personally come across several instances recently that have tested my resilience. With starting a new business and planning for a wedding, things never go exactly as I originally hope. But I have learned to accept that things are not always in my control and change can be a positive thing that usually puts me on a new path, but often a path with greater reward. 

     It is important to remember that success comes with having a great support system of friends, family, and loved ones to help you along the way. Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

1. http://www.apa.org/helpcenter/road-resilience.aspx

 

Wellfie Wednesday Tip #95: Reframing Pain (Part 2)

Happy Wellfie Wednesday! Welcome back! This week's post is brought to you by Aaron (@AaronPerezPT). Enjoy!

     Today's post correlates well with my last #WellfieWednesday post Reframing Low Back Pain. Where I had compared low back pain to the common cold. I really like that analogy; however, it seems most applicable to acute low back pain. Unfortunately, back pain is more likely to persist and can become disabling. Today’s post introduces a helpful way to reframe persistent pain scenarios through a simple yet powerful thought experiment and diagram.

The circle below represents my life and several activities that bring my life meaning and joy.  

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At times, pain is also part of my life.

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     Fortunately, I’ve never dealt with persistent pain and disability. However, I’ve worked with many people who have. And I’ve learned that sometimes when pain becomes a persistent problem we gradually do less and less of the activities we enjoy. This effectively makes pain a larger part of our life. 

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     While pain alleviation is often a primary goal, making this the primary focus of rehab sessions can be unproductive. Rather, focusing on function and strategies that gradually allow us to resume meaningful activities can be really helpful. With more of our life back in the picture, pain will no longer be such a big part of it. It won’t be easy, but it can be done. Pain is often a part of life. Suffering doesn’t have to be. 

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     This thought experiment really resonated with me when I first learned it at continuing education course a couple years ago. I’ve used it with many patients since then and found it often helps patients reframe their pain and understand the purpose of rehab. I hope it resonates and helps someone else suffering with persistent pain. 

Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #94: Find a Pillow that is Juuuuust Right!

Happy Wellfie Wednesday! Welcome back! This week is brought to you by Diana (@DianaKlatt).

This pillow’s too high. This pillow’s too low. This pillow is juuuuust right.

     A good night’s sleep is crucial to a good day. Sleep wrong and you feel out of balance all day long. So, let’s start at the beginning. Depending on the type of sleeper you are (side, back, stomach, hanging from the ceiling…) your pillow height and type changes. The ultimate goal is to have your spine in proper alignment. Of these types of sleeping positions, back and side are the best options.

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Side sleepers:

Get a pillow that is higher under your neck than your head to help keep your spine straight during sleep. A curved pillow is best for this. If you find yourself tucking your arm under your pillow it’s probably because your pillow is not elevating your head appropriately.

Back sleepers:

You want your head to be at a 15 degree angle. So obviously you should sleep with a goniometer and a partner to constantly check your degrees of flexion… just kidding, or am I?

Stomach sleepers:

Beware! Stomach sleeping has multiple associated problems. Sleeping in this position causes your back to be arched and your neck to be tilted to the side, twisting your spine – both not ideal for optimal blood flow and spine alignment. How can you try to train yourself out of sleeping on your stomach? According to studies the best way to prevent stomach sleeping is to bend the elbow and knee on the side you turn your head towards and put a pillow under your hip and armpit, and then if THAT doesn’t work, you can try to tape a tennis ball to the front of your shirt so you’re not comfortable on your stomach.

     But wait! Pillows aren’t just for your head! You can place pillows under your knees (back sleeping) or between your knees (side sleeping) or other places to help with proper alignment. So how do you travel and keep pillows consistent? You either accept that you’re going to have some weird neck feels or you travel with your own pillow... I tend to go with the first option (which is what has sparked this topic) but I have suggestions for travel pillows if you’re interested!

     Be sure to check your pillow tonight! Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

 

Sources:

https://www.health.harvard.edu/pain/say-good-night-to-neck-pain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274296/

https://www.healthrising.org/blog/2013/06/16/heads-up-are-you-missing-an-easy-way-to-improve-sleep-and-health/

 

Wellfie Wednesday Tip #93: Start Eating Lentils!

Happy Wellfie Wednesday! Welcome back! This week is brought to you by Patrick (@TheFuelPhysio), our crew's Registered Dietitian Nutritionist. 

     This week I want to get you thinking more about LENTILS! Frankly because they're awesome and pack a nutritious punch. Lentils are by far my favorite legume and not only because they're cheap, but because lentils are so versatile. You can add or substitute for them in any meal at any point of the day, whether it be breakfast, lunch, dinner, or heck a snack! If you're looking for ways to incorporate more plant-based food options, this is a great start. Check out the image below for a few quick nutritional facts on lentils. Lentils.org is a great website loaded with recipes and meal ideas. I highly recommended checking it out. 

As you can see lentils certainly pack a punch, providing not only a sufficient amount of protein, but tons of beneficial fiber. 

I'll leave you with one more thing, my FAVORITE lentil recipe! An amazing choice for Meatless Monday or Taco Tuesday! 

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     Go ahead and give lentils a try and let us know how it goes! Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #92: Spring is Here! Maybe...

Happy Wellfie Wednesday! Welcome back! This week is brought to you by Patrick (@TheFuelPhysio). 

     Well folks, I think Spring is here. Maybe... I've been fooled once this year, thinking Spring had come. The calendar certainly told me so, but than it got cold again. The weather this year has certainly been a wild ride, especially for our friends in the Northeast. We are finally in a descent temperature range here in South Carolina, mid-60s to 70s, but as I write this it looks as if we are suppose to dip close to the high-30s this evening.

     None the less, Spring will eventually be here to stay, either that or we'll move right into Summer. Regardless, the weather calls for MORE OUTDOOR activities! I want to give a few ideas this week for how you and your family can jump into Spring! 

  • Go on a hike! If you have access to some elevation, take advantage of it. If not, try a longer stroll and explore more of the community in which you live.
  • Take a bike ride! A great alternative to hiking or walking. And you also get to explore more of your surroundings. 
  • Plant a garden! Whether it be a flower or vegetable garden, it gives you more reason to be outdoors. I've personally already started our new flower garden and have been waiting to start prepping for the new vegetable garden. The best thing about vegetable gardens is getting your own fresh produce!  
  • Be one with nature! You don't even have be physically active outdoors to receive some benefits. Take time to soak up some sun and beneficial Vitamin D (remember to apply sunscreen if out for long). While your out, try some meditation or mindfulness strategies to boost health and reduce stressors. 

     Let us know how you plan to jump into Spring! Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #91: Reframing Low Back Pain

Happy #WellfieWednesday! Today’s post is brought to you by Aaron (@AaronPerezPT).

     I hate getting a cold. Don’t you? My nose runs, my head and body ache, I sound even more nasally than I normally do. And what I hate the most, there’s not a damn thing you can do about it! Staying in bed just seems to make it worse as there’s nothing distracting me from the annoying scratch in my throat. Over-the-counter medications sort of help manage symptoms, but time seems to be the best medicine.

     I also hate getting low back pain. It’s just as annoying as a cold. It makes daily tasks a bit more tedious. And what I hate the most, there’s not a damn thing you can do about it! Staying in bed just makes it worse as there’s nothing to distract me from the ache. Over-the-counter medications sort of help, but time seems to be the best medicine.

     I first heard the phrase “Back pain is the common cold of the spine” from Adiraan Louw. I recall him using this metaphor in one of his presentations. When you think about it, the similarity really is striking. In short, damn near everyone gets it, and there’s not much you can do about it, so don’t let it stop you from living your life.

     Now, I know this advice is easier said than done.  Moreover, our reactions to these unfortunate experiences, particularly those of us in the medical field, are often in stark contrast. For a cold, you are likely to receive education, reassurance and encouragement that “this, too, shall pass.” For back pain, your treatment might be similar, but there’s a good chance it may also involve imaging and/or pain medication. How would you respond this recommendation? Would you have any hesitation to scan your back with an x-ray or MRI? Probably not, it seems reasonable enough. Now, how would you respond if the same recommendation were made for a cold? Imagine, “Sir/Ma’am, we’re going to need an x-ray of your face to ensure nothing serious is going on, and possibly an MRI to view the status of your boogers, x-ray won’t show those.” Seems ridiculous, right? It is! And, the kicker, research has shown some of our treatment recommendations for low back pain to be just as ridiculous. Recent guidelines are recommending far more conservative approaches for back pain.

     I realize I run the risk of over-simplifying and discrediting how debilitating low back pain can be. That cannot be dismissed, as low back pain is the leading cause of disability globally. Nonetheless, I firmly believe that reframing low back pain, and pain in general, to improve our response as a society will go a great way towards reducing suffering. Along those lines and coinciding with the title of this post, I highly recommend checking out Pain Reframed Podcast for more on reframing pain. I plan to do a mini-series on low back pain in hopes the blogs may be useful for those of us struggling with it. As much as it sucks, back pain is a part of life. When you catch it, keep calm, and crack on.

     Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

Wellfie Wednesday Tip #90: Sleep Phone-Less

     Happy #WellfieWednesday friends! Welcome back! This week is an oldie, but a goodie. Published back within our first 2 weeks of Wellfie Wednesday tips. Eric (@Eric_in_AmERICa) brought up the idea of sleeping without your phone! [Insert gasps and looks of shock/horror here].

     While I know this may sound unthinkable, I bet most can relate to the feeling of lying down in bed after a long day, pulling up Facebook or Instagram, and next thing you know you’ve been scrolling for 2 hours and are having muscle spasms in your thumb. The light from our phones, tablets, and even TV screens disrupt the natural sleep-wake cycle in the brain (Circadian Rhythm) and prevents your body from relaxing in preparation for sleep.

     My wife and I personally made this change about a year ago and had both noticed a difference in our ability to fall asleep faster. Since we both used our phones as alarm clocks, we had to invest in traditional alarm clocks (about $30 total), but it was worth the change. Ditching the phones gave us extra time for sleep and improved our mental clarity when waking up the next day.

     So give it a shot, and let us know how it goes! And trust me, that political rant from the kid you knew in high school who you haven’t spoken to in 12 years and the cat video from your crazy Aunt will still be there in the morning.

     Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

 

Further information:

http://www.journals.elsevier.com/sleep-medicine

http://www.medicalnewstoday.com/articles/249592.php

https://sleepfoundation.org/ask-the-expert/electronics-the-bedroom

http://www.webmd.com/sleep-disorders/features/power-down-better-sleep#1

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Wellfie Wednesday Tip #89: Happy RDN DAY! (March 14th, 2018)

Welcome back! Happy Wellfie Wednesday! This week is brought to by Patrick (@TheFuelPhysio), our crew's RDN (Registered Dietitian Nutritionist).

     Today I’m here to celebrate RDN Day! As a part of National Nutrition Month®, the Academy of Nutrition and Dietetics celebrates RDN Day “on the second Wednesday in March, [a day that] increases awareness of registered dietitian nutritionists as the indispensable providers of food and nutrition services and recognizes RDNs for their commitment to helping people enjoy healthy lives.”(1) All of the information seen today has been collected from the Academy of Nutrition and Dietetics’ website (eatright.org). See the links below for additional information.

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This year’s RDN Day Key Messages are as follows (2): 

  • Registered Dietitian Nutritionists are the food and nutrition experts who can translate the science of nutrition into practical solutions for healthy living.
  • Registered Dietitian Nutritionists have degrees in nutrition, dietetics, public health or a related field from well-respected, accredited colleges and universities, completed an internship and passed an examination.
  • Registered Dietitian Nutritionists use their nutrition expertise to help individuals make personalized, positive lifestyle changes.
  • Registered Dietitian Nutritionists work throughout the community in hospitals, schools, public health clinics, nursing homes, fitness centers, food management, food industry, universities, research and private practice.
  • Registered Dietitian Nutritionists are advocates for advancing the nutritional status of Americans and people around the world.

Have you ever wondered what an RDN can do for you? Here are just a few of the benefits of working with a registered dietitian or registered dietitian nutritionist. (3)

  • The highest level of nutrition counseling. Anyone can call themselves a nutritionist, but only a registered dietitian (RD) or registered dietitian nutritionist (RDN) has completed multiple layers of education and training established by the Accreditation Council for Education in Nutrition and Dietetics. In addition to holding a bachelor's degree, an RD or RDN must fulfill a specially designed, accredited nutrition curriculum, complete an extensive supervised program of practice at a health care facility, foodservice organization or community agency and pass a rigorous registration exam. What's more, roughly half of all RDs and RDNs hold graduate degrees and many have certifications in specialized fields, such as sports, pediatric, renal, oncology or gerontological nutrition.
  • Personally tailored recommendations. When you see an RD or RDN, the last thing you'll get is one-size-fits-all diet advice. After learning about your health history, favorite foods, eating and exercise habits, an RD or RDN will help you set goals and prioritize. Follow-up visits will focus on maintenance and monitoring your progress.
  • Help managing chronic diseases. If you have high cholesterol, high blood pressure, diabetes or cancer it can be hard to know what to eat. An RD or RDN can review your lab results with you, help you understand your condition, provide education about the nutrients that affect it and help you create an eating plan that includes all the important nutrients that can help you manage your condition.
  • Guidance navigating food allergies, sensitivities and intolerances. When you suffer from conditions such as celiac disease, food allergies or lactose intolerance, it's easy to be overwhelmed by what you think you can't eat. That can translate into a boring diet and may even lead to nutrient deficiencies. An RD or RDN can teach you how to read food labels so you’ll know which ingredients to avoid and a help you find substitutions to keep your diet balanced and tasty.
  • Practical lifestyle advice. Fad diets may sound like the quick ticket to weight loss, but they rarely work for very long. A registered dietitian or registered dietitian nutritionist will partner with you to develop a safe and realistic eating plan that you can stick with for the long haul. To guide and motivate you, an RD or RDN will use creative and out-of-the-box strategies to help with meal planning, grocery shopping and mindful eating.

A bit more on National Nutrition Month®

“"Go Further with Food" is the theme for 2018, and its importance is timely for many reasons. Whether it's starting the day off right with a healthy breakfast or fueling before an athletic event, the foods you choose can make a real difference. Preparing your foods to go further, by planning meals and snacks in advance can also help to reduce food loss and waste. This year's theme for National Nutrition Month® encourages us to achieve the numerous benefits healthy eating habits offer, but it also urges us to find ways to cut back on food waste. Learning how to manage food resources at home will help you "Go Further with Food", while saving both nutrients and money.” (4) 

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Key Messages:

  1. Include a variety of healthful foods from all of the food groups on a regular basis.
  2. Consider the foods you have on hand before buying more at the store.
  3. Buy only the amount that can be eaten or frozen within a few days and plan ways to use leftovers later in the week.
  4. Be mindful of portion sizes. Eat and drink the amount that’s right for you, as MyPlate encourages us to do.
  5. Continue to use good food safety practices.
  6. Find activities that you enjoy and be physically active most days of the week.
  7. Realize the benefits of healthy eating by consulting with a registered dietitian nutritionist. RDNs can provide sound, easy-to-follow personalized nutrition advice to meet your lifestyle, preferences and health-related needs.

 

     We hope this week's tip was informative for you! Thanks again for all of the #WellfieWednesday support, be sure to post your pictures this week and tag the WW crew members in your post (@TheFuelPhysio@Eric_in_AmERICa@AaronPerezPT@DianaKlatt@kuhnalyssa_spt) and keep the wave of healthy change going!

- WW Crew

 

Sources: 

1.    https://www.eatright.org/food/resources/national-nutrition-month/national-nutrition-month

2.    https://www.eatright.org/food/resources/national-nutrition-month/registered-dietitian-nutrition-day

3.    https://www.eatright.org/food/resources/learn-more-about-rdns/what-an-rdn-can-do-for-you

4.    https://www.eatright.org/food/resources/national-nutrition-month/national-nutrition-month-celebration-toolkit

Wellfie Wednesday Tip #88: Simple Nutrition #EatMorePlants

Happy Wellfie Wednesday! Wellcome back! This week’s post is brought to you by @AaronPerezPT. Enjoy!

     I hate diets almost as much as I hate math. So, today I’m going to combine both in a post you will love! I want to talk about some simple math for smarter choices when it comes to food. The nutrition tip uses a “Carb:Fiber” ratio, which involves a little label reading as well. I think I first heard about this from a @MikeEisenhart tweet a while back. I couldn’t find the tweet, but I at least asked nutrition nerd / #Wellfiewednesday editor / super hero, Patrick Berner (@TheFuelPhysio), to verify that this is indeed decent nutrition advice if that makes ya feel better. If I recall correctly…

     For this ratio, simply divide the total number grams of carbohydrates by the grams of fiber. Dr. Michael Greger recommends a ratio of 5:1 or less. If any higher, put it back on the shelf. A higher ratio will be seen in those foods that are more processed than others. Here’s a great video from Dr. Greger’s Nutrition Facts Website explaining this rule. Essentially, the “process” of making these “food-like substances” takes the fiber out (and nutrients), and adds in a lot of refined carbohydrates/additional sugar, for taste and palatability. You may notice that most of the carbohydrates are consisting of sugars. Side note, “food-like substances” is a phrase stolen from @MichaelPollan. I still love his 3 simple nutrition rules:

  1. Eat real food
  2. Not too much
  3. Mostly plants

     Anyway, ideally you want a ratio less than 5:1, more like a 2:1 or 3:1, which can be obtained using the idea of #EatMorePlants. A serving of broccoli or lentils for example will yield this ratio. 

     Applying the math to my own life, I came to the sad realization that one of my favorite “healthy breakfasts” consisting of honey nut cheerios with a fruit cup was not much better than a donut. No wonder it tasted so good. 

   
  
   
  
    
  
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    Dole pineapple fruit cup: 15 g total carbs, 1 g fiber, 14 g sugar

Dole pineapple fruit cup: 15 g total carbs, 1 g fiber, 14 g sugar

   
  
   
  
    
  
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   X-NONE 
   
    
    
    
    
    
    
    
    
    
   
   
    
    
    
    
    
    
    
    
    
    
    
    
    
  
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
  
   
 
 /* Style Definitions */
table.MsoNormalTable
	{mso-style-name:"Table Normal";
	mso-tstyle-rowband-size:0;
	mso-tstyle-colband-size:0;
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-parent:"";
	mso-padding-alt:0in 5.4pt 0in 5.4pt;
	mso-para-margin-top:0in;
	mso-para-margin-right:0in;
	mso-para-margin-bottom:10.0pt;
	mso-para-margin-left:0in;
	line-height:115%;
	mso-pagination:widow-orphan;
	font-size:11.0pt;
	font-family:Calibri;
	mso-ascii-font-family:Calibri;
	mso-ascii-theme-font:minor-latin;
	mso-hansi-font-family:Calibri;
	mso-hansi-theme-font:minor-latin;}
 
    1.5 cups Honey nut cheerios (2 servings because who’s really eating ¾ cup of cheerios?): 44 g total carbs, 4 g fiber, 18 g sugar

1.5 cups Honey nut cheerios (2 servings because who’s really eating ¾ cup of cheerios?): 44 g total carbs, 4 g fiber, 18 g sugar

   
  
   
  
    
  
   Normal 
   0 
   
   
   
   
   false 
   false 
   false 
   
   EN-US 
   X-NONE 
   X-NONE 
   
    
    
    
    
    
    
    
    
    
   
   
    
    
    
    
    
    
    
    
    
    
    
    
    
  
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
  
   
 
 /* Style Definitions */
table.MsoNormalTable
	{mso-style-name:"Table Normal";
	mso-tstyle-rowband-size:0;
	mso-tstyle-colband-size:0;
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-parent:"";
	mso-padding-alt:0in 5.4pt 0in 5.4pt;
	mso-para-margin-top:0in;
	mso-para-margin-right:0in;
	mso-para-margin-bottom:10.0pt;
	mso-para-margin-left:0in;
	line-height:115%;
	mso-pagination:widow-orphan;
	font-size:11.0pt;
	font-family:Calibri;
	mso-ascii-font-family:Calibri;
	mso-ascii-theme-font:minor-latin;
	mso-hansi-font-family:Calibri;
	mso-hansi-theme-font:minor-latin;}
 
    1 cup skim milk: 12 g total carbs, 0 g fiber, 11 g sugar