Strongwomen.com - Your Virtual Trainer with Dr. Miriam Nelson

Here in Boston, we've just been through the coldest three weeks I can remember since I moved to this area in 1983. Brrrrr! Not only is it cold outside, but the streets and sidewalks are crusted with ice and snow. So it's been next to impossible to exercise outdoors. What do you do for aerobic exercise when the weather is crummy? Some of my friends work out at fitness centers. But I prefer to stay home and jump rope with my kids. We do this in our big family room, which has a stereo system. I put on one of our favorite CDs; we get our jump ropes - and we jump to the music. This is strenuous exercise, so we take quick breaks between songs.

Other at-home options for wintry days: rent an exercise video from your local video store. Or just play some jazzy music and dance! Be sure to keep up with your strength training. Fortunately, that's easy to do regardless of the weather.

And a note to our readers in Australia, New Zealand, Brazil, and other countries in the southern hemisphere: We know that all this doesn't apply to you, because it's mid-summer in your part of the planet. We're all envious! Enjoy the balmy weather, and save this newsletter for next July.

Strong Women, Strong Bones, my new book about osteoporosis, is coming to bookstores in early April. Meanwhile, you can get an early look by visiting the Strong Women web site (http://www.strongwomen.com) where the first chapter is posted. Also see the short excerpt below, about bone density testing.

The March and April Newsletters will present additional excerpts, plus information on my upcoming appearances around the country on TV, radio, and in person.

Excerpt from Strong Women, Strong Bones: Everything you need to know to prevent, treat, and beat osteoporosis Chapter 5: Put your bones to the test

Bone density is the best single predictor of future fractures. Density accounts for about 80 percent of the strength of your bones. The best bone density tests predict fractures more successfully than cholesterol levels predict heart attacks or blood pressure predicts stroke. Yet these tests are underutilized, and insurance doesn't always cover them. As a result, less than 10 percent of people with significant bone loss are aware of their problem.

Important as these tests are, not everyone needs to be tested right now. Should you have a bone density test? The answer is Yes if -

Several different tests are used to measure bone density, which is also referred to as bone mineral density or BMD. All these tests are safe, painless, quick (no more than 10 to 20 minutes), and precise.

This chapter of Strong Women, Strong Bones describes the most common bone density tests, explains how to interpret the results - and provides tips for getting your insurance to cover the cost.

Q: I'm 43 and have osteoporosis of hip, osteopenia of spine. A new athletic center recently opened in my town, and I've also begun doing water aerobics a few times a week. I know swimming on its own is not valuable for strong bones, but what about water aerobics? Does it have any effect, positive or negative, on bone density? Some have even speculated that my osteoporosis may be the product of my early years when I was a competitive swimmer, and swimming was my ONLY exercise.

A: It's wonderful that you're enjoying the sessions despite the aftereffects! But you really shouldn't be suffering so much. It sounds as if your body has announced that you were overdoing the exercise. I think you were wise to increase the time between sessions and to reduce the weight on the machines. If you continue to experience pain and fatigue, I suggest you cut back further on the weight and then increase gradually.

A: First you need to understand that your early years of competitive swimming did not harm your bones. On the contrary, if you were well nourished when you were younger, any exercise you did would *help* your bones. You are right that swimming now will not help you reverse bone loss. Water aerobics may offer a slightly better benefit for bone than swimming. But even though you're upright, the water still supports most of your body weight. So the forces applied to bone during water aerobics are not strong enough to have a positive impact. This doesn't mean you should skip water aerobics - there are lots of other benefits, including fun! But for the sake of your bones, make room in your schedule for other physical activity too.

To reverse bone loss you need to do weight bearing exercises (like brisk walking), in combination with strength training. Because you're at risk for fractures, discuss exercise with your doctor before you start. I hope you're also getting plenty of calcium, as well as vitamin D. Because you're young - and your bones need to last for many years - please talk to your doctor about medication, which also can be helpful to you. A combination of therapies is by far is the most effective way to improve and maintain your bone health, so you don't experience fractures as you get older.

Q: I really like the diet in Strong Women Stay Slim. I'd love to have an exchange for cake. I work at a place that frequently celebrates birthdays and has farewell parties - all seem to include cake.

A: Page 192 of Strong Women Stay Slim suggests an exchange of 1 Grain plus 4 Extras for a slice of chocolate layer cake. That's a useful average number. However, as you might guess, there's a lot of variation in cake equivalents, depending on both the type of cake and the portion size. A sliver of unfrosted angel food cake - which is a light, fat-free cake - might be the equivalent of 1 Grain plus 1 Extra. But the numbers could jump to 2 Grains and 5 or more Extras for a thick wedge of a dense fudge cake made with butter and whole eggs, which is filled and frosted with chocolate buttercream. Make your best guess and don't worry about getting the exchanges exactly right - sometimes you'll be a little too high and sometimes a little too low. So long as you don't consistently underestimate what you're consuming, it doesn't really matter. If you're maintaining a healthy weight, or losing half a pound to two pounds a week if you want to lose weight, then you know your estimates are on target.

Q: I'd like to know if there's any research out there concerning strength training and Parkinson's Disease. Could it be of benefit in an older patient with advanced Parkinson's?

A: I know of no targeted research that addresses this question. Here at Tufts University - where many of our exercise studies recruit elderly volunteers - over the years we've had a number of participants who suffer from Parkinson's. We find they do very well. They become stronger; their balance (which is impaired by the disease) improves; they experience a generally improved sense of wellbeing. Unfortunately, we don't know how long these benefits last, or if they could actually reverse the effects of the disease over time.

When someone with Parkinson's disease asks me about strength training, I tell him or her to discuss the possibility with their doctor. I also urge them to work with a physical therapist or personal trainer, at least at the beginning, so they can select appropriate exercises and make sure their form is correct. And I remind them to pay attention to their body - feeling good is the best indication that exercise is beneficial.

Q: For a couple of years, I had wanted to begin strength training. I read your books to give me the impetus. They worked. I joined a local YMCA and got the expected and some unexpected results. For about two years before that, I was suffering (and I don't use that term lightly) from hemorrhoids. I tried everything: creams, hydrocortisone, increasing fiber, all which produced temporary relief if any at all. My doctor said that short of surgery, there wasn't any way of getting rid of them.

I was resigned to the fact that turning forty meant that I'd begun to fall apart from the bottom up! I was seriously considering surgery. However, as I said, I began weight training and in about four to six weeks, I noticed how I wasn't having the terrible itching I'd been living with. Now I don't notice the hemorrhoids at all. Anyway, I decided to mention an unmentionable subject because I've never read or seen anything written about this.

A: What a fascinating letter! I discussed your report with one of my Tufts colleagues that is a gastroenterologist. Neither of us has heard about this possible benefit of strength training - and we know of no research evidence on "Preparation S." But there could be a connection. Doctors sometimes recommend the Kegel exercises to relieve hemorrhoids, since it's helpful to strengthen the muscles of the anus that hold veins in their proper place. Though the exercises of the Strong Women program don't specifically address this part of the body, strength training does produce biochemical changes that affect all the muscles - that's why physically fit people are less likely to suffer from constipation than their sedentary peers. And I suspect it's the reason that some women get relief from minor stress incontinence once they become stronger. It's also possible that you're benefiting indirectly from improved diet or increased physical activity. These are changes that people often make - sometimes without realizing it - when they start strength training.

My advice is to keep up your strength training program. Since you know you're vulnerable to hemorrhoids, be especially careful to breathe as you do the lifts. Holding your breath increases pressure in your abdomen, which can exacerbate hemorrhoids. The easiest way to make sure you breathe properly is to count out loud as you lift. While I won't claim credit for curing your hemorrhoids, I'm delighted that you've found this unexpected relief. May it continue!

Here are excerpts from a few of the inspiring letters we've received recently. If you enjoy reading them, check out the collection of reader mail on our Web site and in back issues of the Newsletter.

"With fitness and bone density on my mind, and with a weak upper body, I began my weight bearing exercises at a local fitness club. Working on the machines was fine, but motivating myself to go several times a week was the hard part. When a friend gave me "Strong Women Stay Young," I was all set. I ordered the ankle weights you recommend in the book and began with 2 pound weights I already had for my arms. I am able to exercise easily before work, and after I am done, I feel good both physically and mentally.

Not quite a year later, going very slowly adding weight, and doing the exercises twice a week, I marvel at the changes in my body. I am always showing my husband and teenage boys my new muscles. My stomach is flatter, and my leg muscles are stronger. Those gallon milk cartons are now a breeze to whip around. I can tell the difference in my legs when I run or get up from a squat.

I am very excited about the whole program and feel it is such a balanced approach to fitness and wellbeing. When my friends try this or that fad diet, I just keep going happily along with my weights (and walking several times each week), feeling good about myself and my body."

"When I saw Miriam on the Today Show in 1997, I rushed right out and bought Strong Women Stay Young. I have been lifting weights for three years. My husband has taken it up. We also walk two miles about three times a week, uphill and down. I am up to 8 pounds on the arms and 10 pounds on the legs and am very proud of myself. So are our kids proud of me!"

I also write for Selfcare.com. Look for "Ask the Expert" in their Healthy Weight Center: http://www.selfcare.com/hwc.

Three-Minute Spinach Quiche

If you enjoy the flavors of Greek spinach pie, you'll love this super-simple quiche. The no-work crust is a whole-wheat tortilla, available in most supermarkets. The filling can be mixed in less time than it takes to heat the oven. And even though this dish is quick and easy, it's special enough to serve to company for brunch. Make one recipe per guest.

Ingredients

1 whole wheat tortilla, about 2 ounces or 8-9 inches in diameter (2 Grains)

1 cup chopped spinach, fresh or defrosted frozen (2 Vegetables)

1/2 cup whole milk cottage cheese (1 Dairy plus 2 Extras)

1 egg (1 Protein plus 1 Extra)

1 tablespoon farina or flour (Next to Nothing)

pinch salt, or to taste

pinch pepper, or to taste

a few sprigs of fresh dill or 1/2 teaspoon dry dill weed (optional)

Heat oven to 400 degrees. Place the tortilla in a small ovenproof dish that will hold it in the shape of a mini-pie crust. If you don't have such a dish, line a baking sheet with foil. Tear off two additional strips of foil, each about 4 inches wide and 12 inches long. Crumple each strip into a long bar, then twist the ends together to form a circle about 6 inches in diameter - it will look like an aluminum foil halo made by a kindergartener. Tear off another sheet that's big enough to hold the tortilla, and put the tortilla on it. Put the halo on the baking sheet and place the tortilla over it, so the bottom of the tortilla rests on the baking sheet and the halo holds up the sides. (This takes a lot longer to read about than to execute!) You can make more than one quiche on the same baking sheet - just use more halos.

Mix together the spinach, cottage cheese, egg, farina or flour, salt, pepper and optional dill. Spoon into the tortilla shell. Bake for 25 minutes. The quiche filling should be firm if you jiggle it - if not, bake it for a few more minutes.

Allow the quiche to cool (it will get firmer) for 5 to 10 minutes, then serve. Or serve lukewarm. Accompany with a salad or with fresh fruit - orange sections or fresh pineapple chunks are good choices.

Yield: 1 serving

Per serving:

2 Grains

2 Vegetables

1 Dairy

1 Protein

3 Extras

Note: You can trim the Extras by using non-fat cottage cheese and substituting three egg whites for the whole egg.