Fueling on a Budget for Traveling Sports Teams

sports teams

By Nancy Clark MS RD CSSD

“When we travel as a team, we eat at fast food places because they fit with our small budget.What’s the best fast food for athletes…?”

“After my workout, the last thing I want to do is cook dinner. Where can I buy affordable but healthy sports meals…?”

A limited food budget creates a fueling challenge for many athletes, including college teams traveling to games, students responsible for their own meals, parents of active kids, and semi-pro players hoping to get to the next level. The name of the fueling game is: How can you buy enough healthy calories with the least amount of money? These practical tips can help optimize a low-budget sports diet.

1. Encourage the team bus (or your car) to stop at a large supermarket.

Everyone can find something they like: vegetarians,  gluten-free eaters, picky eaters who want to lose weight, and chowhounds who need lots of calories. By walking around the inside perimeter of the store, you will find the makings for a balanced meal—even hot meals, if desired. Shop for:

Fresh fruit: Banana, apple, pear, grapes. Buy what’s on sale.

Fresh veggies: While you can easily create a colorful salad at the salad bar area, it might be a bit pricey. The simpler option is to simply buy: a green  or red pepper (eat it whole, as you might eat an apple), a bag of baby carrots (along with a container of hummus), or a container of cherry tomatoes. Enjoy the whole thing; a hefty dose of veggies on one day can help compensate for another day when you have none.

(To clean the fresh produce, plan ahead. Pack extra water to rinse the produce before getting on the bus. Or nicely ask  an employee in the store’s produce area if he or she could help you by giving the fresh produce a quick rinse.)

Protein: Buy a quarter-pound of deli turkey, roast beef, or ham along with a few whole wheat rolls to make sandwiches. Small or large tubs of cottage cheese, tuna packets, and peanut butter are other popular protein options. Share a rotisserie chicken with friends (or save the leftovers if you can refrigerate them within an hour.)

Grains and other carbs: Pita, wraps, baked chips, whole-grain crackers and  pretzels are carb-based options that refuel your muscles. Look for freshly baked whole-wheat rolls, hearty breads, and whole-grain bagels. You might be able to find a plastic knife at the salad bar so you can slice the rolls to make a nice sandwich with deli meat and lowfat cheese. Pop a few cherry tomatoes between bites, and you’ll have a balanced meal with all 4 foods groups: 1) lean meats/beans/nuts, 2) lowfat dairy or calcium-alternative, 3) fruit/vegetable, 4) grain.

Calcium-rich foods: You can easily buy a small or large tub of lowfat yogurt, a single milk chug—or even a whole a quart of chocolate milk if you are really hungry. For athletes who are dairy-free, soymilk is a fine alternative. Pick up some pre-sliced lowfat cheese in the dairy or deli area. (Note: Hard cheese, such as cheddar, is lactose-free and comes in convenient single portions.) Add an apple and whole grain crackers—voila, a balanced sports meal! While it may not be the hot meal your mom had in mind, it will do the job of contributing needed nutrients to refuel from the day’s event, fuel-up for tomorrow, and invest in future good health.

Beverages: You can save a lot of money (plus save space in landfills) by packing your own gallon jug of water. To spend money on plain water (void of calories, carbs, and vitamins) seems wasteful when tap water is free. Instead buy 100% juice (orange, grape, carrot, V-8) to boost your fruit/veggie intake and simultaneously boost your immune system with anti-inflammatory phytochemicals. Plus, 100% juice is a strong source of carbohydrate to refuel depleted muscles, as well as fluid to replace sweat losses. Chocolate milk is another winning beverage, with protein to build and repair exhausted muscles, as well as carbs to refuel them.

If the team bus (or your car) is pulling into a fast food restaurant, at least choose one that will support the nutritional needs of athletes. Here are a few suggestions:

• At Taco Bell, you can get the most amount of healthy calories for a bargain price when you order their bean burrito. Two bean burritos cost only $2.20 and provide 750 (mostly quality) calories.

• At a burger place, choose a grilled chicken sandwich (no fries). It will be more expensive and offer fewer calories than a burger, so plan to supplement the sandwich with some Fig Newtons, pretzels or raisins that you pre-packed from home.

•At a pizza place, order the cheese pizza, preferably with veggie toppings like mushroom, pepper, and/or onion. Nix the pepperoni, sausage and other greasy meat options, as well as the double cheese. You’d end up fat-loading with that type of pizza. It would fill your stomach but leave your muscles poorly fueled. Remember: muscles need carbs (such as thick pizza crust) to replenish glycogen stores.

• Be cautious of super salads. While they have a seemingly healthy glow, they can be unfriendly for many sports diets, particularly if you are weight-conscious.Making a substantial salad with not only colorful veggies but also grated cheese, chopped egg, diced chicken, slivered almonds, pumpkin seeds, and olives offers you a hefty dose of calories, but not enough grains/carbs to refuel your muscles. Adding even a little bit of dressing to a big salad often adds  400 or more calories. A sandwich can have fewer calories….

• Hungry athletes who need lots of inexpensive calories can do well by packing sandwiches made with peanut butter & jelly (or PB & jam, honey, raisins, banana, pickles or even cottage cheese—whatever tastes good to you). Peanut butter is versatile and a great sports food because it offers protein, B-vitamins, and good fats that knock down inflammation. It’s inexpensive, travels well without refrigeration, is good for you, and tastes great! It’s even good for dieters because it keeps you feeling fed, and curbs the urge to eat cookies. For the $2 needed to slap together a hefty 600-calorie PB&J (made with 2 slices Pepperidge Farm Bread, 3 Tbsp. Teddie all-natural peanut butter, and 2 Tbsp. Welch’s grape jelly), you couldn’t even buy a Muscle Milk ($3.69 for 230 calories). Shop wisely and fuel well!

Image from: www.sheknows.com/parenting/articles/809104/how-to-deal-with-over-competitive-coaches

Boston-area sports nutritionist Nancy Clark MS RD counsels both casual and competitive athletes at her private practice in Newton (617-795-1875). Her Sports Nutrition Guidebook and her food guides for runners, cyclists and soccer players are available at www.nancyclarkrd.com. For online education, visit www.sportsnutritionworkshop.com and www.NutritionSportsExerciseCEUS.com.

Caffeine: Performance Enhancement in a Mug


By Nancy Clark MS RD CSSD


Whether you are looking for a hit, boost, pleasing stimulant, or excuse to socialize with your friends, coffee is the go-to beverage for many athletes. Coffee-drinkers enjoy the way a cup of morning brew enhances their feelings of well-being and their ability to accomplish daily tasks. An estimated 80% of us drink coffee daily. Why, we are more likely to drink coffee than eat fruit! Thank goodness moderate coffee intake is typically not associated with health risks.

For athletes, caffeine is a proven performance enhancer. In their new book Caffeine for Sports Performance, sports dietitians Louise Burke and Ben Desbrow and exercise physiologist Lawrence Spriet address all-things-caffeine that an athlete might want to know. Here are just a few tidbits that I gleaned from this comprehensive resource. Perhaps the information will help you add a little bit of zip to your workouts.

Note: No amount of caffeine will compensate for a lousy diet. If you choose to use caffeinated products to enhance your sports performance, make sure you are also fueling wisely!


• A cup of pre-exercise coffee can help most athletes work harder—without realizing it. Caffeine has been shown to enhance performance by about 1% to 3%, particularly in endurance sports. For example, cyclists who consumed caffeine prior to a 24-mile (40-km) time-trial generated 3.5% more power than when they did the ride without caffeine.


• Athletes vary in their responsiveness to caffeine, from highly effective to negative. Some of the side effects associated with too much caffeine include higher heart rate, anxiety, “coffee stomach”, irritability, and insomnia.


• The recommended performance-enhancing dose of caffeine is about 1.5 mg/lb (3 mg/kg) body weight. This can be consumed 1 hour before the event, and/or during the event (such as a caffeinated gel or defizzed cola every hour). For example, triathletes commonly consume caffeinated gels before each segment, to distribute the caffeine throughout the event rather than have a big pre-race jolt that might make them feel shaky and unable to concentrate. Some athletes delay caffeine intake until fatigue starts to appear, and then they ingest 0.5-1 mg/lb (1-2 mg/kg) body weight.


• Caffeine’s ergogenic effect maxes out at about 200 to 250 mg caffeine. (This is much less than previously recommended.) More is not better.  Experiment during training to learn what amount (if any) works best for your body!


• Because the amount of caffeine in coffee and tea varies, elite athletes commonly use caffeine pills or commercial products to ensure the desired intake.  A comparison of the caffeine content in 16 ounces of coffee from 20 coffee venders ranged from about 60 to 260 mg. Even when the researchers purchased the same brand of coffee (Starbucks Breakfast Blend) on six consecutive days, the caffeine content ranged from about 260 to 565 milligrams per 16 ounces.


• Research suggests the caffeine content of espresso also varies. A customer might get served 0.5 to 3.0 ounces of espresso (depending on the barista’s generosity) with a caffeine range of 25 to 214 mg. In general, the larger venders (such as Starbucks) offer a more consistent product. But this means you don’t know what you will be getting if you plan to purchase a pre-exercise espresso or coffee.


• Energy drinks are a popular source of caffeine. A study of 500 college students in North Carolina reports 51% drank at least one energy drink in an average month in the semester. Sixty-seven percent used the energy drink to stay awake; 65%, to increase energy; and 54%, to drink with alcohol while partying. Of the party-drinkers, 49% consumed 3 or more energy drinks. That makes for a wide-awake drunk who may believe it’s OK to drive a car…


• Caffeinated chewing gum is popular among (sleep deprived) soldiers. The gum effectively boosts physical and mental performance and helps maintain reaction time, vigilance, and ability to think clearly. The caffeine in chewing gum gets delivered quicker than via a pill (achieving significant levels in the blood in 5 vs. 30 minutes) because it gets absorbed though the cheeks, not the gut.


• Caffeinated colas offer not only caffeine but also a hefty dose of sugar. Colas, taken later in an event, can provide a much-needed source of fuel so the combination of caffeine + sugar can provide a nice boost! Hence, some athletes claim defizzed Coca-Cola is their preferred sports drink despite having only 35 mg caffeine per 12-ounce can.


• Caffeine is only a weak diuretic and is no longer considered to be dehydrating. A novice coffee drinker can become tolerant to the diuretic effects of caffeine in 4 to 5 days of regular caffeine intake. Even high doses (3 mg/lb; 6 mg/kg) have no significant effect on urine production in coffee or tea drinkers. Hence, there appears to be no hydration-related reason for athletes to avoid caffeinated beverages.


• Caution: Consuming caffeine might contribute to negative effects. For example, let’s say you are running, rowing, or swimming in more than one competitive event in a day. If caffeine helps you go harder in the first event, will that “fry” you for the second event? Can taking another dose of caffeine counter that fatigue? With a weekend tournament, will too much caffeine on the first day ruin your sleep, so you are unable to perform as well on the second day? More research is needed to answer those questions but for the moment, these situations provide good examples of why advice to use the smallest effective dose of caffeine is sensible.


• In 1984, caffeine was banned by the International Olympic Committee (IOC) and the World Anti-Doping Agency (WADA). But in 2004, WADA reversed the ruling. New research indicated the amount of caffeine needed to reach the threshold dose was detrimental to performance. Although caffeine is no longer banned by WADA, it is on the banned list for NCAA, the governing body of collegiate sports. Collegiate athletes can be cited for doping if their caffeine level is higher than 15 micrograms/ml urine. (A normal urine caffeine level is between 1-2 micrograms). Unlikely but possible.


• Youth athletes should be fully mature and eating an optimal sports diet before even considering the use of caffeine. Again, no amount of caffeine will compensate for lousy fueling practices.


• For even more helpful tips and tid-bits, get a copy of Caffeine for Sports Performance. You’ll actually stay awake while reading it; this book is not a snoozer!


Boston-area sports nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes. Her private practice is in Newton, MA 617-795-1875). For information about her Sports Nutrition Guidebook and her food guide for marathoners, cyclists, and soccer players, see www.nancyclarkrd.com. For online education, see www.sportsnutritionworkshop.com.





Common Sources of Caffeine


For a 150-pound (68 kg) athlete, the recommended dose of caffeine is about 200 mg one hour before exercise. That’s the amount in a large mug (16 oz) of coffee. No problem for most coffee-drinkers!


Brewed coffee 250 ml (about 8 oz; small) 80 (ranges 40-110)
Starbucks Breakfast Blend 600 ml (20 oz; venti) 415 (range 256-564)
Tea, black 250 ml (about 8 oz; small) 25 -110
Tea, green 250 ml (about 8 oz; small) 30-50
Coca-Cola 1 can (12 oz / 335 ml) 34
Red Bull 1 can (8 oz / 250 ml) 80
PowerBar caffeinated gels 1 pouch (1.25 oz / 40 g) 25 – 50
GU caffeinated gel 1 pouch (1 ox / 32 g) 20-40
Jolt Caffeine Energy Gum 1 piece 33
NoDoz 1 tablet 200 (USA), 100 (Australia)



Getting Older, Day by Day


By Nancy Clark, MS RD CSSD

Like it or not, every one of us is getting older, day by day. As a fitness exerciser or an athlete, you might wonder how aging impacts performance—and what you can do to retain youthful fitness. The following information is gathered from a workshop (www.sportsnutritionworkshop.com) presented by Dr. William Evans, an exercise physiologist and expert on aging, muscles, and protein. The following information can help you chart a healthy course into your future.

• The average person loses about 1% of their fitness per year. Aerobic capacity goes down, particularly after age 60. Staying active helps maintain a slighter higher ability to uptake oxygen than a non-athlete, but the rate of loss is the same.

• Muscle is an active tissue (as compared to body fat). The more muscle you have, the more calories you can eat without getting fat. Yet muscle loss creates a subtle change in metabolism that can contribute to weight gain with aging.

• We lose muscle as we age, starting as young as age 20, with a steady decline year after year. To treat this age-related loss of muscle, you need to lift weights or do other forms of resistance exercise. Yet, even strong athletes still lose some muscle with aging.

• With aging, the average person loses more fast-twitch muscle fibers (used in sprinting) than slow-twitch fibers (used for endurance). This loss starts early in life and explains why elite sprinters peak in the early 20s. In comparison, elite distance runners maintain their slow-twitch muscle fibers until age 40ish. But even top athletes notice they slow down after age 40, at which time the nerves that connect to muscles start to die off, resulting in a loss of both slow- and fast-twitch fibers. Athletes can lose about 20% of their muscle fibers between ages 40 and 70.

• With age, we not only lose muscle but also tend to gain fat. It’s easy to eat more even though we need less. The cause of weight gain is not due to a “slow metabolism.” Metabolic rate remains constant, but daily activity easily declines. A study with obese people suggests they sat three hours more per day than their lean peers; this saved them about 350 calories a day.

• Body fat secretes adipokines (hormones) that have negative effects on muscle strength and contributes to increased inflammation, particularly after ages 60 to 70. Inflammation leads to heart disease and diabetes. Hence, fatness can be a powerful predictor of disability in people ages 50 to 75. Stay lean!

• When young people gain weight, about one-third of the weight gained is lean muscle. When older people, in particular older women, gain weight, it’s all fat. When older people lose weight (due to illness or a low-calorie diet), half of the weight lost is muscle. Hence, yoyo dieters who gain fat and lose muscle are on a downward spiral. Being fat but fit is preferable to going on and off diets.

• Muscle loss is the key reason why older people become frail and end up in nursing homes. When they stop exercising, they experience a steep drop in strength. The good news is they can do something about frailty: lift weights! In only12 weeks, 60- to 70-year-old men regained the fitness they had lost over 15 years.

• To maintain (but not gain) strength, a person can lift weights just one day a week. Lifting weights does not stress the heart nor increase blood pressure. Aerobic exercise actually causes a greater increase in blood pressure because it uses more muscles and more oxygen, which means the heart has to pump more blood than with strength training.

• Even 90-year-olds in a nursing home can triple their strength in 10 weeks. That means they can walk faster, get to toilet by themselves, be less depressed, and stay in the independent living part of elder-care housing. Tell your parents and grandparents to start a weight lifting program so they can stay out of the nursing home!

• How much weight should people lift to build muscle? Three sets; the first two sets should have 8 reps; the final set is to exhaustion. If you can lift a weight 12 times in the final set, you need to lift heavier weights the next time. Because muscle damage stimulates muscles growth, you want to spend more time lowering the weight than lifting it.

• Most strength gains occur in the first 3 months of starting a lifting program, due to early neuro-muscular changes. The nervous system learns how to recruit muscles more efficiently and this stimulates more muscle cells.

• Strength training helps prevent bone loss. In a year-long study with post-menopausal women, all of the women who lifted weights improved their bone health. Those who did not lift weights lost ~2% bone density in one year. Exercise is better than osteoporosis drugs—plus, you’ll get stronger!

• By lifting weights and building muscle, older people should be able to eat more calories (which boosts their intake of health-promoting protein, vitamins, minerals). Yet, adding exercise does not always entitle a person to eat more calories. In a study with 62-year-old people who walked briskly for one hour a day (five days/week) for 3 months, their daily energy expenditure remained stable—despite the brisk walking. How could that be? They became more sedentary the rest of the day; they napped more and slept longer. They compensated for having exercised…

• About 25- to 33-percent of people older than 65 years are eating too little protein. This results in loss of muscle and bone—and leads to expensive medical problems. The goal is to eat at least 0.55 grams of protein per pound of body weight each day to maintain and build muscle. For a 140-pound person, this equates to about 75 grams of protein, or 25 grams per meal (for example, Breakfast: 3 eggs; Lunch: 1 can tuna; Dinner: 4 oz. chicken).

The Bottom Line: Stay young by staying active and by lifting weights or doing some type of resistance exercise to strengthen both muscles and bones. And remember the words of gerontologist Water Bortz: “No one really lives long enough to die of old age. We die from accidents and most of all, from disuse.” Use it or lose it!

Image from: spectrumwellness.net/would-you-like-to-live-to-be-100-years-old-in-perfect-health/

Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sport Dietetics) counsels active people in her private practice in Newton, MA (617-795-1875). For more information, read the new 5th edition of her Sports Nutrition Guidebook or her food guides for marathoners, soccer players, and cyclists. They are available at www.nancyclarkrd.com. Also see www.sportsnutritionworkshop.com for online CEUs.


Inguinal Hernias: What are they and how are they repaired?

Inguinal Hernias: What are they and how are they repaired?

By Steven F. Samuel, MD, general surgeon

A hernia occurs when the lining that separated the intestine from the skin weakens and a hole forms.  Hernias can be congenital, meaning individuals can be born with them.  They can also occur from increases in weight, straining and other activities causing the lining to become stretched.

A hernia can occur anywhere in the abdomen, but many occur in the groin. This type is called inguinal hernia. Some studies report as much as 80 percent of hernias are inguinal. This type of hernia is also more common in men than women.

A great number of my patients with an inguinal hernia say they were doing an activity and experienced pain in their groin.  Upon investigation, they noticed a bulge.  You may push on the bulge and it will go away, but return again with activity.

Other signs and symptoms of an inguinal hernia include:

  • A bulge in the area of the pubic bone
  • A burning or aching sensation at the bulge
  • Pain or discomfort in your groin, particularly when bending over, coughing or lifting
  • A heavy or dragging sensation in your groin
  • Weakness or pressure in your groin
  • Pain and swelling around the testicles

Anytime you notice an abnormal bulge in your abdomen or groin, you should see a physician for evaluation and treatment.

Hernias of all kinds, including inguinal, can be repaired through an elective, outpatient surgical procedure.  According to the National Institutes of Health data, roughly 600,000 surgical procedures are performed annually to repair inguinal hernias.

Inguinal hernias have a three to five percent chance of recurrence. They can be repaired multiple times. However, subsequent repairs can be more complicated. Surgical mesh is often used to strengthen tissue during hernia repair and help prevent recurrence of the hernia.

When diagnosed with a hernia of any kind, it is best to have it repaired quickly.  Without repair, organs and tissue from the abdomen can come through the hole and become strangled, cutting off the blood supply to those areas. This is called a strangulated hernia, which can be life threatening. Once that occurs, an emergency surgery will be needed, followed by a prolonged hospital stay.  At times, the strangulated organ may need to be resected, meaning a portion may be damaged and require removal, which can result in long term affects.

There are a limited number of cases where surgical repair may not be the preferred course of treatment. For example, patients of advanced age, or who have diabetes or hypertension may not be well enough to undergo surgery.  If an individual is too ill to undergo surgery, treatment usually involves monitoring of the hernia. In these cases, we would regularly monitor and watch closely for signs of a strangulated hernia.

If you think you have a hernia of any kind, seek medical attention. A simple procedure can repair the hernia and help you to avoid serious complications.

Image from: http://www.momokd.com

Steven F. Samuel, MD, is a general surgeon with Jewish Physician Group which is  part of KentuckyOne Health.  For more information, go to www.KentuckyOneHealth.org.



Losing Weight: Dieting, Food & Exercise

By Nancy Clark MS RD CSSD

As an athlete, you are unlikely obese, but you may have concerns about your weight or have relatives who struggle with their weight. To address the complexities of how to deal with undesired body fat, the Weight Management Group of the Academy of Nutrition & Dietetics held a conference (Indianapolis, April 2013). Here are some highlights.

Dieting and weight

•  An estimated 35% of all US adults are not only overfat but also pre-diabetic, including 50% of adults over 65 years. Relatives who have watched a loved one needlessly die from diabetes see first-hand the need to prevent themselves from going down the same road. There are clear benefits from eating wisely and exercising regularly! Losing just 5% of body weight can reduce health risks attributed to diabetes.

•  Most dieters want to lose weight quickly. The problem is that plan tends to backfire. You can lose weight fast or lose weight forever—but not lose weight fast and forever.

• Most dieters regain about two-thirds of their weight loss within a year and all of it within 3 to 5 years. Tips to maintain weight loss include: exercise regularly, eat fewer fatty foods, watch less TV, have strong social support, and sleep more than 5 hours a day.

• Chewing gum can help lean people consume fewer calories, but that is not the case for obese gum-chewers. (Perhaps the act of chewing increases their desire to eat?)

•  To stay on track, successful dieters should plan ahead by predicting everything that could possibly go wrong with their eating plan and develop strategies to deal with the unexpected. For example, if the waiter serves the salad soaked with dressing (not on the side, as requested), the dieter knows he can send it back, not eat it, or eat less of it.

• If you “blow your diet,” please don’t hate yourself. Just regret you over-ate and learn from the experience. You learned to overeat for a reason. (For example, overindulging in birthday cake may have been your “last chance” to eat cake before your diet started again the next meal.) The better plan can be to enjoy a reasonable slice of cake for several days. You’ll feel less need to overindulge when you know you can have more cake the next day (just fit it into your calorie budget).

• Other success-promoting dietary habits include using portion-controlled foods and keeping food and weight records. High-tech diet aids include: tracking steps by wearing a pedometer (goal: 10,000 steps a day), and wearing an armband or other body-activity monitor that detects changes in activity over time. Some popular high-tech tools include New Lifestyles-1000 pedometer, FitBit Zip, and Nike Fuel Band.  (Note: Accuracy of the high-tech tool is less important than day-to-day reproduce-ability.)

• Websites or apps like FatSecret.com, CalorieKing.com, LoseIt.com, and MealLogger.com can also be helpful. In the near future, you’ll be able to take a photo of your meal and an app will then calculate the calories. This info will be very helpful when eating in restaurant with super-sized meals.

Food and weight

•  An estimated 80% of weight loss happens by eating fewer calories; 20% relates to exercise. You need to change your diet to lose weight and change your exercise to keep weight off.

• Overweight people tend to eat by time cues. Noon is lunchtime, regardless if the clock is significantly wrong!

• Adults may eat more of a food if it is deemed healthy. That is, subjects ate more oatmeal cookies when they were described as high fiber, high protein as compared to high sugar, high butter. And yes, even healthy high fiber and high protein calories count!

• In contrast, adolescents (who are heavily influenced by their peers) tend to eat less of a food labeled healthy.  For teens, eating carrots is just not as acceptable as eating chips.

• People who eat a high protein diet (25% of calories) tend to eat fewer calories per day. A protein-rich breakfast with 25 to 35 g protein helps manage appetite for the rest of the day.

• The decline in hearty breakfasts mirrors the rise in obesity. Try eating an 800-calorie protein-rich breakfast and see what that does to your appetite for the rest of the day!  You’ll undoubtedly notice you feel less need to “reward” yourself with evening treats.

• A 100-calorie portion of natural whole almonds actually has only 80 available calories due to digestibility. The same likely holds true for other high fiber, high fat “hard” foods, such as other kinds of nuts. People who frequently eat nuts are actually leaner than folks who avoid nuts;; hence, you need not fear them as being “fattening” (in moderation, of course, as with all foods).

Exercise and weight

• Weight loss is about quality of life; exercise is about health. However, exercise strongly predicts who will be able to maintain their lost weight. While the reason for this is unknown, some researchers wonder if purposeful exercise allows the reduced obese person to eat more calories? (You know—the more you exercise, the more you can eat.) Or perhaps exercise is a marker of discipline and dedication to maintain a healthier eating style and lifestyle?

• Lifting weights is a good entry point for unfit people who want to start exercising. First they get strong, and then they can add on the walking, jogging, and aerobic activities.

• Lifting weights reduces the loss of muscle that occurs with diet-only reducing plans and creates the same health benefits of slimming the waist-line and improving blood glucose levels (hence reducing the risk of diabetes).

• Because weight loss without exercise contributes to loss of muscles and bone-density, some health professionals advise against weight loss for older people. Instead they recommend that people over 60 years focus on adding on exercise rather than subtracting food. You are never too old to lift weights!

• An effective exercise program includes 110 minutes per week of moderate to vigorous physical activity and two times a week of lifting weights for about 20 minutes.

• Men who maintain a stable weight tend to be active about 70 minutes a day. In comparison, obese men are less active and likely to be frail. Do obese people become frail—or do frail people become obese?

The bottom line: Keep active, enjoy whole foods that are minimally processed, live lean, and be well!

Image from: ic.steadyhealth.com

Nancy Clark MS RD CSSD (Board Certified Specialist in Sports Dietetics) counsels both fitness exercisers and competitive athletes in her private practice in the Boston-area (617-795-1875). Her Sports Nutrition Guidebook, Food Guide for Marathoners and Cyclist’s Food Guide all offer additional weight management information. The books are available via www.nancyclarkrd.com. See also www.sportsnutritionworkshop.com.



America’s Big Health Problem: OBESITY

By Carlos Rivas, MS, CSCS 

            The obesity epidemic is a big contributor to the skyrocketing healthcare costs in the United States.  The most recent estimates indicate that more than 66% of adults are classified as overweight, 32% as obese, and 5% extremely obese.  What is more frightening is that childhood obesity seems to be rising at alarming speed as well. Childhood obesity rates have more than tripled since 1980 and it seems that it will continue to climb along with the adult rate.  Overweight and obesity are linked to numerous chronic diseases, including cardiovascular disease, diabetes, many forms of cancer, and numerous musculoskeletal problems.  It is estimated that the direct and indirect costs of obesity are in excess of $117 billion.  Obesity is also the leading cause of Type 2 diabetes, a disease that is totally preventable.  In fact, 57 million Americans have what we call prediabetes, a disease defined as having a blood pressure higher than 130/80; triglyceride levels greater than 150; fasting blood glucose levels greater than 100; and a waist line greater than 35 inches for women and greater than 40 inches for men. 

Adult obesity rates have increased in 23 states and did not decrease in any state in the past year.  Sixteen states experienced an increase for the second year in a row, and eleven states had an increase for the third consecutive year. The percentage of obese or overweight children in the United States is above 30% in 30 states.  As you can clearly see, the only way we as a country are going to be able to compete with the rest of the world is by changing our health behaviors.

            The management of our body weight is dependent on energy balance, which is affected by energy intake and energy expenditure.  In other words, for a person who is overweight or obese to reduce body weight, energy expenditure must exceed energy intake.  A weight loss of 5% to 10% provides significant health benefits, and these benefits are more likely to be sustained through better eating habits and participation in habitual physical activity. 

            The Proformance Professional Personal Trainers and Wellness Coaches follow the FITT principles as stated by scientific evidence to work best for those who are overweight or obese. 

Frequency: 5 days per week

Intensity: Initial exercise training intensity should be moderate (40%-60% Heart Rate Reserve).  Eventual progression to 50%-70% of Heart Rate Reserve resulting in further health benefits.

Time: Performance of 10-minute segments of continuous exercise 3 times per day.  Eventual progression of 30-45 minutes of continuous exercise activity per day.

Type:  The primary mode should be aerobic physical activities that involve large muscle groups.  As part of a well-balanced program, resistance-training exercises need to be included.  Resistance exercise will enhance your muscular strength and physical function.

Bottom Line:  You must know why you are deciding to eat better, drink more water, and exercise more!  You must have a compelling reason why you have decided to make major improvements in your lifestyle.  My major reason for following a healthy lifestyle has always been to avoid taking unnecessary medications.  I want to have the energy needed to help as many people as I possibly can.  Having dis-ease does not make it easy for me to accomplish my goals, so I choose to avoid disease by following a simple lifestyle management program I call “5 of 5”.

Image from: http://www.livescience.com

Carlos Rivas, MS, CSCS, ACSM-CPT is the Director of Fitness and Wellness Operations for Proformance Fitness, located at 2041 River Road, Louisville, KY, 40206. He is also the founder of FitCorp, a Highly Individualized Worksite Wellness Company.  Carlos has a Master’s degree in Exercise Physiology and has over 20,000 hours of Professional Personal Training and Wellness Coaching experience. Carlos can be reached by phone at 502-741-9428 or by email: carlosfitpro@gmail.com

How Many Calories Do You Need Each Day?

By Barbara Day, M.S., R.D., C.N.

There’s an App for this!

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home or lose weight.  There are some FREE apps that you can use to help to determine how many calories you need each day.

A FREE app, My Fitness Pal, for your smart phone or online at can help to determine how many calories you need each day: www.myfitnesspal.com/tools/bmr-calculator and how many calories you burn when playing soccer or lifting weights: www.myfitnesspal.com/exercise/lookup. Add the calories plus the calories you burned practicing to get how many calories you need on most days.

Once you determine how many calories you need each day, the timing of your food intake is also important. Eating 5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs will maximize your performance. Never skip breakfast.

Other excellent apps and websites to determine calories are: LOSE IT! (www.loseit.com), SPARK PEOPLE (www.sparkpeople.com).

The Old Fashion Way to Determine Your Calories

To determine how many calories you need each day, you can calculate the calories the OLD FASHION WAY by using the HARRIS BENEDICT EQUATION to determine your resting metabolic rate (RMR) then choosing an activity factor to estimate the total calories per day.

Harris Benedict Equation


RMR = 88.362 + [1.889 X HT (in)] + [6.089 X WT (lbs)] – (5.677 X Age)


RMR = 447.593 + [(1.219 X HT (in)] + [(4.20 X WT (lbs)] – (4.7 X Age)

HT = height in inches   WT = weight in pounds   age = age in years

Activity Levels

Very Light-seating and standing activities, driving, no regular exercise.

Light – child care, walking on a level surface 2.5 – 3 miles per hour, some regular exercise.

Moderate – walking/running 3.5 to 4 mph, cycling, regular exercise 3 to 4 times/week -30 to 40 minutes duration.

Heavy – walking uphill with a load, basketball, soccer, regular exercise 4 times/week 40 minutes or more in duration.

Very Heavy – distance running, hiking with backpack up and down hills, regular exercise 5 times/week for at least 1 hour in duration.

TABLE 1.  Activity Factors. Choose your activity level from the table below. Then do the math.



Little to no exercise

RMR X 1.2

Light (1 – 3 days per week)

RMR X 1.375

Moderate exercise (3 -5 days/week)

RMR X 1.55

Heavy exercise (6-7 days/week)

RMR X 1.725

Very heavy (twice/day heavy workouts)

RMR X 1.9

Example, 1300 X 1.55 (moderate) = 2015 calories/day

You can also determine how many calories you burned by wearing a heart rate monitor that determines calories burned during exercise. (Not all heart rate monitors calculate calories). Then you can add those calories to your resting metabolic rate calories to get an estimate of active calories burned while exercising.  Example, 1300 X 500 calories = 1800 calories.  So, you could safely eat at least 1800 calories without gaining weight.

Again, it’s just an estimate. Weigh only once a week about the same time.  I suggest weigh after the first void in the morning before drinking anything with as few clothes as possible.

 Using Oxygen Consumption to Calculate your Personal RMR

The BodyGem Resting Metabolic Rate device is the handheld, portable and an effective tool that gives you an accurate RMR measurement result in 10 minutes or less. To perform a measurement, you simply breathe into the indirect calorimeter, which measures their oxygen consumption (VO2), the resulting RMR number is clearly displayed on the device’s LCD screen. It has been validated against the gold standard Douglas Bag, and other commonly used metabolic carts. The test costs anywhere from $75 to $150 per test. For the best results, you should take the test when you are fasted. But you still need to estimate the active calories you burn.

Body Media FIT™ On-Body Wellness Core Armband Monitor

The BodyMedia FIT CORE which is promoted by Biggest Loser is another way to determine how many calories you burn each day. The CORE’s biggest plus is that it track calories burned for 24/7. It cost about $119.  Unlike other fitness trackers, which estimate calories burned using an algorithm of steps and weight, the CORE uses special sensors to track not just your activity but also your body’s reaction to that activity. This makes it much more accurate as a calorie tracker, so you can realistically see how many calories you’re burning. But you have to buy subscription-based Activity Tracker in order to find out how many calories you have burned in the 24 hours.  The CORE Armband does not display any information on the device itself.  That will cost you  $6.95/month or you can opt to purchase a $69 optional display, which syncs with the CORE and lets you see a quick view of progress toward your daily goals. If you want to track your progress, you’ll still need to purchase the Activity Tracker.

What’s the Take Home Message?

I think it’s helpful to know how many calories you need each day so you can manage your health. In today’s world, lifestyle is the major contributor to increasing your risk of many diseases like heart disease, stroke, diabetes, and cancer.  Lifestyle includes your diet and also your daily activity.

Image from: www.greatist.com

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.    


Osteoporosis Prevention and Treatment

By Rebecca Terry, M.D.

The most common bone disease is also among the most preventable.

A silent disease, osteoporosis can progress undetected for years until a fracture happens.  Fractures occur when an imbalance in bone remodeling causes bone resorption to occur at a faster rate than bone formation creating a loss in bone mass and structure and causing bone to weaken and the risk of fracture to increase.

In the U.S., a postmenopausal woman’s risk for hip fracture exceeds her risk of breast, endometrial and ovarian cancer combined.  American women have a 50 percent chance of developing an osteoporotic fracture sometime during their lives.

The most common sites for fracture are the spine, hip and wrist. These fractures may heal without incidence, but many result in chronic pain, disability and death. Twenty percent of hip fracture patients will require long-term nursing home care, and only 40 percent will fully regain their pre-fracture quality of life.

Vertebral (spine) fractures can cause chronic back pain, height loss and permanent changes in the spine alignment. This change, called kyphosis, limits physical activity, impairs the ability of the lungs to fully expand, alters digestion and bowel function and has been associated with depression and lowered self esteem. In the U.S., the estimated annual cost of caring for patients with these fractures was estimated at $17 billion in 2005. With the aging population, the number of hip fractures and the associated cost could double or triple by 2040.



The majority of osteoporotic fractures can be prevented. The National Osteoporosis Foundation (NOF) recommends several interventions for reducing low bone mass and fracture risk:

  • An adequate intake of calcium and vitamin D
  • Lifelong participation in regular weight-bearing and muscle-strengthening exercise
  • Avoidance of tobacco
  • Identification and treatment of alcoholism
  • Treatment of physical and health factors that increase the risk of fracture

Daily calcium intake and vitamin D have been shown to reduce fracture risk and increase bone density. Recommended daily consumption is at least 1,500 mg of calcium from childhood to age 30 while our skeleton is actively laying down its peak bone mass. Once peak bone production ends, the recommendation drops to 1,000 to 1,200 mg. The average American gets only 600 mg of calcium in their diet. This, coupled with losing estrogen’s protection of bone reservoir in the first three years following menopause, causes skeletal calcium to deplete at an accelerated rate. So, women over age 50 need 1,500 mg daily.

Calcium-rich foods are the ideal first-line approach, but supplements can also be used. About 75 to 80 percent of the calcium consumed in American diets is from dairy products. One cup of milk and 6 oz. of yogurt each provide 300 mg. Before age 30 and after menopause we need five servings daily. Calcium-fortified orange juice is another good source.

Vitamin D and calcium go hand in hand. The body needs vitamin D to absorb calcium. It is also essential for muscle performance, balance, mood and possibly cancer prevention. The NOF recommends 800 to 1,000 IU of vitamin D daily for adults over age 50. Good dietary sources are vitamin-D-fortified milk and cereals, egg yolks, saltwater fish and liver. Soy milk does not contain vitamin D. Sunlight is another source. Twenty minutes of sun exposure on the arms and legs two to three times a week increases the body’s Vitamin D levels. Many calcium supplements also include 400 IU of vitamin D.  The safe upper limit for vitamin D was set at 2,000 IU daily in 1997. More recent evidence indicates that higher amounts may be needed as we age due to lowered absorption of the vitamin from our GI tract.

Regular weight-bearing exercise increases bone mass while lowering the risk for fracture by preventing falls.  It improves agility, posture and balance.  Thirty minutes daily is the minimum. Walking, jogging, Tai’Chi, stair climbing, jumping on a trampoline, dancing and tennis are good examples of weight-bearing exercise. Muscle-strengthening weight training helps build bone over time. If you have osteoporosis, avoid sit ups and exercises that require forward flexion of the spine; these can increase the risk of spinal fractures. Physical therapists are good resources for initiating muscle-strengthening and resistive exercise programs.

Tobacco products promote skeletal bone loss. A smoking cessation program is essential for osteoporosis prevention and treatment.  Excessive alcohol intake of more than three drinks daily is another culprit.

Prevention of falls is key. Risk factors include a personal history of falling, muscle weakness, gait problems, poor balance and poor vision. Remove throw rugs and install assistive devices, such as hand rails, in bathrooms to help prevent falls. Evaluate medications for possible oversedation.  Exercise to improve balance and muscle tone. These recommendations can be supplemented by hip protector devices worn daily to prevent fractures in patients who have established osteoporosis.


Diagnosis & Management

The NOF recommends a detailed history and physical exam, bone-density assessment and using the World Health Organization’s 10-year fracture probability assessment tool.  All postmenopausal women should be evaluated for osteoporosis risk factors and, if necessary, undergo bone-density testing by densitometry.

DXA or dual-energy x-ray absorptiometry, which measures bone mass in the hip and spine, is the gold standard for diagnosing low bone mass. A DXA may be ordered if there are risk factors for low bone mass and the patient is premenopausal. Risk factors include, but are not limited to, smoking, alcohol intake, low vitamin D, anorexia and bulimia, genetic factors, hyperthyroidism and hyperparathyroidism, malabsorption, blood disorders, renal failure and certain medications.  Patients who undergo bone density testing via DXA and have osteopenia may then benefit from FRAX calculation to determine their fracture risk and if therapy should be started.

The two main categories of drug therapies for low bone mass are antiresorptive (prevent bone destruction) and anabolic agents (build bone mass). Antiresorptive agents include bisphosphonates (i.e., Fosamax, Actonel, Boniva, Reclast), calcitonin, estrogens and progesterones, and Evista. The commonly used anabolic drug is parathyroid hormone or Forteo.  All of these drugs have shown efficacy in reducing fracture risk. Not all the agents are appropriate for every patient, and decisions for therapy should include discussions of risks and benefits relative to the patient’s medical history and severity of bone loss.

Prevention of osteoporosis is possible through adequate calcium and Vitamin D intake and minimal lifestyle changes. Diagnosis is easily established by measuring bone mineral density by DXA, which all women age 65 and older should undergo regardless of clinical risk factors. Younger postmenopausal women should be tested based on their clinical risk profile, and women with fractures after age 50 should be tested.  Based on the results women and their physicians can plan therapies to lower the risk of fractures.

Image from: www.fortworthdental.com

Rebecca Terry, M.D., graduated from Transylvania University and the University of Louisville School of Medicine. Her residency training was at the University of Oregon. Dr. Terry was a founding partner of Women First of Louisville PLLC and her current practice focuses on gynecology. She is also certified in clinical bone densitometry and has been named in Louisville Magazine as one of Louisville’s “Top Docs.”  Her special interests include laparoscopic surgical procedures, conservative management of uterine bleeding problems, diagnosis and treatment of abnormal pap smears, osteoporosis and gynecologic urology, management of menopause and perimenopause, treatment and prevention of osteoporosis and preventative health care services.

Hyperpigmentation – Brown Spots

By Tom Haas, MD, FACS, MBA


            One of the most distressing skin problems facing women today is skin discoloration or uneven skin tone.  These brown splotches or spots are most frequently a result of sun exposure or hormones and can affect women of all ages and race.

Skin gets its color from melanin, a pigment your body produces naturally.  An over-production of melanin in certain areas shows up as brown patches or spots most likely on the face, neck, upper chest, hands, arms and legs.


There are 3 main reasons your skin becomes overly-pigmented the most common being sun-exposure.  Your skin will produce melanin to protect from the sun’s harmful UV rays, the result is a tan.  When over-exposure occurs, sun-damage is the result often appearing as brown spots medically referred to as lentigos but sometimes called “age spots” or “liver spots.”  This exposure is cumulative and not directly related to a sunburn on a particular day.  Once this over-production of melanin has started it is difficult to stop without medical intervention.

The second most common form of hyperpigmentation is due to hormones often referred to as melasma or chloasma.  Hormone shifts or changes contribute to the production of the melanin.  This is the result of pregnancy, oral contraceptives, or various stages of menopause.  Pregnancy for example can trigger an over-production of melanin resulting in the “mask of pregnancy” on the face.  It is important not to directly expose yourself to the sun while taking hormones, as this could make it worse.

The third most common form of hyperpigmentation is from injury (termed Post-Inflammatory Hyperpigmentation) to the skin including surgeries, cuts or abrasions.  Skin diseases such as acne may leave dark spots once the condition is cleared.  Hair waxing and improperly performed laser treatments can also contribute.


It is sometimes hard to prevent hyperpigmentation problems, hormonal shifts are unpredictable and accidental injuries are out of your control.  But, the most important preventative measure is sun-protection. By using a broad-spectrum sunscreen like SkinCeuticals Ultimate UV Defense SPF 30 you can help prevent further UVA/UVB damage.  In addition, carefully select medical advisors and staff when pursuing treatments involving lasers, lights, chemical peels, or manual exfoliations.


Intense Pulsed Light (IPL) has become very popular in the past several years.  IPL, often referred to as Photofacial or Photo laser, uses a medically-selected light in specific wavelengths to rejuvenate the look of your skin.  It can actually repair a great deal of sun-damage with no downtime and minimal pain.  It is approved by the FDA in theUSAto treat age and sun damage, birth marks, pigmentation and blemishes, fine lines and wrinkles, acne, scars, open pores, and rosacea.  The controlled flashes of light are absorbed by the brown spots creating a heat that eventually breaks up the accumulated melanin.  The brown spots will then slough off after a couple days.  Three to five treatments are typical spaced four weeks apart.  It is important to understand not all hyper-pigmentation can be completely removed.  Sometimes the best result is a “blending” of the affected area which appears as an overall improvement.

Topical cosmeceuticals can also contribute to an even skin tone and diminish discoloration considerably.  Natural active ingredients such as Kojic Acid and Arbutin work synergistically to help break up hyperpigmentation as found in SkinCeuticals Phyto+.  Another popular topical agent is hydroquinone, a skin lightener, which decreases the production of melanin in the skin.

Lastly, chemical peels with Hydroxy acids and manual exfoliations such as microdermabrasion help exfoliate of the top layer of the skin contributing to more even texture, tone and youthful glow.

It is important to remember, sunscreen should be worn daily under make-up and especially during any ongoing medical treatments or programs for hyperpigmentation.

Image from: www.bellairlaserclinic.ca/hyperpigmentation

Tom Haas, MD, FACS, MBA,  has been in practice for 14 years specializing in cosmetic plastic surgery. IMAAGE, a state-of-the-art plastic surgery and medical-spa facility. For more information: www.myimaage.com


Dealing with Depression: Living by Yourself after All Those Years

By Deborah P. Rattle, MSSW, CSW

For many, growing older offers a time for reflection, rejuvenation and opportunities for exciting new challenges and rewards.  Conversely, the difficult changes that many older adults face – the death of a spouse, adult children living far away, financial stress, medical problems – can present great challenges and, for some, a path to depression. But, depression is not a normal or necessary part of aging.  Contrary to some opinion, growing old and depression do not have to go hand-in-hand.

Everyone, older adults included, feels sad or blue at times in their lives, but these feelings generally pass with time.  When the feelings don’t pass, it’s time to seek advice from a physician or other behavioral health professional.

As with other medical experiences, however, it’s best to be prepared to be your own best advocate. Why? Some health professionals mistakenly think that persistent depression is an acceptable response to other serious illnesses and the social and financial challenges that may accompany aging.  Exacerbating this belief, many older adults describe their symptoms of depression in physical health terms – leading the healthcare professional to concentrate only on the physical complaints and ignoring the consideration of depression as the root, not the symptom, of illness.

Unfortunately, this approach contributes to low rates of diagnosis and treatment in older adults.  Additionally, many older adults have difficulty acknowledging depression – seeing it as a sign of weakness or a personal failure.  Recent data from the Centers for Disease Control indicated that among adults age 50 or older, 7.7% report current depression and 15.7% report a diagnosis of lifetime depression.

Unacknowledged and untreated depression not only prevents older adults from enjoying life and its rewards, it takes a heavy toll on physical health and can complicate existing medical conditions.  Untreated depression also increases the risks of alcohol and prescription drug abuse and suicide. Research also reveals a higher mortality rate for those who go untreated.

But, there is good news. With treatment and support, depressed older adults can get better. No one, whether they are18 or 80, has to live with depression.

Effective treatments – through medication and counseling – are widely available. The first step to success is talking openly with a physician, spiritual counselor or behavioral health therapist. These professionals can guide older adults in determining the most appropriate intervention to ease the depression and accompanying symptoms.

As important as appropriate medical care and counseling are to addressing depression, the effects of lifestyle decisions can’t be overlooked. Having and maintaining a strong and close social network is important at all ages. Cultural experience indicates this importance grows as we age.

In our community, there are many opportunities for fellowship and social support – faith-based senior health ministries, older adult higher learning courses at local colleges/universities and senior adult activity centers.  Senior centers are located in many neighborhoods and offer older adults opportunities to learn and master new skills, take part in group outings or wellness programs and enjoy gratifying volunteer opportunities and experiences in intergenerational programs.


Due to increased interest and awareness of depression in the general population, as well as the older adult community, both the US Department of Health & Human Services and the World Health Organization recommend priority action in identifying and treating depression.  These websites illustrate effective programs for addressing depression among older adults:


1.  IMPACT (Improving Mood-Promoting Access to Collaborative Treatment).



2.  PEARLS (Program to Encourage Active Rewarding Lives for Seniors). The PEARLS Implementation Toolkit can be found at http://depts.washington.edu/pearlspr.


3.  Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors).



Causes and risk factors that contribute to depression in the older adult include:

Loneliness and isolation – Living alone; dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.

Reduced sense of purpose – Loss of identity due to retirement or physical limitations on activities.

Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.

Fears – Fear of death or dying; anxiety over health or financial issues.


Depression Indicators

Persistent sadness or “empty feelings.”

Feelings of hopelessness and/or pessimism.

Feelings of guilt, worthlessness and/or helplessness.

Irritability, restlessness.

Loss of interest in activities or hobbies once pleasurable.

Fatigue, decreased energy.

Difficulty concentrating, remembering details and making decisions.

Insomnia, early morning wakefulness or sleeping too much.

Overeating or loss of appetite.

Thoughts of suicide, suicide attempts.

Persistent aches or pains, headaches, cramps or digestive problems that don’t ease – even with treatment.

(Source: National Institute of Mental Health)

Image from: www.circleofrights.org/older-adults-and-depression/

Deborah Rattle, MSSW, CSW is the Planning Officer for Seven Counties Services, Inc., the largest comprehensive behavioral healthcare organization in Kentucky.  She also serves as a lecturer and part-time practicum faculty for the Kent School of Social Work Field Education Office at the University of Louisville. Rattle is president of the KIPDA Region Mental Health & Aging Coalition and co-president of the KY State Coalition on Mental Health & Aging.  She has over two decades of experience in developing and implementing programs that enhance the behavioral health of older adults.