Pearly Whites for the Long Haul

By: Nikki Nies

With 3/4 of adults having a certain level of periodontal disease, whether its the simple gum inflammation to the damage to soft tissue and bone that support the teeth, these issues can be prevented with proper oral care, which includes brushing, flossing and a healthful diet.

Thank you Health Perch for sharing this great infographic!


Photo Credit: Health Perch 

AA’s Protective Body Against Osteoporosis

Image-10-21-13-at-4.30-PM-560x440By: Nikki Nies

Between 2012 and 2013, the growth of the Asian American (AA) community increased by 2.9%, making them the fasting growing ethnic group in the U.S.19 Representing 19.4 million of the American population, the AA bone biology and calcium and vitamin D intake deserve better understanding, as intake is often times lower than the recommended dietary guidelines.2  Many AA families have immigrated to the U.S., bringing not only physical possessions, but dietary and cultural practices as well.  AA tend to consume less dairy products due to perceived and/or actual lactose maldigestion and lack of culturally inundated use.7  Of the calcium rich foods consumed, AA tend to consume calcium more from orange  juice, soy and dark green leafy vegetables.5,18,19 Yet, there is a 47% prevalence of  vitamin D deficiency for Asian emigrants, with mean 25(OH)D 23.7-60.1 nmol/L for ethnic minorities in comparison to white at 65.4-79.6 nmol/L.13  vitamin D deficiency is  associated with female gender, dark skin, being covered while indoors and longer residency in host country (>2 years).13

AA women possess some of the same risk factors are associated with osteoporosis in Caucasians, even though rates of fragility fracture differs among groups.7,8 Additionally, AA hip fracture incidence is lower than Caucasians, which is hypothesized as due to shorter height, lower incidence or severity of falls, lower bone mass, better bone quality-including shorter femoral neck axis length (FNAL) and hip axis length (HAL) and/or differences in soft tissue thickness.3,6,12,15,16  The biological differences in Caucasians and AA body composition provide AA a protective layer, literally, against osteoporosis even with suboptimal calcium and vitamin D intakes. It has been surmised AA reach peak growth velocity sooner than other ethnicity groups, with earlier epiphyseal closure, which leads to shorter leg length and FNAL.3 Potential explanations of lower bone mineral density (BMD) may include AA skin pigmentation, reduced sun exposure, lower vitamin D intake, smaller bone size in hip geometry, with suggestions that AA have greater resistance to buckling, compressive and/or impact forces.3,6,8,16 Furthermore, use of imaging technology indicates the Chinese skeleton compensates for smaller bone size in trabecular and cortical bone compartments, which provides greater bone strength.3  Cortical bone has been found to be a protective barrier to fractures due to its thickness, cross sectional area, cortical porosity, mineralization, crystallinity and presence of microcracks.7calcium.figure2

During the menopause transition, a decline in ovarian function beginning about 2 years before the final menstrual period (FMP) is followed by an increase in bone resorption and then bone loss. The magnitude of the increase in bone resorption is inversely associated with body mass index (BMI).15  With a higher BMI, this may influence osteoporosis through increased weight bearing and increased adiposity, which is a source of leptin and estrone; they are known to positively affect the maintenance of BMD.15 AA tend to have lower BMIs than Caucasians, which may correspond in bone resorption, appearing to account for the ethnic variation in perimenopausal bone loss.15

With extensive research on postmenopausal women’s bone health, it is equally important to understand adolescent calcium needs as the growth period is crucial for optimal bone health due to the bone accumulation and as half of adult peak bone mass occurs at this time.2,19   A randomized crossover design studied 29 AA adolescents’ calcium intakes, ranging from 600-1600 mg/day, measuring bone turnover rate and calcium absorption using double stable calcium kinetic analysis.19 Both genders had low habitual mean intake, low mean serum 25-hydroxyvitamin D concentrations, with true fractional calcium absorption inversely related with calcium load and calcium retention increased with increased calcium consumption.19  Calcium retention is dictated by calcium intake, with absorption efficiency increased within the  first year after spermatorrhea in boys, but decreased with menstrual cycle in girls.20  The most important factors of calcium absorption include sex–higher absorption rate for boys, age, pubertal development  and retention.10,20

With the minimal calcium intake at 1110 mg/day for Chinese American boys and 970 mg/day for girls, it leads to maximal retention, which is considerably lower than that for Caucasian girls.  The study suggests lower calcium recommendations for AA adolescents than for Caucasian adolescents. Although, AA adolescents habitually have lower calcium and vitamin D intake, bone gain is similar in comparison to Caucasians, which due to increased calcium absorption efficiency and renal calcium conservation and due to the inverse relationship of calcium load and true fractional calcium absorption.9,10,19  Boys retained significantly more calcium than girls as calcium intake increased through lower fecal excretion and higher net absorption.  As a controlled feeding crossover study, both genders were studied, providing insight into adolescent populations’ calcium intake, which has a limited amount of data.  However, by using Chinese American participants, it is hard to generalize results to the entire AA adolescent population.  Future research can and should compare Wu et al’s results using more ethnically diverse AA participants.19

Talk about bone health is not complete without looking into AA women’s lifestyle predictors of peak BMD.4 In a cross sectional study of 48 Mexican American (MA) and 58 AA women, participants were tested for BMD, body composition, aerobic fitness and muscle function.  Pearson’s correlations and multiple linear regressions found AA hip BMD was lower in MA when adjusted for age, BMI, income and physical activity.4  Lean body mass was the strongest predictor of BMD for both ethnicities, but stronger for AA.4  A potential explanation of this mechanism includes earlier plateau in AA BMD compared to other ethnic groups, lower rates of skeletal remodeling, differences in hormone concentrations and effects.4 Also, AA had significantly lower total, spine and hip BMD (P<0.05).4

Total BMD (g/cm2) 47/57 1.11 ± 0.008 1.05 ± 0.06**
Spine BMD  (g/cm2) 47/57 1.05 ± 0.13 1.00 ± 0.10*
Hip BMD (g/cm2) 47/57 0.98 ± 0.11 0.86 ±0.11**
Spine t score 47/57 -0.002 ± 1.14 -0.364 ± 0.90
Hip t score 47/57 0.130 ± 0.83 -0.741 ± 0.84**

*Significant at P <0.005, **significant at P <0.01

While these results are the first of its kind, dietary recall bias has to be noted and causal relationships can not be drawn from any variables and BMD.4 However, all questionnaires were given in the participants’ preferred language and questionnaire and lab assessments were performed by the same research team. Again, by using specific minority groups-MA and CA,  it is hard to generalize results to the entire AA population.4

Moreover, by observing CA cortical thickness and cortical volumetric BMD (Ct.BMD), it can help shed light on the microarchitectural differences between AA and Caucasian risk for fractures.1 In a cross sectional study, pre and postmenopausal women were observed, with CA having smaller bone area at radius and tibia, greater cortical volumetric bone density and thickness and greater trabecular thickness than white women, which provides additional resistance to fractures.1 In CA, lower cortical porosity and higher tissue mineral density contribute to higher mineral BMD, more dense, thicker cortices.1,9

Premenopausal white women (n=46) Premenopausal Chinese women (n=46) Postmenopausal white women (n=68) Postmenopausal Chinese women (n=29)
Height (cm) 165±7 162 ± 6** 162± 6 157± 5***
Weight (kg) 63± 17 56 ± 10* 66±12 58±8***
BMI (kg/m2) 23.1 ± 5.5 21.6±3.5 25.3± 4.9 23.6± 2.6±*
Calcium intake (mg/d) 1394 ± 1570 885 ± 557* 1557± 730 901± 544***
OCP duration (years) 7.4 ± 6.4± 3.7 ± 3.3* N/A N/A
Baecke sport index 1.6 ± 0.7 1.1 ± 0.6*** 1.2± 0.5 1.2± 0.7
PTH (pg/mL)b 31 ± 13 37 ± 13* 38± 12 37±11
25-hydroxyvitamin D (ng/mL)c 36 ± 14 25 ± 9*** 38± 14 31±10*

OCP=oral contraceptive use; PTH=serum intact parathyroid hormone  bData for 174/192 women  cData for 152/192 women

*p < 0.05 between race by menopausal status;**p <0.001 between race by menopausal status ***p < 0.001 between race by menopausal status

The above listed results show CA have thicker, denser cortices due to lower cortical porosity and higher tissue mineral density.1 Studies have shown a strong relationship between cortical porosity and bone strength, with each SD increase in cortical porosity increasing risk of fracture 22-55% depending on skeletal site.  However, with noninvasive assessment, this may have led to confounding errors in density assessment as thicker cortices may result in more beam hardening artifact of measurement.1image_(2)

Repeatedly, Asian women are found to have lower areal BMD, which is the amount of bone mineral divided by the bone scanned area, and lower wrist, arm and hip fracture rates than Caucasians.1,9,17 Using high resolution technology, a study led by Walker et al., 2010 aimed to better understand this paradox, assessing cortical and trabecular bone noninvasively.17 32 white and 31 Chinese American women’s 25-hydroxyvitamin D, serum calcium, creatinine, alkaline phosphatase activity, intact PTH and thyroid stimulating hormone were measured.  Biochemical data was analysed using two sided t test and Pearson’s correlation for BMD and microarchitectural variables.17

Results showed CA were shorter, at lower weights, higher parathyroid hormone and a trend of less sun exposure than Caucasians.17 At the radius and tibia, CA women’s trabecular BMD was 22% and 15% higher respectively.17  Although, CA have smaller bone size, cortical thickness was 22.5% greater in CA than white.  When weight and physical activity factors were adjusted, differences in bone size decreased in radius and tibia, which suggests protective effects.2,17 In this study, the physical difference between CA and Caucasian women provide AA lower rates of hip fractures: greater trabecular and cortical thickness at radius and tibia, at tibia, trabecular number is greater, trabecular separation and inhomogeneity are lower.11,17 Participants were obtained as a convenience sample, which may instill selection bias–with healthy premenopausal, not postmenopausal women used and it can not be discerned if the results are applicable to postmenopausal.  This variation in menarche may skew the results and considerations must be made in regards in FMP.

The AA population’s body composition has a lowered risk for osteoporosis and fractures, with  body composition changes that accelerate bone loss within the FMP. In a eight year cohort study, 3302 Japanese and African American women spanning premenopausal age and beyond, estradiol, FSH and urine N-telopeptide (NTX) was measured.14 Results showed that in postmenopausal women, urinary and serum type I collagen NTX, a marker of bone resorption, levels were higher in perimenopausal women due to decreased estrogen production in perimenopausal and postmenopausal ovaries.14 The mean increase in urinary NTX was most markedly see in those with BMI >25 kg/m2, with increases greatest in Japanese Americans.  The study concluded ethnic variation in BMI helped explain the variation in perimenopausal bone loss as there was a decline in ovarian functioning starting 2 years before FMP with an increase in bone resorption and bone loss.14  Limitations of the study included the sole use of Japanese Americans as the AA experimental population and the obtainment of hormone levels on basis of single annual sample, which may not provide the best portrayal of hormone levels as menstrual cycles are irregular and the timing of blood sampling could have impacted the hormone levels.14 Causal relationships can not be determined from the results, with BMI as a measure of obesity, but not an indicator of contribution to increased fat mass, lean mass or both.

While AA are classified at increased risk of osteoporosis due to their lower calcium intake, their bone biology and metabolism show protective effects against osteoporosis in comparison to Caucasians.  Future research should expand on past studies’ findings, including using additional sample sizes when feasible and more consistent use of the type of ethnic participants.  While CA are the largest sub-minority group of AA, if future research states study’s are looking at AA, ethnic groups beyond CA should be used to elevate studies’ findings.  In addition, longitudinal studies may provide greater insight in the long term effects of AA calcium intake, bone health and risk of fractures.

From this extensive research, it is understandable and reasonable to lower calcium and/or vitamin D recommendations for AA in comparison to Caucasians due to AA’s increased calcium absorption efficiency at lower intakse, while continuing to promote the importance of bone health education.   By explaining the AA physical differences– lower bone mass, bone quality-including shorter femoral neck axis length (FNAL) and hip axis length (HAL) and/or differences in soft tissue thickness, this may curb fears about suboptimal calcium intake.3,6, 12,15Additionally, it would be helpful to recommend additional dairy rich calcium products as many AA obtain calcium from orange juice, soy products and dark leafy green vegetables..19 These recommendations would be appropriate to enhance the AA diet.  While the AA bone biology and cultural differences physically provide a protective layer against osteoporosis even at lower calcium intakes than other ethnic groups, adequate bone health education should be provided to this particular population.


Photo Credit:Vegan American Princess, Asian American Business Expo and Pointe Med


  1. Boutroy S, Walker MD, Liu XS, et al. Lower cortical porosity and higher tissue mineral density in chinese american versus white women. Journal of Bone and Mineral Research. 2014;29(3):551-561.
  2. Burrows M, Jones A, Mirwald R, Macdonald H, McKay H. Bone mineral accrual across growth in a mixed-ethnic group of children: Are asian children disadvantaged from an early age? Calcified Tissue International. 2009;84(5):366-378.
  3. Cong E, Walker M. The chinese skeleton: Insights into microstructure that help to explain the epidemiology of fracture. Bone Research. 2014;2.
  4. Crespo N, Yoo E, Hawkins S. Anthropometric and lifestyle associations of bone mass in healthy pre-menopausal Mexican and Asian American women. Journal of Immigrant and Minority Health. 2011;13(1):74-80.
  5. CROSS NA, KIM KK, YU ESH, CHEN EH, KIM J. Assessment of the diet quality of middle-aged and older adult korean americans living in chicago. J Am Diet Assoc. 2002;102(4):552-554.
  6. Finkelstein J, Lee M, Sowers M, et al. Ethnic variation in bone density in premenopausal and early perimenopausal women: Effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab,. 2002;87(7):3057-3067.
  7. Jackson K, Savaiano D. Lactose maldigestion, calcium intake and osteoporosis in african-, asian-, and hispanic-americans. Journal of the American College of Nutrition. 2001;20(2):198S-207S.
  8. Khandewal S, Chandra M, Lo JC. Clinical characteristics, bone mineral density and non-vertebral osteoporotic fracture outcomes among post-menopausal U.S. south asian women. Bone. 2012;51(6):1025-1028.
  9. Nam H, Shin H, Zmuda J, et al. Race/ethnic differences in bone mineral densities in older men. Osteoporos Int. 2010;21:2115-2123.
  10. Opotowsky S. Dietary calcium intake, fractional calcium absorption, urinary calcium excretion, and levels of calcitropic hormones and bone markers in young, healthy chinese-american and caucasian women .DORIS DUKE MEDICAL STUDENTS’ JOURNAL. 2001-2002;I:44-50
  11. Renzaho AMN, Halliday JA, Nowson C. Vitamin D, obesity, and obesity-related chronic disease among ethnic minorities: A systematic review. Nutrition. 2011;27(9):868-879.
  12. Sowers M, Zheng H, Greendale G, et al. Changes in bone resorption across the menopause transition: Effects of reproductive hormones, body size, and Ethnicity. J Clin Endocrinol Metab. ;98(7):2854-2863.
  13. Thomas P. Racial and Ethnic differences in osteoporosis J Am Acad Orthop Surg. 2007;15(1):S26-S30.
  14. Tung W. Osteoporosis among asian american women. Home Health Care Management & Practice. 2012;24(4):205-207.
  15. Walker MD, Liu XS, Zhou B, et al. Premenopausal and postmenopausal differences in bone microstructure and mechanical competence in Chinese-American and white women. Journal of Bone and Mineral Research. 2013;28(6):1308-1318.
  16. WIECHA JM, FINK AK, WIECHA J, HEBERT J. Differences in dietary patterns of vietnamese, white, african-american, and hispanic adolescents in worcester, mass. J Am Diet Assoc. 2001;101(2):248-251.
  17. Wu L, Martin BR, Braun MM, et al. Calcium requirements and metabolism in chinese-american boys and girls. Journal of Bone and Mineral Research. 2010;25(8):1842-1849.
  18. Yin J, Zhang Q, Liu A, et al. Factors affecting calcium balance in Chinese adolescents. Bone. 2010;46:162-166.

Healthy Eating in College

eating_healthy_in_college1By: Nikki Nies

With the impending semester upon us, it’s never too early to talk about healthy dining on campus.  While freshmen are often times required to buy a meal plan with tuition, those living in nearby apartments or are juggling school and home responsibilities, the stress of school can quickly get to students.  Unfortunately, the first habit to go is eating healthy.  Yet, it doesn’t make sense to opt for cheesy fries that don’t have as much energy producing qualities as a strawberry banana smoothie when the time crunch is really being felt!

I admit, I find myself eating on the go more often than not, but that doesn’t mean I’m going through McDonald’s drive thru or grabbing a Hot Pocket out of the microwave on my way out! With careful planning before the work load gets into the “meat” of things, you can set up your semester with some healthier options.

Planning ahead for upcoming semester, trimester or quarter, use the following suggestions for long term use:

  • Have a mini fridge in your dorm and/or access to fridge in apartment or suite for on the go breakfast items, such as a piece of fruit, yogurt,string cheese and/or pb&j  to store leftovers and to have produce on hand!
  • Opt for “healthier” options at fast food chains.  Order salads with dressings on the side, pizza with half the cheese, roast beef sandwich, sweet potato and/or fruit cup.  Limit the high fat, greasier options, such as French fries, fish sandwiches and/or fried chicken.
  • Monitor your sugar intake, which tend to quickly add up quickly.  Often times, coffee creamers, cookies, cocktails, cereals are packed with sugar.  Not sure how to check the sugar content? Here’s how to read a nutrition fact label.
  • Keep your room or apartment stocked with healthier snacks so you’re not tempted to head for the vending machines or order late night pizza.  Next time you’re at the grocery store, grab some pretzels, unbuttered popcorn, rice cakes, whole wheat crackers, hummus and/or granola.
  • Keep a reusable water bottle on hand!  It’s important to stay hydrated throughout the day.  It’s common for people to mistake thirst for hunger, plus drinking regular bouts of water can keep you focused.
  • Take advantage of the dining hall’s salad bar! Fill up on fresh fruits and veggies, but go easy on the salad dressing!  Vegetables are very filling for few calories!cafeteria
  • Attempt to eat meals on a consistent basis.  Yes, college is known to be hectic and one may not always a have a set schedule, but eat when you’re hungry and avoid skipping meals as much as possible.
  • Recognize your body’s cues.  I understand it’s a lot easier said than done, but listen to your body as it tells you when it’s hungry and when it’s full.  No need to overeat, that’s what leftovers are for!
  • Recognize portion sizes and stick to them.  You often need less food than you think or may like to fill you up! You’ll let meals stretch longer, while sticking to the recommended portion sizes.
  • Limit alcohol intake.  Alcohol is packed with calories, but provides few nutrients.
  • If you’re going grocery shopping.  Mix it up! It’s easy to get bored eating the same meals day after day and to opt for late night pizza, but don’t give in!
  • Fill up on calcium. Just because you’ve graduated high school, doesn’t necessarily mean you’re done growing.  Make sure to eat enough calcium rich foods to continue to prevent osteoporosis. You don’t have to be entirely dependent on milk for your calcium, so keep on hand low fat yogurt, green leafy vegetables and/or low fat cheese
  • If you’re out and your stomach’s growling, don’t feel guilty about grabbing fast food.  Sometimes you have to eat what’s available, eating fast food once in a while isn’t going to kill you.  It’s when such habits become a weekly and then daily habit one should worry.

Yes, this is a lot of information to remember, but you don’t have to add all these suggestions tomorrow.  People tend to be more successful long term with small, gradual changes.

Photo Crdit: Diets in Review and Healthy eating in College


Food for thought: The challenge of healthy eating on campus

50 Reasons To Exercise


Type I Diabetes

Type 1 Diabetes Mind Map

By: Nikki Nies

Diabetes is an extensive, complicated disease.  Health care professionals needs to have a better understanding on not only the treatment options, but the underlying mechanisms of diabetes.With diabetes complications interrelated with other health problems, there’s a definite need for Certified Diabetes Educators (CDE), who have gone through additional training and courses to better articulate the problems associated with diabetes.

Previously known as juvenile diabetes, as it is more commonly diagnosed in young children and adolescents, nowadays, type 1 diabetes is commonly known as insulin dependent.  With type 1 diabetes, the body doesn’t produce enough insulin and requires external insulin to compensate for the deficient amount produced in the body.  Type 1 diabetes contributes to 5-10% of all diabetes cases worldwide.  insulin-cell-Converted

Insulin is a hormone produced by the pancreas, needed to convert sugar, starches and other foods into energy for daily activities. Without conversion to glucose, insulin builds up in the bloodstream causing problems with the heart, blood vessels, nerves, eyes and kidneys.

Direct causes of type 1 diabetes is unknown but can includes genetics, geography–the farther away from equator tends to increase risk of type 1 diabetes, early consumption of vitamin D rich milk may be linked to type 1 diabetes, being born with jaundice, a child who’s mother is 25 years or younger when child’s born, having a mother that has preeclampsia during pregnancy,a respiratory infection just after birth and/or exposure to certain viruses.


  • Weight Loss
  • Fatigue
  • Blurred Vision
  • Extreme Hunger
  • Increased Thirst
  • Frequent urination

Common tests used to diagnose diabetes include checking one’s hemoglobin A1C, a oral glucose tolerance test (OGTT), fasting plasma glucose test and a random or causal plasma glucose test.

American Diabetes Association (ADA) Diagnostic Criteria for Diagnosing Diabetes

Indicator Normal Pre-diabetes Diabetes
Fasting Plasma Glucose <100 mg/dL 100-125 mg/dL 126+ mg/dL
OGTT—2 hr post glucose rich beverage <140 mg/dL 140-199 mg/dL 200 mg/dL or greater
Casual or random plasma glucose and symptoms 200 mg/dL or greater
A1C <5.7% 5.7-6.4% 6.5% or greater

There is no “instant” cure with type 1 diabetes, but it is manageable.  Constant monitoring of blood sugar levels decreases risk of complications and increases one’s quality of life.   The earlier one develops type 1 diabetes and lives a life of uncontrolled diabetes increases the risk of further complications.

As stated, treatment is “life long” including regular insulin injections, exercise, eating healthy foods, educating oneself on diabetes, monitoring blood sugar and maintaining a healthy weight.

Preventable Complications:

  • Heart and blood vessel complications: includes coronary artery disease with chest pain, heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure
  • Nerve damage (aka neuropathy):  excess sugar can cause damage to the walls of capillaries that nourish nerves; can cause numbing, tingling, burning or pain in extremities; damage to nerves in gastrointestinal tract can cause nausea, vomiting, diarrhea and/or constipation; can cause experience erectile dysfunction
  • Eye damage (aka retinopathy): diabetes can cause damage to blood vessels in the retina; may lead to blindness, cataracts and/or glaucoma
  • Foot damage: can be due to poor blood flow; if left untreated, can lead to infection and the need for amputation
  • Osteoporosis: diabetes may lead to lower than normal bone mineral density–>osteoporosis
  • Skin and mouth complications: Diabetes may lead to gum, bacterial or fungal infections
  • Pregnancy complications: with high blood sugar levels, can increase risk of miscarriage, stillbirths and/or birth defects; if a pregnant women has uncontrolled diabetes, it may lead to ketoacidosis, retinopathy, preeclampsia and/or pregnancy induced high blood pressure
  • Hearing problems

Type 1 diabetes is not preventable, but long term complications are.  Yes, the constant monitoring of blood sugar levels may sound like a hassle, but do you really want to struggle with additional complications?  My guess is no.  So, if you’re living with type 1 diabetes, you owe it to yourself and your loved ones to take care of yourself.


Oh, Osteoporosis


By: Nikki Nies

If one deconstructs the word osteoporosis it literally means porous bones (osteo=bones; porosis=porous).  Osteoporosis makes one’s bones weaker and more likely to break.  Not to generalize, but preventative advertisements usually target women as they are the predominant sex to have osteoporosis.

Identifying risk factors are important for prevention and to zero in on treatment options.

Risk Factors:

  • Small or thin frame
  • Older age
  • Caucasian or Asian ethnicity
  • Taking certain medications
  • Osteopenia–low bone density
  • Depends on how much bone mass one attained during youth
  • Family history of osteoporosis
  • Thyroid Problems: with too much thyroid hormone can cause bone loss
  • Low calcium intake–contributes to diminished bone density and fractures
  • GI surgery–with a reduction in the size of one’s stomach or a bypass of intestines can decrease the size of the surface area available to absorb nutrients (i.e. calcium)
  • Eating disorders–anorexics have a higher risk of developing osteoporosis as there’s an overall decrease energy intake, which can cause reduce the amount of calcium consumed; can cause a cessation of menstruation–>weakens bones
  • Hormone levels–with a reduction in estrogen levels, increases one’s risk of developing osteoporosis
  • Steroid use–i.e. prednisone and cortisone; long term use can interfere with bone rebuilding process
  • Tobacco Use
  • Excessive alcohol consumption
  • Sedentary lifestyle

Osteoporosis is called a silent disease, with symptoms not always clear.  The best way to diagnose someone is through a bone mineral density test.


  • Over time loss of height
  • Back pain
  • Stooped posture
  • Bone fractures


  • Exercise
  • Consuming calcium and vitamin D rich foods and/or supplements
  • Certain biphosphonates may slow the process of bone loss (i.e. Actonel, Binosto,Boniva and/or Fosamax)
  • Hormone Related Therapy
  • Prevent falls–wear low heeled shoes that are nonslip, keep brightly lit homes, prevent tripping over wires
  • Cessation of alcohol and/or smoking


Prevention: Eating a calcium and vitamin D rich diet, exercising regularly and not smoking can provide someone with the best chances not to develop osteoporosis.

Nothing in life is 100% certain, but by taking a proactive approach and reducing one’s controllable risk factors can decrease one’s chances of developing osteoporosis many folds.

Photo Credit: Bio News Texas and University of Maryland Medical Center 


The Female Athlete Triad


By: Nikki Nies

Life consists of the constant struggle to maintain balance in life.  Everything from balancing work, daily chores and sleep to balancing relationships with friends and families.  There also needs to be a constant balance between healthy activities.  Often times, athletes are told by coaches or are self-motivated to lose weight for the hopes of better performance.  Not to generalize, but female athlete triad is sometimes found in cross country running, gymnastics, and figure skating as these sports require “leaner” body compositions.

While regular exercise is necessary to maintain health, the consequences of overexercising should not be discounted.  With extreme exercise regimes, there is a higher risk of doing more harm than good.  Such consequences can lead to a combination of three conditions: disordered eating, osteoporosis and amenorrhea, which collectively is called the female athlete triad.  One does not need to have all three conditions occurring simultaneously for alarm.

  1. Disordered Eating: can range from bulimia to the restriction to certain food groups to calcium-supplements-benefits-and-side-effectslimiting daily calorie intake
  2. Osteoporosis: can be caused by low calcium intake and low estrogen levels; defined as the weakening of the bones due to improper bone formation or loss of bone density; can lead to stress fractures or injury
  3. Amenorrhea: absence of menstruation for 3 or more consecutive months;  symptoms: hair loss, headache, vision change, excess facial hair and/or milky nipple discharge; can be caused by excessive exercise without enough calories consumed to compensate for calories expended

The Female Athlete Triad may also occur in conjunction with an eating disorder.  It’s imperative if a friend, teammate, child or sibling is displaying the following symptoms, to not disregard them:

  • Brittle hair or nails
  • Chest pain and/or heart irregularities
  • Sensitivity to cold
  •  Using laxatives
  • Dental cavities–tooth enamel may be worn away due to vomiting
  • Continues with dieting even with weight loss
  • Preoccupation with food and weight

To definitively diagnose someone with athlete triad one has to be properly screened through a list of Q&A and screenings by a physician.

NPPA_100111_pg23_table2_lgWith hectic schedules, it can be easy to overlook possible symptoms of female athlete triad, but it’s critical to be aware of symptoms.  Working with a therapist, physician and dietitian may be helpful for those diagnosed with Female Athlete Triad.

If this information could help a loved one, please pass on in a kindly manner.  Thank you. 

Photo Credit: AlgaeCal 


Anorexia Nervosa


By: Nikki Nies

TV advertisements, billboards and commercials show physically fit, attractive women.  It downplays the behind the scenes touch ups and alterations done to reach final image.  These images resonate  with children, adolescents and adults attempting to emulate their role models.

It’s not realistic to think people can stop emulating celebrities, but to monitor and guage how often such idealation impact daily life and thoughts is crucial.  With a constant fixation on outward appearance and body image, it can lead to an eating disorder, such as anorexia nervosa.The concept of anorexia is not new, but stems from the Hellenistic times of fasting.  Early known fasters include Catherine of Siena and the Mary, the Queen of Scots.  Not until the 19th century was anorexia accepted as a medical condition until the 19th century, with limited exposure to medical profession until the late 20th century.  Once anorexia was included in the Diagnostic and Statistical Manual (DSM), more information was published to the public, which increased the availability of treatments.


  • Use laxative or diuretics to lose weight 1287
  • A low body weight
  • Abnormal blood counts
  • Insomnia
  • Fatigue
  • Osteoporosis
  • Swelling of extremities
  • Excessive exercise
  • Flat mood
  • Irregular heart rhythms
  • Bluish discoloration of fingers
  • Constipation or slow emptying of stomach
  • Thinning hair, dry skin and/or brittle nails
  • Low blood pressure
  • Feeling cold—with lower than normal body temperature
  • Shrunken breasts
  • Lack of menstrual periods
  • Have food rituals or restrictions
  • Spend a lot of time rearranging food on plate or hiding food
  • Warning signs of suicide (i.e. giving away belongings, being angry, failing grades, substance or alcohol abuse, depression, recent job loss)

Body’s starvation mode can cause all of the bodies’ resources to pull together to survive.

Potential Consequences

  • Limits bowel movement–>constipation
  • Decreased iron intake–>anemia
  • Insominia
  • Low blood pressure
  • Low heart rate
  • Liver damage, kidney failure, dehydration–>death
  • Lack of calcium–>fractures
  • More susceptible to bruises because of inadequate intake of vitamin C and K since these are 2 vitamins vital to blood and cells
  • Produce more cortisol–>bone loss
  • Greater risk of not reaching peak bone density
  • Not enough keratin–>hair loss and brittle nails
  • Altered testosterone levels
  • Cold feet and hands
  • More susceptible to bruises
  • Weakened immune system
  • Deficiency in potassium, magnesium and/or sodium
  • Imbalance of electrolytes
  • Slowed digestion from lack of protein and/or carbohdyrates
  • Amenorrhea,may becausedbyosteopenia, osteoporosis and/or infertility
    • Decreased estrogen levels and gonadotropin hormones


  • Receive medical care from doctors,therapistsandRDs
    • Reevaluate definition of “healthy”
    • Develop meal plan to gain weight—scheduling times to eat
      • Nutritionguidelines: weight gain of 2-3 lbs. for hospitalized patients
        • 0.5-1.0 lbs for outpatients
        • start with 1000-1600 calories per day meal plan, increasing as needed
    • Maudsley Method:  parents are held responsible to help their adolescent eat on a more consistent basis and to prevent the disorder to remain chronic.
    • Family therapy and cognitive behavioral therapy
    • Medicines—mood stabilizer, anti depressants, anti psychotics, estrogen, calcium, zinc and/or vitamin D supplements
    • Family and friend support
    • Reevaluate amount of exercise

Although, anorexia often is associated with adolescent girls and women, young male adolescents and men should not be overlooked.  While the stress of being a part of the American culture can cause many to fall prey to the “thin” concept, it’s important to surround oneself with love and support.  If you know someone who could use your help, don’t hesitate to talk to them or find someone who could help your concerned family member.

If this information could help a loved one, please pass on in a kindly manner.  Thank you.  

Photo Credit: Anne of Carversville and Women’s Health Zone


Benefits of Breastfeeding


By: Nikki Nies

One of the common first questions posed to new moms is bottle or nipple fed?  While breastfeeding may be initially thought as unrealistic for working mothers, those feeling detached or with hectic schedules, perhaps you need a little a more convincing.

 I’ve personally not given birth, but I can understand and empathize with the concept of wanting to provide the best for one’s children. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists strongly recommend breastfeeding, as it’s one of the first, best acts of love a mother can give.

Benefits of Breastfeeding:

  • Provides ideal amount of nutrients–provides perfect mix of vitamins, protein and fat
  • More easily digested than infant formula
  • Breast milk contains antibodies, which can help fight off bacteria and/or viruses
  • Can satisfy baby’s emotional needs–best way to keep baby comfortable!
  • Protects against Crohn’s disease
  • Reduces risk of allergies and/or asthma 762_breastfeeding-poster
  • When exclusively breast fed for first 6 months, may decrease risk of ear infections, respiratory illnesses and/or bouts of diarrhea
  • Babies are less likely to be constipated
  • Most convenient method of feeding!
  • Breast milk composition provides newborn all the nutrients needed
  • May increase intelligence in the future
  • May need less trips to the hospital and/or doctor
  • Increases maternal bond with newborn
  • More likely for babies to to stay on target on growth charts
  • Plays a role in the prevention of sudden infant death syndrome (SIDS)
  • May lower future risk of diabetes, obesity and/or certain cancers
  • For mothers, reduces risk of breast and ovarian cancer, increases recovery from childbirth, reduces risk of osteoporosis, burns extra calories–>helps one lose more pregnancy weight faster
  • More environmentally friendly–less waste with formula cans and bottles
  • More budget friendly–with breastfeeding, one doesn’t have to worry about purchasing baby bottles, sterilizing and/or measuring formulas
  • Saves time!

Yes, every mother’s situation is different.  If your doctor states your baby needs to be bottle fed temporarily, of course, bottle feed.  But, if all’s clear, don’t knock breastfeeding until you’ve tried it.  Make sure to try different positions and compare notes with friends on some useful tips. Good luck!

Photo Credit: Fluffy Baby Shop and Ann elise in the big world


Added Category: Severe Obesity


By: Nikki Nies

Often times the words overweight and obese are used interchangeably.  Being overweight is being above a weight considered normal or desirable while obesity is considered BMI over 35.  Being severely obese is greater than a Body Mass Index (BMI) of 40 or more than 100 pounds over ideal body weight.

Severe obesity is associated with additional complications: heart disease, type II diabetes, high blood pressure, artherosclerosis, stroke, gallbladder disease, high cholesterol, osteoarthritis, osteoporosis, sleep apnea and some cancers (i.e. breast or colon).

There’s approximately 9 million Americans categorized as severely obese.  About 45,000 12- to 19-year-olds in the U.S. have BMIs of 50 or higher. For example, a 5’4 person who weighs 291 lbs. would have a BMI over 40.  A normal weighted person has a BMI of 18.5-24.9.


What gets me is the dominanting age population of those severely obese.  A lot of attention and resources have been provided for adults, which I’m not trying to devalue, however, what are we doing wrong as a nation that is encouraging the next generation to have BMI’s of 50+?  I thought Michelle Obama’s “Let’s Move” inititative was being well received, MyPyramid was revamped to modern times and is now MyPlate, soda has been banned in many schools, yet severe obesity is more present than ever.

After a certain weight, diet and exercise can only help so much.  So, what can be done? I honestly don’t know because I feel there’s a lot of advocates to help curb childhood obesity.  This is not a one solution fits all, but each person’s journey to a healthier life is individual, but there’s a lot of resources available to help anyone on their journey to a healthier individual!