Wellness Education

Rittenhouse Women’s Wellness Center™ places disease prevention education at the heart of its mission. We want our clients to be aware of the most up-to-date medical information via one-on-one consultations available through our Total Wellness Services and through our educational articles. The following information can help you learn more and keep better track of your well-being. Also visit our Resources page for help in finding further information.

Please remember that the information in these articles is not intended to replace the advice of a medical doctor. 

Endocrine Disruptors and How to Lower Your Risk

May 31, 2012

By: Leslie Saltzman, D.O., Medical Director

An endocrine disrupter is a chemical that can disrupt or interfere with the proper functioning of the endocrine system. The endocrine system consists primarily of glands that produce hormones that help to guide the development, growth, reproduction, and behavior of human beings and animals. Hormones work by attaching to specialized receptors on cell surfaces. A problem can occur if a chemical (instead of a natural hormone) binds to the receptor and blocks the action of the hormone. Consequently, normal biological function can be blocked by the presence of endocrine disrupting chemicals.

These days there is growing evidence linking this class of chemicals to problems in humans. These include breast cancer, infertility, low sperm counts, genital deformities, early menstruation and even diabetes and obesity.

Endocrine disruptors are everywhere. They’re in thermal receipts that come out of gas pumps and A.T.M.’s. They’re in canned foods, cosmetics, plastics and food packaging. Test your blood or urine, and you’ll surely find them there, as well as in human breast milk and in cord blood of newborn babies.


  • Food and drink storage: Avoid plastic:
  1. Use refillable stainless steel or glass water bottles when on the go;
  2. Store and heat food in glass, ceramic, or paper; not plastic
  • Food packaging: Avoid BPA Opt for:
  1. Fresh or frozen fruit and veggies;
  2. Dry beans;
  3. Food and drink packaged in glass, not cans;
  • Fish: Avoid mercury, dioxin, and PCBs in fresh water fish and ocean fish:
  1. Trim fat from all fish to minimize dioxin and PCBs;
  2. Choose small non-predatory fish (salmon, perch, trout, tilapia, whitefish, pollock, etc) to minimize mercury;
  • Pesticides: Teething toys: Give babies teethers made of natural materials: cotton, wood, etc.;
  1. Opt for organic food (especially meat and dairy when possible) or food consistently low in pesticides (Get the list);
  2. Use non-toxic strategies to fend off pests inside the home, on the yard, and on your pets;
  3. Encourage non-toxic alternative to pesticides in your child’s school;
  • Personal Care Products: Check cosmeticdatabase.org for a safety rating of over 69,000 personal care products. There’s a special section for “babies and moms” that lists baby wipes and diaper creams to avoid;

Stop Sitting - Get Up and Move!

May 31, 2012

By: Shannon Feck, Personal Trainer

If you had to guess, how many hours per day would you estimate you spend working at a desk, listening to teachers, using a computer, eating at a table, riding in a car, flying on an airplane, watching television, attending sporting events, etc.? Some medical research reports that the average person spends 9 hours of their waking hours (roughly 60%) performing these types of “activities” – and the one common denominator among all of them is SITTING! According to several researchers, the very “act” of sitting for prolonged periods (even among those who may exercise routinely) decreases metabolism, impedes circulation, and increases your chances of developing certain diseases.

The human body was not designed to hold one posture for 8-9 hours per day (such as sitting at a desk at work). Studies have shown that holding this inactive posture for long periods of time disrupts metabolic functions and circulation. Because your legs, which include the largest muscle groups in your body, do not contract while sitting, metabolism decreases. In fact, you burn more calories chewing gum than you do while sitting! Poor circulation can also occur, which can lead to issues like blood clots.

Furthermore, recent studies have linked prolonged sitting to higher levels of triglycerides, cholesterol, blood sugar, and waist size – all of which increase the risk of developing obesity, heart disease, and diabetes. One study conducted by Epidemiologist Steven Blair, a public health professor at the University of South Carolina, found men who reported more than 23 hours a week of sedentary activity had a 64 percent greater risk of dying from heart disease than those who reported less than 11 hours a week of sedentary activity.

While federal health guidelines suggest a minimum of exercising 30 minutes per day 5 days per week, achieving this minimum amount of activity may not be enough to combat the effects of the amount of sitting we engage in every day. In fact, the scariest findings of Steven Blair’s study were that most of the subjects routinely exercised!  So what does this mean for our everyday lives and how can we possibly overcome the inevitability of sitting, which affects our work, transportation, and social lives? Get up and MOVE!! In 2012, a Duke University study demonstrated that people who got up for 2 minutes out of every 20 minutes improved their glucose levels and circulation within weeks! Here are ways you can easily move every hour of your “seated” day:

  • Get up and talk to a co-worker instead of emailing
  • Pump your feet/circle your ankles at your desk, on an airplane, etc.
  • Take the stairs instead of the elevator
  • Sit on an exercise ball at your desk
  • Schedule “walking” meetings with your co-workers
  • Do 5 squats every half hour at your desk or while you watch television
  • Park further away in the parking lot
  • Stop every couple of hours in your car and take a walk around a rest stop
  • Do stretches on the floor or couch while watching a movie

The key to combating the effects of sitting, which is what the average person spends most of their waking time doing, is to get up and MOVE!! Even if you can only fit in a few minutes per hour, these small steps pay off in big ways when it comes to your health - let us know how we can help you get moving at the Rittenhouse Women’s Wellness Center!

Calcium and Your Body

May 31, 2012

By: Christina Ushler, Registered Dietitian

Calcium is one of the most abundant minerals in the body, representing about 1%-2% of the total body weight. Calcium plays many vital roles in the body, and is known for assisting with blood coagulation, muscle action, heartbeat, and nerve function. It is better known for its role in helping to maintain the development of bones and teeth. Bones and teeth represent about 99% of the body’s calcium, and our body pulls from this storage if inadequate amounts are supplied in the diet.

Adequate intake of calcium is 1,000mg per day for men and women ages 19-50 years old. Deficiency of calcium can include symptoms that affect mostly bone and muscle. Tetany, rickets, and osteoporosis are common diseases associated with calcium deficiency. Tetany is a condition characterized by intermittent muscle contractions that fail to relax, muscle spasms, or numbness/tingling in the hands and feet. Rickets is a condition where children have softened bones. Osteoporosis is a condition of thinning bone tissue and porous bones. Calcium deficiency has also been associated with the development of hypertension, colon cancer, and obesity.

Weight-bearing exercise, such as walking or jogging increases calcium absorption. However, caffeine, alcohol, and smoking decrease the absorption. An upper limit of 2,500mg per day is cautioned for those ages 1 year and older. Conditions such as constipation, nausea, vomiting, loss of appetite, kidney toxicity, confusion, and irregular heart rhythm can occur with excessive amounts.

The best way to obtain calcium in your diet is through whole foods. Calcium is most commonly known to be found in milk-based products. However, many people do not realize that calcium can be obtained and found in many plant-based foods, some of which include: greens such as collards, mustard, kale, and bok choy; tofu coagulated with a calcium compound; soymilk; fruit juice; cereals; blackstrap molasses; and broccoli.

Many of the foods mentioned below can be easily added to the diet to ensure proper calcium intake. A salad with 1 cup beet greens, 5 dried figs, 1 ounce of almonds, and orange slices provides approximately 400mg of calcium. This is already almost half of your recommended daily allowance. If you are interested in learning more about nutrition, schedule an appointment with a Registered Dietitian today.

The following provides the calcium content in some non-dairy foods:






Amount of Calcium    (mg)





Soy or Rice Milk   (fortified)


1 cup

Tofu (fortified)


1/4 cup

Orange Juice   (fortified)


1/2 cup

Collard Greens


1/2 cup

Dried Figs


5 each



1/2 cup



1/2 cup

Bok Choy


1/2 cup



1/2 cup

White Beans


1/2 cup



1 cup (raw)



1/2 cup



1/2 cup

Veggie or Soy Patty


1 each

Beet Greens


1/2 cup



1 oz.

Dried Beans &   Peas


1/2 cup



1/2 cup

Soy Milk   (non-fortified)


1 cup

Baked Sweet Potato   (w/ skin)


1 medium

Mustard Greens


1/2 cup




Tofu (unfortified)


1/2 cup


What is Body Mass Index ?

April 30, 2012

By: Jillan Rowbotham, D.O.

Body mass index, or BMI, is a quick, inexpensive tool designed to determine how healthy a person’s weight is for their height and help determine risk for obesity related health issues. BMI is calculated by dividing weight in kilograms by height in meters squared. A healthy BMI is 18.5-24.9, 25-29.9 is considered overweight, and over 30 is considered obese. BMI has long been criticized as an inaccurate assessment as it does not distinguish between body weight due to muscle (which weighs more) versus fat. Percentage body fat a more accurate assessment but cannot be easily measured in the office. The American Society of Bariatric Physicians defines obesity in women as >30% body fat. A recent study published in PLoS One, an on-line scientific journal, compared rates of obesity based on BMI and percent body fat with some surprising and concerning conclusions, particularly for their female participants.

Dr. Eric Braverman and co-author Nirav Shah, New York State’s health commissioner, compared a person’s BMI with body fat percent as determined by DEXA scan (Dual-energy X-ray absorptiometry) which has the ability to differentiate between bone, fat, and muscle tissue. (The usual DEXA scans used to screen for osteoporosis do not routinely measure fat and muscle tissue as was done in the study). They found that nearly half of women categorized as overweight by BMI were found to have >30% body fat, consistent with obesity. This misclassification in women increased with advancing age.

Obesity versus overweight; this is not simply an issue of semantics. The larger issue raised by this study is there is a large group of women where BMI, the most commonly used assessment of obesity, is underestimating their risk of future disease. These so-called “normal weight obese” may have an increased risk for conditions such as high cholesterol, coronary artery disease, high blood pressure, and diabetes but may not be getting the appropriate focused counseling to improve their health.

Does this mean everyone should go out and get a DEXA scan? Cost and inconvenience make this less than ideal. Though we are still in search of a perfect screening test for obesity it is important to remember that weight is only one factor related to risk for disease. Healthy lifestyle habits, such as regular exercise and a diet rich in fruits and vegetables, are important for everyone regardless of what the scale says.

Planning a Trip to an Exotic Destination?

April 26, 2012

Affordable Travel Preparation

For preventive medical care no matter where you're headed, RWWC is ready to help. We'll review your itinerary and medical history, provide the necessary vaccinations and prescriptions, and give you advice for staying healthy throughout your trip. You should plan to see us six weeks before your departure to allow ample time for vaccinations.

If your insurance does not cover travel medicine, the cost of the visit is $75 plus the cost of any vaccinations that you may require. Routine vaccines including Hepatits A, Hepatitis B and Tetanus/ Pertussis/ Diptheria are routinely covered by insurance. The typhoid vaccine costs $75.

Special Vaccinations

Certain vaccinations, including those against rabies, Japanese encephalitis and Yellow Fever are only available at specialized travel clinics. We'll help you determine whether you need any of these vaccines and direct you to the appropriate clinic. Note that travelers to equatorial Africa and parts of South America will require proof of vaccination against yellow fever. For more details, visit the CDC travel website.

What You Should Know About Irritable Bowel Syndrome (IBS)

April 26, 2012

By: Christina Ushler, Registered Dietitian

Irritable bowel syndrome (IBS) is a gastrointestinal disorder with abdominal pain, accompanied by diarrhea or constipation. This syndrome can lead to alterations in frequency and form of bowel movements, and is the most common gastrointestinal complaint in the United States and Canada. It is estimated to affect as many as 20% of the population. IBS symptoms can be aggravated by stress, anxiety, depression, and emotional trauma.

Individuals with IBS have been found to have an increased sensitivity to stimulation of the gastrointestinal tract. This means that the same stimuli in normal patients do not result in symptoms that patients with IBS experience. Increased levels of the hormone serotonin, as well as infectious and inflammatory components could be causes as well. Abdominal pain, alteration in bowel habits, gas, and some upper gastrointestinal symptoms (reflux and noncardiac chest pain) are major symptoms for IBS.

Gas is produced when food passes into the large intestine and is only partially digested. Intestinal bacteria can act on the undigested food, and by-products of their metabolism result in gas production. Patients with IBS can have an increased sensitivity to certain foods, such as lactose, wheat, high-fat foods, caffeine, sorbitol, or high-fiber foods.

Symptoms of IBS can lead individuals to change their food intake, or avoid specific foods altogether. This can subsequently lead to nutrient deficiencies, potential underweight, and malnutrition. Nutrition therapy goals will focus on decreasing anxiety, normalizing dietary patterns, assuring adequate nutritional intake, and taking the necessary steps to reduce gas production. Individuals with IBS should focus on increasing fiber to 25 grams per day, as tolerated. If sensitivity to high fiber foods initially occurs, adding one high-fiber food at a time is recommended. Adequate fluid and hydration are necessary as well. Probiotics and prebiotics have also received attention for their potential use in IBS. Additional nutrition advice can be discussed with a Registered Dietitian. Set up your appointment today by calling 215-735-7992.

Exercise: Good for Your Brain!

April 26, 2012

By: Shannon Feck, Personal Trainer

We all know exercise provides many external physical benefits, such as slimming waistlines, toning muscle, and improving mobility and strength, but does it provide internal benefits as well? The answer is YES – to our brains!! The simple act of contracting a muscle requires brainpower, and beyond that, the positive effects of the communication between mind and body are numerous. In fact, many studies have shown that exercise can elevate cognitive functioning, prolong the onset of some degenerative diseases, and alleviate conditions like depression and anxiety!

When we exercise, communication between neurons from our brain and our muscles occurs at what is called the neuromuscular junction. Here, acetylcholine (which affects memory and attention) and dopamine (which helps control fine motor movement) are transmitted from the nerve to the muscle fiber’s surface. This process “initiates a chain of events that lead to muscle contraction” (www.fi.edu). The process of contracting muscles, which is essential to exercise, demonstrates the synergistic relationship between the mind and the body in its most basic form.  

Because exercise stimulates the nervous system, it enables our minds to perform at a higher level. Studies have shown that movement can stimulate the Hippocampus in the brain, which primarily controls memory and learning. For instance, Charles Hillman, a professor at the University of Illinois, conducted a study called “Cognition Following Acute Aerobic Exercise” and discovered that only 30 minutes of moderate exercise “resulted in a 5-10% improvement in cognition” (www.abcnews.go.com). Evidence also suggests that the cerebrum, responsible for “memory, intelligence, and language” increases in size after physical activity (www.livestrong.com).

Not only does movement improve cognitive functioning, it can also delay the onset of degenerative diseases, such as Alzheimer’s disease and dementia. In one study published in the “Annals of Internal Medicine,” adults who exercised at least three times per week were 40% less likely to develop Alzheimer’s. Medical professionals theorize that these results are directly related to the fact that exercise can positively impact the Hippocampus (where Alzheimer’s typically begins).  

Lastly, physical activity can mitigate the effects of depression and anxiety. One study suggesting this was published in “The American Journal of Preventative Medicine” and demonstrated that adults who exercised for 30 minutes 3-5 times per week reduced their symptoms of depression by 50%. While all the reasons for these results may be unclear, one theory is that exercise increases two chemicals in the brain, Nerve-Growth Factor and Brain-Derived Nerve Factor, which contain anti-depressant properties.

Exercising stimulates more than just positive physical responses from your body; it also stimulates very real responses from your brain! Even 30 minutes of moderate exercise 3-5 days per week can have both short-term and long-term impacts on cognitive functioning. Make physical activity a part of your life today and let us know if we can help you reach your goals at the Rittenhouse Women’s Wellness Center!

The Power of Food Enzymes

March 28, 2012

By: Christina Ushler, Registered Dietitian

Did you know that life would cease to exist without enzymes? We are constantly bombarded with information regarding proteins, fats, and carbohydrates – in other words, “macro” nutrition. Not as much emphasis is placed on the “micro” nutrition that fuels our system every day. Micronutrients are specific nutrients that are needed by our body in smaller amounts, but this is not to say that they do not play a pivotal role in our physiology. Micronutrients encompass vitamins, minerals, phytonutrients/phytochemicals, and enzymes.

Enzymes can be the answer for vitality, weight loss, immunity, and longevity. Enzymes act as energizing forces or “catalysts” to speed up biochemical reactions in our body. Enzymes perform special functions in the body and are required for all metabolic processes, including cellular reproduction, metabolism, growth, digestion, elimination of wastes, thinking, reasoning, immunity, and memory. There are three classes of enzymes: metabolic enzymes (working in the body’s blood, tissues, and organs), digestive enzymes (produced in the body for digestion), and food enzymes (contained in raw food). Every cell, tissue, organ, and system functions from enzyme reactions. Even minerals, vitamins, hormones, and neurotransmitters need enzymes to be present in order to function properly. Without them, life would cease to exist.

Foods found in nature in their raw state have an abundant supply of enzymes. Mother nature has placed enzymes in raw food to aid in the digestive process instead of forcing the body’s own supply of enzymes to do this. We inherit a specific amount of enzymes at birth, and this can be decreased as we age by eating an enzyme-deficient diet and too many processed foods (ie packaged foods) and fast foods. Enzymes are affected by temperature and food enzymes are destroyed at temperatures above 129F. This is important to remember because many people are eating foods that are too heavily processed and cooked at too high a temperature, which subsequently decreases or diminishes enzyme activity. Without the proper amounts of food enzymes in our diet, our organs work harder and begin to wear out over time. This can manifest into degenerative diseases like cancer, heart disease, and diabetes. Raw foods with live enzymes help to alleviate the stress put on our organs.

Now that spring is here, green smoothies are a perfect way to add some life back into your diet! Check out this website for some delicious green smoothie recipes:


Chocolate: The New Health Food?

March 28, 2012

By: Monica Duvall, M.D.

Just in time for Easter, a new study has found that healthy people who eat chocolate regularly are slimmer than those who eat chocolate less often--good news for those of us with a sweet tooth! The study assessed data from more than 1000 people aged 20-85. The subjects reported eating chocolate an average of 2 times a week, while exercising an average of 3.6 times a week and following a healthy diet. Those who ate chocolate more frequently (5 times a week) had a body mass index which was one point lower than those who did not eat it as regularly. Body Mass Index, which measures body fat from a person's height and weight, is optimally between 18 and 25. For the average American woman, who is 5'4", a 1-point difference in BMI translates to a difference of about 6 pounds--pretty significant!

This study comes on the heels of other research over the past couple of years which has suggested a variety of additional health benefits related to chocolate. Last summer, a British study which analyzed data from over 100,000 people concluded that those who ate the most chocolate on a regular basis had a 37% lower risk of heart disease, a 31% lower risk of developing diabetes, and a 29% lower risk of stroke than the others. Earlier studies by researchers at Harvard showed associations between chocolate or cocoa consumption and decreased blood pressure, deceased LDL (bad) cholesterol, increased HDL (good) cholesterol, and decreased insulin resistance (a hallmark of Diabetes).

These positive health benefits can be traced to powerful antioxidants called Flavonoids which are found in the cocoa bean. Flavonoids help fight inflammation, improve blood vessel flow, and may have effects on metabolism. Chocolate with higher cocoa content has more flavonoids, and presumably, confers more of the benefits everyone is talking about.

A caveat of the above studies is that they did not identify the optimal amount of chocolate necessary to confer benefit, nor did they specify what type of chocolate the study subjects were eating.   And of course, much processed chocolate is loaded with sugar, fat and calories. So what is the takeaway here--how to make use of this exciting news? The answer is somewhat elusive for now, but for those who are looking for a DAILY chocolate fix, an ounce of either dark or unsweetened chocolate, with respective cocoa contents of 70% and 100%, seems to be a smart choice. An alternative is pure cocoa powder, which can be added to coffee or other foods once a day. The key is to choose chocolate with a high cocoa content--and enjoy it in moderation.

Will I Bulk Up If I Add Strength Training To My Exercise Routine?

March 27, 2012

As summertime approaches, you may be thinking of how you’re going to tone up and get in great shape for that beach vacation you have planned. If you haven’t added several strength training routines to your work-outs each week, you should! While a lot of females believe that strength training will cause their bodies to bulk up, the fact is that it’s very difficult for a female to achieve significant gains in muscle mass and size for several reasons. To get that toned look, burning body fat and creating lean muscle mass through proper resistance training is the key!

In order for a female to greatly increase muscle mass from strength training, a few things would have to take place. First, her diet would need to consist of a large number of calories and a high quantity of proteins. She would also need to have a high level of testosterone and most likely be consuming some form of muscle building supplement, such as Creatine. She would also need to perform “high volumes and intensities of strength training over a long period of time” (www.thetitusreport.com). Lastly, a female would need a genetic predisposition for muscle hypertrophy, which is the growth and increase of the size of muscle cells.

Genetically, females have higher levels of estrogen and lower levels of testosterone than men. This results in women having higher amounts of body fat and lower amounts of lean muscle mass.   Because men possess higher levels of testosterone and thus higher amounts of muscle mass, they have a tendency to bulk up during strength training. Female bodies will NOT react the same way to resistance training that male bodies do. Given genetics and the extra supplementation and caloric intake needed to achieve muscle mass gains, it is virtually impossible for a female to bulk up from weight training.

So, in adding resistance training to your work-outs each week, how much weight should you use, how many repetitions, and what types of exercises should you perform to get your best results? Many fitness magazines such as “Self” or “Women’s Health” will tell you to focus on low weights and high repetitions so as not to get bulky, however we’ve just discussed that it is nearly physically impossible for females to bulk up. Instead, pick a weight if you’re using dumbbells (or a color if you’re using resistance bands, etc.) and perform 2 sets of 10-15 repetitions. The last 2-3 repetitions should be difficult to perform (but always with good form) – at this point you’re reaching a point called muscle fatigue, which is where you feel like you cannot perform one more repetition. If the last 2-3 repetitions are easy, it’s time to bump up your resistance load! Lastly, make sure your work-outs have a balanced approach and include exercises that hit all of the major muscle groups.

Remember as you approach bathing suit season, the best way to increase muscle tone is to make strength training a priority and don’t worry about developing big, bulky muscles because it’s physically not in the cards for the majority of women. Even females who have more of a genetic predisposition to muscle hypertrophy have to make sure they’re consuming a large number of calories and taking muscle building supplements to build mass! Contact us at the Rittenhouse Women’s Wellness Center if we can help you introduce strength training to your routine!  

More Reasons to Get a Colonoscopy

February 29, 2012

By: Dr. Leslie Saltzman, Medical Director

A recent study published in the February 23, 2012 issue of the New England Journal of Medicine provides evidence that colonoscopies cut the risk of death from colon cancer by over 50%.

Despite good data supporting the efficacy of colon cancer screening, many patients are still not being screened.

Worldwide colon cancer is the second most common cancer diagnosed in women, and the second most common cause of cancer death. For most patients, an initial colonoscopy is recommended at age 50. Patients with a family history of colon cancer, colon polyps or inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis) may require screening at an early age.

The test involves a bowel prep, which essentially means taking a few doses of laxatives and a clear liquid diet for a day before the test. To make it easier for patients, I recommend that patients schedule the test for early in the morning. Patients are given sedation through an IV and the test is painless, patients may experience mild cramping and gas for several hours after the test. If a polyp is found during your colonoscopy it can be removed, thus preventing colon cancer.

Lifestyle can also affect your risk of developing colon cancer. To lower your risk: Engage in regular physical activity; choose a diet high in fruits and vegetables; avoid processed meats; limit your consumption of alcohol and maintain a normal body weight.

Managing Your Health in the Winter with Seasonal and Local Eating

February 28, 2012

By: Christina Ushler, Registered Dietitian

It seems to be a big challenge for many of us to properly nourish our bodies in the winter. Comfort foods such as macaroni and cheese and hot cocoa can be even more tempting when the weather is brisk outside and we are striving to stay warm. Unfortunately, these comfort foods can be high in calories, fat, and sodium (to name a few). They can also wreak havoc on our health and lead to increased weight, lower energy levels, and depletion of vital nutrients that are essential to our well-being. We need the nutrients found in fruits and vegetables more than ever in the winter months to fight off colds and retain our vitality. It is essential to choose seasonal, local, and organic fruits and vegetables as often as possible.

Seasonal and local foods are important for several reasons. Seasonal foods give you the nutrients that nature intended for that specific time of year. Also, many of the fruits and vegetables we see in the supermarket today are being transported at great distances and are picked too soon before they are fully ripe. This is detrimental to the nutrient density of the foods and causes these foods to be highly depleted in vitamins, minerals, and other essential ingredients. In addition, foods transported at a great distance can be sprayed with chemicals and other harsh ingredients in order to ripen or prolong the freshness. The produce then has even less vital nutrients and is laden with chemicals and artificial ingredients.

Seasonal food will likely come from a local farm. This in turn is a great benefit to our environment and your wallet. Some delicious winter vegetables include potatoes, turnips, broccoli, cauliflower, carrots, beets, squash, fennel, endive, kale, and brussels sprouts. Winter fruits include oranges, grapefruits, pomellos, tangerines, clementines, kiwis, kumkwats, lemons, and pears. This list is not conclusive and the availability of foods will vary by region. The following website is a great resource to finding local and organic farms in your area:


Seasonal Recipe for Winter:   Potatoes with Kale



1 pound medium red potatoes
4 cups shredded kale (see procedure below)
2 tablespoons extra-virgin olive oil
1 large onion, chopped
Salt to taste



1. Cover the potatoes with water and boil them until tender. Peel while hot, then cool in cold water and drain. Cut into thick slices. Refrigerate if you are cooking the potatoes in advance.

2. Just before serving, wash the kale, drain, and remove the stems and midribs. Stack leaves, roll up lengthwise, and shred crosswise.

3. In a large skillet, heat the olive oil and add the onion. Sauté over medium-high heat, stirring, until onion just begins to brown.                                                                                                 

4. Add kale, tossing it about until it all wilts. Reduce heat to medium and stir-fry kale for 5 minutes.

5. Add the potatoes and cook until they are heated through. Season to taste and serve.

Nutrients Per Serving – Serves 6
Calories: 135.9
Protein: 3.5 grams
Fat: 5.0 grams
Saturated Fat: 0.7 grams
Monounsat Fat: 3.3 grams
Polyunsat Fat: 0.6 grams
Carbohydrate: 20.5 grams
Fiber: 3.3 grams
Cholesterol: 0.0 mg
Vitamin A: 6,366.3 IU
Vitamin E: 1.3 mg/IU
Vitamin C: 51.7 mg
Calcium: 72.1 mg
Magnesium: 33.7 mg

Recipe found from www.DrWeil.com

Pre and Post Workout Meals

February 28, 2012

By: Shannon Feck, Personal Trainer

Metabolism is comprised of two processes, catabolism and anabolism. Catabolism, or “Destructive Metabolism”, occurs when the body breaks down complex molecules into simpler compounds. This process releases energy and heat necessary for activities such as exercise. Anabolism, or “Constructive Metabolism,” does just the opposite in that it synthesizes simple substances into more complex living matter. This process enables your body to grow and repair itself, speeds up chemical reactions, and regulates various body processes (American Heritage Medical Dictionary). Both Catabolism and Anabolism require fuel to properly function, and this fuel comes in the form of pre-workout and post-workout meals. Not only is the type of food consumed in each phase important, the timing becomes crucial as well so that your body gets the nutrients it needs when it needs them to perform at a high level during exercise and recover most effectively after exercise!


What And When Should I Eat Before Exercise?

Fueling your body before it enters the Catabolic phase will require you to maintain your Glycogen stores, which is what your body primarily uses for energy during exercise. Consuming an easily digestible (low fiber and low fat) snack 30-60 minutes before working out will ensure that your body has enough fuel to perform at a high level. Snacks consisting of simple carbohydrates, which your body can quickly and efficiently break down during your workout, are optimal. A piece of fruit, a glass of skim milk, sweet potatoes, and yogurt are all great examples of easily digestible pre-workout snacks high in carbohydrates that will give your body the energy it needs to maximize performance (www.livestrong.com).    


What And When Should I Eat After Exercise?    

After exercising and while blood flow is increased, consuming a meal 30-60 minutes post-workout consisting of carbohydrates and lean protein will help your body replenish the glycogen stores lost and signal your body to leave the Catabolic state and enter the Anabolic state. Carbohydrates made up of a moderate to high Glycemic Index, such as bananas, watermelon, and raisins enable your body to refuel glycogen used during exercise and helps speed up the recovery time to prepare for the next workout. Low-fat proteins, especially whey proteins, trigger the body to move from a Catabolic phase to an Anabolic phase. Because whey has 100% bioavailability, your body is able to use all of it and also absorb it more quickly than other forms of protein which aids the efficiency of the muscle recovery process after exercise (American College of Sports Medicine). Some natural examples (non-supplement or powders) of foods containing whey protein are milk, low fat ricotta cheese, and yogurt.


Our bodies are machines that run on the fuel created by the food we consume. Knowing how and when to fuel your body before and after exercise becomes paramount in maximizing the effectiveness of your workout! Call us today at the Rittenhouse Women’s Wellness Center to learn more about this overall approach to becoming the healthiest and strongest you can be!

The Importance of the Whooping Cough Vaccination

January 31, 2012

By: Jillan Rowbotham, D.O.

Whooping cough is on the rise in the U.S., including the Philadelphia area. Staying up to date with your vaccinations can help protect you and your loved ones.

Whooping cough, also known as pertussis, comes as a vaccine in a combination with tetanus and diphtheria vaccines. The combo vaccination is known as tdap. Most people complete the initial series of vaccinations when they are young and the CDC now recommends a tdap booster every ten years for adults. Whooping cough can infect people at any age but those who are unvaccinated or are too young to be fully vaccinated are at most risk for serious complications, including death. It is important to make sure you are up to date with your tdap booster if you are spending much time around little ones as they most often contract the disease from a caretaker or family member. Expectant moms can get the tdap booster after the 20th week of pregnancy or may be offered it immediately after delivery.

Whooping cough is spread from person to person by respiratory droplets, such as through coughing and sneezing. Droplets usually don’t travel more than three feet so reasonably close contact is required. Initial symptoms are similar to that of the common cold: runny nose, sneezing, and a mild cough. The cough then worsens to bouts of spasmodic coughing sometimes followed by a deep forced inhalation which can sounds like a ‘whoop.’ This phase of coughing can last one to six weeks, though sometimes up to ten weeks. Being vaccinated reduces the risk of contracting whooping cough and can decrease the severity of symptoms. If you have close contact with some with a confirmed diagnosis of whooping cough please contact the office, prophylactic antibiotics may be administered regardless of vaccination status.

For more information visit http://www.cdc.gov/features/Pertussis/

Winter Skin Blues

January 31, 2012

By: Molly Hagen, Medical Aesthetician

The winter weather can be very harsh on your skin, but it doesn’t have to be. With just these 5 tips and some loyalty you should be glowing in no time. For starters, always remember to treat your face differently than your hands and feet. The hands and feet tend to crack and flake more than the skin on your face does. For those areas, use a petroleum jelly or a thicker Vaseline type cream. Avene carries a hand cream for these tricky areas that does wonders for your skin.

Seek a specialist. Talking to an aesthetician or a doctor is a great way to get professional advice on your skin and the advice that you may be looking for. Sometimes this small investment is worth it in the long run. A professional can recommend and diagnose any issues that you are facing with your skin in the winter time. Sometimes it can be more than just dry, cracked skin and it’s best to take care of it sooner than later.

Exfoliate and moisturize more. I’m sure you hear the word “moisturize” quite often in the winter time in regards to your skin. The one thing that most people tend to forget is that you need to exfoliate the dead, dry skin first, then moisturize so that you are moisturizing new fresh skin. This will give you that summer time glow that seems to be missing in the winter. Moisturizing with a light creamy based lotion will be the best, something heavy but not too greasy. Avene Clean-ac Moisturizer will leave your skin hydrated, soft and supple. A microdermabrasion is the best way to receive a deep exfoliation without any downtime so you can slaw away all of that dry, chapped, dull skin.

Hydrate more than ever. Drinking water has always been recommended but in the winter, drink more! The more water you have in your system, the more hydrated your skin will be. Everything that your body intakes is shown through your skin, so the more hydrated you are the more hydrated your skin will look and feel. Luke warm water is the best for you, so fill up that water bottle!

Cover up, it’s cold outside. Layers are the best way to protect your skin from the harsh winds and temperatures. Make sure that you are wearing gloves to protect your hands and a scarf to protect your face. The harsh winds can chap your skin and the cracking of the skin comes next, so be prepared and bundle up.

SPF. Never forget to protect your skin with sunscreen. Even though it’s winter, it doesn’t mean that the sun isn’t out and it can’t damage your skin. The winter sun is even more damaging because the rays reflect off of the snow making it more intense. Don’t count on your makeup either; find yourself a facial lotion sunscreen with a SPF of 30 or higher.

By following these suggestions, you can almost guarantee that your skin will never again suffer from extreme dryness through the winter months. If you have questions or would like to meet with a professional call the Dermacenter at 215-735-7990.

The Importance of the Whooping Cough Vaccination

January 31, 2012

Whooping cough is on the rise in the U.S., including the Philadelphia area. Staying up to date with your vaccinations can help protect you and your loved ones.

Whooping cough, also known as pertussis, comes as a vaccine in a combination with tetanus and diphtheria vaccines. The combo vaccination is known as tdap. Most people complete the initial series of vaccinations when they are young and the CDC now recommends a tdap booster every ten years for adults. Whooping cough can infect people at any age but those who are unvaccinated or are too young to be fully vaccinated are at most risk for serious complications, including death. It is important to make sure you are up to date with your tdap booster if you are spending much time around little ones as they most often contract the disease from a caretaker or family member. Expectant moms can get the tdap booster after the 20th week of pregnancy or may be offered it immediately after delivery.

Whooping cough is spread from person to person by respiratory droplets, such as through coughing and sneezing. Droplets usually don’t travel more than three feet so reasonably close contact is required. Initial symptoms are similar to that of the common cold: runny nose, sneezing, and a mild cough. The cough then worsens to bouts of spasmodic coughing sometimes followed by a deep forced inhalation which can sounds like a ‘whoop.’ This phase of coughing can last one to six weeks, though sometimes up to ten weeks. Being vaccinated reduces the risk of contracting whooping cough and can decrease the severity of symptoms. If you have close contact with some with a confirmed diagnosis of whooping cough please contact the office, prophylactic antibiotics may be administered regardless of vaccination status.

For more information visit http://www.cdc.gov/features/Pertussis/

Aerobic vs. Anaerobic Exercise

January 30, 2012

By: Shannon Feck, Personal Trainer

Fitness circles have historically tossed around the term “aerobic” in reference to a form of exercise, specifically cardio exercise. However, “aerobic” actually defines one of the two ways in which our bodies produce energy while exercising, the other way being an “anaerobic” process. The aerobic and anaerobic metabolic processes involve different types of exercise and provide different benefits for our health. In order to maintain a balanced approach to fitness, you should make sure to include both types in your weekly routine.



Our bodies produce energy aerobically, which means “with oxygen,” and anaerobically, which means “without oxygen,” during exercise. Aerobic metabolism occurs during endurance-minded exercise and involves slow-twitch muscle fibers. In order to produce energy for this type of activity, our bodies break down carbohydrates “with oxygen.” Once the carbohydrate or glucose supply diminishes, the oxygen in our bodies begins to use stored fat as fuel. Anaerobic metabolism occurs during activities involving short, powerful bursts of speed and utilizes fast-twitch muscle fibers. Different from aerobic metabolism, anaerobic metabolism uses glycogen from blood sugar to fuel our bodies instead of oxygen (www.livestrong.com).



The aerobic process occurs during activities that moderately raise the heart rate for an extended amount of time ranging anywhere from several minutes to several hours. Some examples of these activities include running, cycling, and swimming. For instance, depending on your fitness level, walking at 4.5mph for 30 minutes would be considered an aerobic activity. The anaerobic process happens when exercise is performed at a high rate of speed for a short period of time followed by a rest period. This type of exercise greatly increases your heart rate and includes things like strength training, weight lifting, and interval training while running, cycling, swimming, etc. For example, pick the quickest pace you can go for 30 seconds on a treadmill then switch to a moderate pace for 2 minutes. Alternating between these speeds in this manner is considered an anaerobic activity.  



The aerobic and anaerobic metabolic processes provide different, but essential benefits to our health. Exercise focused on the aerobic metabolic process, such as running or biking, increases heart health by lowering blood pressure and your resting heart rate. It also improves circulation and reduces the risk of cardiovascular disease. Activities involving the anaerobic metabolic process, such as strength training, help increase muscle strength and muscle mass, which helps the body to burn calories more effectively. It also improves bone density mass, thus aiding in avoiding fractures. Lastly, studies have shown that engaging in exercise involving both forms helps to improve mental health!


The best approach to your fitness health is a balanced approach that involves both low to moderate intensity and high intensity exercise regimens so that your body engages both aerobic and anaerobic metabolism. Come see us today at the Rittenhouse Women’s Wellness Center so we can help you achieve this balanced approach!

Winter Weather Health Tips

January 30, 2012

By: Amalia Krantz, Registered Dietitian

It’s February! The New Year is fully on its way and a whole month has gone by since we’ve all made those resolutions to eat healthier, lose some weight, and start exercising more. Now is a good time to check in on those goals and evaluate your progress. In the winter we tend to seek food that make us feel warm and comforted, but many of these can be high in calories and fat. This can also be a challenging time to keep up your good intentions to exercise, when it’s chilly outside and so much more tempting to stay cozy on your couch. Keep in mind eating well and exercising also helps to boost immunity and prevent illness during the winter months. With some planning and creativity, you can keep on top of your goals for keeping the weight off and staying healthy.

1. Work out at home – If it’s too cold outside for you to even think about going out to the gym, why not try a new exercise DVD, or pick up some weights. Put on some music and dance or do some good old fashioned jumping jacks. You can even download exercise videos online. Since you don’t have to even leave your living room, there’s no excuse for not working out.

2. Walk indoors – On a treadmill, of course, but if you don’t have one you can put on your sneakers and head to your local mall. Aim to walk 30 minutes to 1 hour, and to keep your heart rate up be sure to save any shopping errands for afterwards. Check with your mall to see if they open early for walkers or if they have any walking clubs.

3. Try a new indoor (or outdoor) sport – Volleyball and tennis are fun ways to stay active, and are not for the warmer months only. Indoor team sports will also help keep you motivated because you have people depending on you to keep the game going. And, since winter only comes once a year, take advantage of the activities of the season and go ice skating, snowboarding, or skiing.

4. Go shopping – for winter workout clothing! Invest in gear that is appropriate for exercising outdoors. If you are comfortably dressed for the weather, you will be more likely to get outside.

5. Supplement with Vitamin D – Shorter days and keeping indoors means less exposure to sunlight, which can lead to lower levels of Vitamin D production in your body.

6. Enjoy the winter harvest – While in summer we naturally think of fresh fruits and veggies, winter has its own gems when it comes to produce. Vitamin-rich fresh foods in season include beets, broccoli, brussels sprouts, citrus fruits, kale, kiwis, persimmons, sweet potatoes, winter squash, and turnips.

7. Sip a cup of cocoa – using skim milk and sweetened with half the sugar or a little agave. A hot cup of green tea also makes a soothing substitute when you start getting those candy bar cravings.

8. Eat whole grains and healthy carbs – These boost serotonin, the “feel-good” brain chemical that helps us beat the winter blues. Try whole grain breads, brown rice, and pasta, as well as sweet potatoes and pumpkin.

9. Warm up with soup – Broth-based soups chock full of beans and veggies are filling and satisfying on a cold winter’s day. A homemade soup using dried beans or lentils is easy to make. Avoid creamy soups which are high in fat and calories or canned soups which are high in sodium.


Tuscan Chicken, Bean and Spinach Soup

YIELD: 6 Servings COURSE: Soups/Stews Ingredients 1 tablespoon olive oil 1 tablespoon unsalted butter 2 garlic cloves, minced 1 cup cup chopped carrot (about 3 medium) 1 medium onion, chopped 1 1/2 cups sliced mushrooms (about 6 ounces) 2 cups chopped peeled butternut squash (about 1 3/4 pounds) 2 (15-ounce) cans cannellini beans, rinsed and drained 4 cups fat-free, less-sodium chicken broth 2 cups organic vegetable broth (such as Emeril's brand) 1 tablespoon Italian seasoning 3 cups cups shredded, cooked chicken breast 2 slices Applewood-smoked bacon, cooked and crumbled 10 ounces fresh spinach 1/2 teaspoon freshly ground black pepper 1/2 cup (2 ounces) grated fresh Parmigiano-Reggiano cheese Preparation 1. Heat oil in a Dutch oven over medium-high heat; add butter, stirring until melted. Add onion and next 4 ingredients (through garlic); cook 3 minutes, stirring frequently. Mash 1/4 cup beans with a fork. Add beans, broths, and Italian seasoning to pan; bring to a boil. Reduce heat and simmer 10 minutes or until vegetables are tender, stirring occasionally. Add chicken; cook 2 minutes or until thoroughly heated. Add black pepper and spinach, stirring occasionally until spinach wilts (about 3 minutes). Ladle about 2 cups soup into each of 6 bowls; top each serving with 5 teaspoons cheese and 11/2 teaspoons bacon.

Nutritional Information

Amount per serving Calories: 401

Saturated fat: 4.1g

Monounsaturated fat: 3.7g

Polyunsaturated fat: 1.2g

Fat: 10.7g Protein: 31.2g

Carbohydrate: 41.7g

Fiber: 9.6g

Cholesterol: 69mg Iron: 6mg

Sodium: 743mg

Calcium: 284mg (Nutrition Guidelines for Healthy Living Cooking Light MARCH 2009)

Top Ten Goals for Total Wellness

December 28, 2011

By: Jillan Rowbotham, D.O.

Consider making some of these goals the focus of your resolution for a healthier you in the new year.

Eliminate tobacco

If you don’t smoke, don’t start. “Social smoking” still counts as smoking; consider making this the last year you light up when having a drink. Even those occasional cigarettes add up over time. If you are not ready to quit right now at least pause to consider it – is there a goal time, even if it is far in the future, you would like to be quit by (ie your wedding or a child’s graduation)? What would change in your life if you were no longer smoking? Just thinking about quitting can bring you closer to being ready. If you are ready to quit and would like some help please come in and see us. Even if you aren’t able to stay quit you are still better off than if you didn’t try.

Increase your water intake

Most of us don’t drink enough water. The Institute of Medicine determined that adequate daily intake for a woman is 2.2 liters, which is just a little more than the classic “eight 8-ounce glasses” or 64 ounces. You need more when you are exercising, sick, pregnant or breastfeeding, or in a warmer climate. Staying well hydrated helps your skin and other important organs and can fight off fatigue and hunger. Count up the amount of non-caffeinated fluid you are drinking in a day – how close to 64 ounces are you?

Get enough sleep

Most adults need seven to eight hours of sleep, six is generally not enough. Getting a good night’s rest can help you function better in every aspect of your waking life. Cutting out some screen time or having the kids help more around the house can help get you into bed earlier. Make this the year you seek help if you suffer from chronic insomnia or anxiety that prevents you from getting sleep.

Moderate caffeine intake

A moderate amount of caffeine is 200 to 300 milligrams (mg) or about two to four 8-ounce cups of brewed coffee a day. Don’t forget to count caffeine in tea (black, green, or iced tea), soda, and hot chocolate. Because caffeine can interfere with your sleep cycle even if you do not have problems falling asleep, I recommend finishing your last caffeinated beverage at least eight hours before you go to bed.

Moderate alcohol intake

If you drink alcohol, do so in moderation. Moderate intake for a woman is one drink a day. One drink is considered 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor.

Be informed about what you are consuming

If you are not in the habit of reading food labels I highly recommend it. Many people underestimate calorie, fat, and sodium content and overestimate portion size. Even with reading individual labels it can be hard to keep track of your total consumption throughout the day. Keeping a food diary can make this easier and there are many websites and apps that make it less time consuming and more informative. Livestrong.com and Sparkpeople.com are two popular sites that also have phone apps.

Start moving

You don’t have to join a gym or start running marathons to be healthy. Take a class, do an exercise video at home, or walk on your lunch break. As a general goal you should aim for at least 30 minutes of physical activity every day but this can be broken up into three 10-minute sessions if you don’t have 30 minutes in a row available. Weight training is an important part fitness and weight loss plans. Meeting with a personal trainer can help you learn what weights and exercises will best help you meet your goals.

Manage stress

Stress symptoms can affect your body, thoughts, feelings, and behavior. Stress can cause many physical symptoms including headaches, digestive issues, chest pain, memory problems, and eczema, to name a few. Stress that is left unchecked can contribute to health problems such as high blood pressure, heart disease, obesity, and diabetes. Managing your stress is an important part of any healthy lifestyle. Regular exercise, particularly yoga and tai chi, getting enough sleep, practicing relaxation techniques, and maintaining a good social support system can help reduce stress. Many people benefit from professional counseling to find stress management strategies that work for them.

Stay up to date with routine screening tests

Depending on your age and other risk factors this may include PAP smears, mammograms, colonoscopies, cholesterol screening, etc. Not sure if you are due for anything? An annual physical provides a good opportunity to review current screening recommendations and get up to date.

Be an active participant in your health

Learn what you can about any health conditions you have and stay informed about what conditions run in your family. Know what prescriptions, over-the-counter medicines, and supplements you are taking and what they are for. Keep track of the dates of your most recent screening tests and any abnormal results. We are always happy to provide a copy of your labs to you and to go over anything you may have questions on – just ask!

Healthy New Year's Resolutions

December 27, 2011

By: Amalia Krantz, RD

Happy New Year everyone!  Since healthy eating resolutions are tops on many people’s lists, here are five tips to help you start off the New Year:

1.      Don’t go on a "diet" - Having a list of "forbidden" foods or a rigid diet plan makes you more likely to obsess about your food choices and feel guilty when you don't stick to it.  Sometimes, if you're in a diet mindset, just having dessert may make you feel bad enough to go off your healthy eating plan altogether. To feel your best and give your body the nutrients it needs, focus on eating more fresh, whole foods and less sugar and processed foods.  It's okay to eat the foods you love, as long as you have them in moderation and you watch your portions.

2.      Start small – Make realistic goals and make a reasonable plan to reach them. Doing too much too soon can make you feel overwhelmed and can lead to early burnout. If you've never exercised before, it's not realistic to say you're going to run every day. Start with a few days a week of walking first and then work your way up as you feel stronger.  If you want to cut down on the dessert you eat every night, try having it every other night to start, and then decrease by one night a week from there.

3.      Try a food diary - Make yourself more accountable and aware of what you eat throughout the day.  Pinpoint times when you seem to eat more, for example if you usually snack at work or attack the bag of potato chips late at night; or if you make it a habit to have seconds at dinner.  

4.      Portions, portions, portions! - Portion sizes are the key to losing and maintaining your weight.  It's easy to lose track of what an accurate portion size is nowadays, especially when you're eating out. Practice eating slowly and stopping when you are full.  Try taking a smaller portion than you usually would (eating on smaller plates also helps) or leave those last few extra bites instead of feeling obligated to finish everything on your plate.

5.      Eat out one less day a week - This will be beneficial for your waistline and your budget!  The best way to know what you are putting into your body is to prepare the food yourself.  The calorie counts for some restaurant foods may encompass more than half your daily requirements, and sometimes even dishes that are marketed as healthy are high in sodium and have hidden fats.  Grab a cookbook for quick dinner meals, make a meal plan and shop for the ingredients for the week to help you stay on track.  Also, pack your own lunch for work (or school) - it's an easy way to take control of what you eat at work, since ordering out can be tempting if you don't have anything planned. 


Stay positive - changes don't happen overnight.  If you have setback, just brush it off and keep going. Remember, healthy eating is for a lifetime.   When you make long-term health a priority over short-term weight loss goals, you'll be encouraged to do the best you can for your body. Don't give up and surround yourself with people who will support your goals. Have a happy and healthy 2012.

A Fitness Plan for the New Year!

December 27, 2011

By: Shannon Feck, Personal Trainer

Have you thought about the health and fitness changes you want to make for 2012? Instead of simply setting goals like losing weight or getting to the gym more often, think of your health like a business plan. Companies do not aimlessly go along hoping that profit margins will increase one day. They set specific goals and timelines defining what they want to do and when they want to get there; then they take action to make those happen. Here are some tips to help you develop your health and fitness “business” plan for the New Year!

Make your goals specific and measureable.

               When setting your goals, try considering all of the benefits that exercise can bring your life no matter how small the accomplishments might seem. Be specific and make sure your goals are measureable. If you want to lose body fat or weight, how much do you want to lose? If you would love to be able to do a push-up, how many? Instead of setting goals like “feeling” healthier or stronger, try defining them more concretely such as being able to walk up a set of stairs without feeling breathless or reducing the medications you take. By setting specific, measureable goals you can see exactly what you have improved upon, because a tangible start and finish exists.

Create a short-term and long-term timeline for accomplishment.

Once you have set your goals, develop a long-term timeline for accomplishing them. Which ones do you want to achieve in 3 months, 6 months, 1 year? Put your timeline on paper and make sure it is realistic. Once you have this big picture in mind, now you must decide the steps necessary to hit those marks. Spend some time creating daily and weekly short-term action plans, such as getting to the gym three times per week or taking time to stretch every morning after getting out of bed. These daily and weekly activities bridge the gap between today and your long-term timeline.

Know yourself and what you need.

                Half of the battle with reaching your goals is knowing yourself. Be honest with yourself and what it is that you need in order to succeed. If you are the type of person who cannot work out once you get home from the office, work around it. Instead of expecting that this will change, hit the gym before you get home or at lunch and get it out of the way. If you know you do not work as hard by yourself as much you would like, hire a personal trainer or take a class and let someone else push you.

Forgive yourself.

                Setting fitness goals and striving to meet them will positively impact your life, however you will experience bumps along the way. There may be some days that you miss your work-out or some days when you do not push yourself in the gym as much as you had intended. Know that this is okay from time to time and recommit yourself to your goals. Instead of beating yourself up for what you did not accomplish or how you failed, focus on the positives! Find small victories in what you have accomplished so far and continue to move forward!

Remember to enjoy the journey.

                You cannot know how far you have come until you know where you have been. Remember to look at each day as a new challenge while keeping your long-term vision on the horizon. Try not to look so far ahead that you lose sight of what you need to accomplish every day. Instead, master those baby steps along the way as they are your keys to success!!

We are here to support you in reaching your fitness goals at the Rittenhouse Women’s Wellness Center, and we wish you the best as the New Year approaches!

Healthy Holiday Alternatives

December 01, 2011

By: Amalia Krantz, RD

The holidays are a great time to be together with family and friends. It is also a time to enjoy all the delicious dishes and traditional foods that are only cooked but a few times a year. Healthy eating during the holidays can be challenging, especially when you are looking forward to enjoying your favorite dishes. However, there are ways to reduce the fat and calorie count in many of these foods without sacrificing flavor. Share the following tips with family and friends so you can all celebrate the gift of health at your holiday get-together. Not only will you feel better after eating these nutrient packed dishes, but you will also thank yourself for thinking ahead of the game and not making weight gain a holiday tradition as well.


Appetizers, although small by nature, can easily pack a calorie punch. Swap cheese and crackers, which are high in fat and sodium, for a piece of bruschetta with fresh vegetable toppings (try tomato and basil or roasted red pepper). Steer clear of any pastry based appetizers, such as pigs in a blanket or quiches, and fill up your plate instead with fresh or roasted veggies and low fat yogurt or hummus dips. To add some heart healthy fats, roast almonds or pecans with olive oil and a little salt. The protein and fat in a small serving of nuts also helps decrease hunger levels before the main meal.

Main Dishes

Soups are a great way to add variety and flavor to your holiday meal with minimal calories. Having a soup course before dinner tends to fill you up and makes you less likely to overindulge at dinner. Make sure the soup is broth-based rather than cream-based. Pureed vegetable soups that include butternut squash, pumpkin, or tomato rely on vegetables for their creaminess and so very little if any additional cream needs to be used. They are high in vitamins, minerals and fiber for added health benefits.

Here are a few ways to transform some of the most traditional holiday dishes (and ones that are traditionally calorie dense) to lighter, more nutritious fare.

  • Candied sweet potatoes – this dish is typically filled with sugar and butter. Instead try tossing root vegetables, such as sweet potatoes, carrots and parsnips, with a little extra virgin olive oil, maple syrup, and flavors like pumpkin pie spice and lemon and orange zests to allow the natural sweetness of the vegetables to shine through.
  • Green bean casserole – loaded with fat and sodium. Replace with steamed or sautéed green beans tossed with lemon juice, olive oil and toasted almonds.
  • Stuffing – instead of using butter and white bread, exchange most of the butter with low sodium chicken stock and switch to whole grain bread. Change up your grains and try using brown and wild rice or wheat berries instead. Add extra vegetables like chopped celery or mushrooms, and fresh herbs to flavor the dish. See this recipe for Wheatberry Stuffing with Apricots from GoodHousekeeping.com http://www.goodhousekeeping.com/recipefinder/wheatberry-stuffing-apricots-1150
  • Mashed potatoes – typically a fat overload. Mashed potatoes can be made just as creamy by using skim milk and a small amount of chicken stock or olive oil. Add roasted mashed cauliflower to add flavor and cut down on the calories.
  • Skip biscuits and use whole wheat rolls instead. Or, you may choose to skip the bread altogether.
  • Add more veggies and salads – Roasted brussels sprouts and carrots and sautéed kale or spinach are all great choices. Add fresh fruit in season like apples, oranges, pomegranates, or pears to salads.


  • Instead of pies or cakes, try poached fruit with low fat ice cream
  • Pumpkin custards skip the crust, which contains most of the fat in a traditional pie
  • Homemade hot chocolate with skim milk – use half the amount of sugar and skip the whipped cream

Enjoy your holiday meal!

Skin Cancer Signs, Symptoms, Causes, Treatments and Prevention

December 01, 2011

By: Marina Bachurina, MD

Dr. Bachurina is a board certified internist at RWWC . Prior to her internal medicine residency at Drexel's Easton Hospital, she was a Dermatologist in St. Petersburg, Russia.


Skin Cancer is the most frequently diagnosed type of cancer. It is usually caused by cumulative sun exposure. In its simplest form, the disease is the uncontrolled growth of abnormal skin cells.


Melanoma is the most dangerous type of skin cancer and the leading cause of death from skin diseases; it is not as common as other types of skin cancer, though the rate is increasing, especially in young people. People who are most at risk typically have fair skin, light eyes, light hair and a history of relatives diagnosed with Melanoma. Some common causes are living in sunny climates, spending a lot of time in strong sunlight, or having had one or more blistering sunburns during childhood. Another common cause is tanning. A weakened immune system, certain types of moles, or multiple birthmarks, can also be risk factors.


As a physician, I suggest checking your skin frequently, looking at the size, shape, color and texture of any suspicious areas. It is important to bring any changes or concerns to the attention of your physician. If a skin cancer diagnosis is suspected, a skin biopsy will be performed, and sent to the lab for further examination. Once melanoma has been diagnosed, CT scans or other types of x-ray tests may be done to see if the cancer has spread.

If you have had melanoma and recovered, it is very important to examine your body regularly for any unusual changes. Your risk for melanoma is increased once you have had this cancer. Melanoma may return years later.

For preventative measures, you should perform a self exam once a month, using a mirror to check hard-to-see places: call your physician at Rittenhouse Internal Medicine if you notice any changes. The American Cancer Society recommends professional skin examinations every year for people older than 40, and every 3 years for people 20 to 40. If you have a family history of melanoma, you will also need frequent skin exams. Most importantly, the best way to prevent skin cancer is to reduce your exposure to sunlight. When exposed, protect your skin with high-quality sunscreens, apply at least 30 min before exposure (even when going outdoors for a short period of time), use protective clothing and hats, and follow these guidelines in the winter too!


Working Out from the Inside Out

November 30, 2011

By: Ava Adames, Personal Trainer

As a personal trainer I naturally like working the muscles of the body and utilizing the functions of them. In fact, throughout my earlier days, I would create a favorite “muscle of the month” that I would choose to work on to find new exercises for muscle leanness. In those days it was largely about the bigger superficial muscles and less about the smaller supporting muscles. As I became more experienced as a trainer I began to have a deeper appreciation for those muscles groups that really stabilize and support the body from the inside out. Two internal muscles come to mind that are beneficial for the foundational and metabolic support of the body. These two muscles are the diaphragm and the pelvic floor. These two internal muscles of the body are big supporters of the respiratory system (diaphragm) and the endocrine system (pelvic floor muscles).

The Diaphragm Muscle

The diaphragm aids the body with breathing. This muscle is dome-shaped and is located between the breast and abdominal region of the body.

We contract the diaphragm to breathe in and out. When you breathe in, the diaphragm moves downward towards the abdomen and when you exhale the diaphragm moves upward towards the wall of the chest.

When the diaphragm is conscientiously stimulated through various breathing exercises it promotes good lung capacity and better circulation for the body. It can also aide in keeping various ailments at bay such as acid reflux.

Exercise systems that promote the use of the breath extensively would be yoga and Pilates. Most health professionals and body workers consider breathing an exercise in itself. Breathing exercises are highly beneficial to incorporate as a part of your weekly wellness regimen.

Exercise to try – Belly Breathing

1. Lie flat on your back to get a proper sense of deep breathing.

(Have some small pillows available to reduce strain by tucking them under the neck and knees. The natural course of breathing in that position will create a slight rise in the stomach upon inhaling and a slight fall upon exhaling).

2. Place your hands palm down on your stomach at the base of the rib cage (The lungs go that far down). What fills the lungs deeper with air is the pushing down of the diaphragm.

The diaphragm creates a suction which draws air into the lungs. The air is then expelled when the diaphragm pushes up. In this process, the life-giving oxygen fills the lungs and gets into the blood stream for distribution to the cells. Carbon dioxide is expelled from the blood into the about-to-be exhaled breath, thus cleansing the body and blood of waste products.

3. Lay the palms of your hands on your stomach just below the rib cage, middle fingers barely touching each other, and take a slow deep breath. (As the diaphragm pushes down, the stomach will slightly expand causing the fingertips to separate somewhat).

This movement indicates full use of the lungs, resulting in a truly deep breath rather than the “puffed chest” breath experienced by many as the greatest lung capacity.


The Pelvic Floor Muscles

The pelvic floor muscles are a group of muscles, nerves and fascia that are complex. These guys are found within the pelvic region of both men and women’s bodies that attach to the front pelvic bones of the body and the back of the coccyx.

The pelvic floor muscles have three main functions which are to support internal smooth muscle functions of the anus, to support and control the flow of urine through the bladder to help supply sexual function.

A loss in the support of the pelvic floor muscles is often common in more women than in men and at earlier stages in life. This is largely due to a woman baring multiple children.

When a woman is pregnant, the pelvic floor muscles can become strained over time due to the weight of the baby. For men pelvic floor concerns are attributed from poor prostate health which can result in a lack of urinal flow in older age.

However, certain exercises such as contracting and isolating the pelvic floor muscles can help tone and prevent the effects dysfunctions from happening or further increasing in both men and women. Exercise systems that support pelvic floor toning are Pilates and some forms of yoga.

Exercise to Try – The Kegal (for both men and women):

1. Find the right muscles. The next time your body requires you to urinate try to stop the flow of urine. If you succeed, you’ve found the pelvic floor muscles. Don’t make a habit of starting and stopping your urine stream, though. Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles, as well as lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.

2. Perfect your technique. Once you’ve identified your pelvic floor muscles, empty your bladder and sit or lie down. Contract your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

3. Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.

4. Repeat three times a day. Aim for at least three sets of 10 repetitions a day. You might make a practice of fitting in a set every time you do a routine task, such as checking email, commuting to work, preparing meals or watching TV.

Which Over the Counter Medication Best Suits Your Needs?

October 28, 2011

It is never a good time to get sick but unfortunately the cold and flu season is once again squarely upon us. The common cold lasts an average of seven to ten days and usually starts with a sore throat and possibly low grade fever, then progresses to nasal and sinus congestion. Finally, a cough, sometimes productive of mucus, is usually the last symptom to develop and the last to resolve. There is not yet a cure for the common cold and antibiotics not only won’t help but increase the risk of allergic reactions, side effects, and development of resistant bacteria. Plenty of rest and fluids is a mainstay of treatment but there are also many medicines available over-the-counter that can help make things a little more manageable - the key is picking the right medicines for the symptoms you are having.

Over-the-counter cold preparations are confusing with endless combinations of medicines and claims to alleviate certain symptoms. The best approach to selecting the most helpful one is to understand what active ingredients are in each pill and what they are expected to treat. This can help you tailor what you are taking to your current symptoms and limit side effects.

Dextromethorphan, also termed as “DM”, is a cough suppressant that acts directly on the cough center in the brain. It comes as a liquid cough medicine or as a pill. In some studies two teaspoons of honey were shown to be just as effective for reducing nighttime coughing.

Guaifenesin works by thinning mucus or phlegm. This can be helpful if you are having a lot of post-nasal drip (mucus down the back of your throat, clearing your throat a lot), or are coughing up mucus. It should be taken with plenty of water.

Oxymetolazone is a nasal spray also sold under the brand name Afrin. It can give you quick relief from nasal congestion but it cannot be used for more than 72 hours or 3 days in a row. If used longer than that it can actually cause worsening congestion. I like to use Afrin for those nights when you simply cannot breathe out of your nose and the misery of that keeps you from sleeping. It also can be helpful if you are congested before plane trips to help your ears equilibrate to pressure changes.

Pseudoephedrine is a very effective decongestant that is sold behind the pharmacist’s counter though you do not need a prescription for it. You will need to show identification to purchase it and are limited to the quantity you can buy at one time. It is the “D” component in Mucinex –D, Allegra – D, etc. Decongestants relieve nasal stuffiness by narrowing blood vessels and reducing swelling in the nose. This narrowing can affect other blood vessels as well, which can increase blood pressure. This medicine is not a good choice for people with heart disease or poorly controlled high blood pressure. Some people cannot take pseudoephedrine because it makes them feel jittery, spacey, or gives them palpitations. It comes in a 4-6 hour preparation or a 12-hour preparation. Until you know how it affects you I recommend the shorter lasting form.

Pharmacies tend to be sold out of it often during the height of cold season so I like to make sure I always keep some on hand.

Phenylephrine is the decongestant that is sold in the pharmacy shelves and can be a good choice for people who do not like the way pseudoephedrine makes them feel. Some feel it is a less effective decongestant.

Navigating the Nutrition Facts Label

October 28, 2011

Understanding how to read a food label is one of the most important tools we, as consumers, can have under our belts. With a barrage of statements such as “low fat,” “healthy choice,” “natural,” “organic,” or “no sugar added” messages on labels, deciphering which choice is the best can be a difficult one.   The nutrition facts label can help you make a more informed choice about the foods you choose to eat. You can use this label to determine whether a food is a good source of fiber, calcium, iron or vitamins A & C, whether or not a food is high in fat, sodium and cholesterol or to compare similar foods to see which one is lower in total calories and fat.

The first place to start on the nutrition facts label is the serving size and the number of servings provided in the entire package. Compare the serving you are going to have to the recommended serving size. If you consume the actual serving size you can use the rest of the information on the nutrition facts label as displayed. If you consume double or triple the serving size you will need to multiply each nutrient on the nutrition facts label accordingly. For example, in the label shown below, the serving size is 1 cup. If you had double that amount – 2 cups - multiply each of the nutrients listed by 2 (intake would be 500 calories, 24 grams of fat, 940 mg sodium, etc).  

After looking at the serving size, look at the calories provided in that serving or in the number of servings you are planning to eat. Then look at the calories from fat that are provided. Limiting the amount of high calorie and high fat foods in your diet can help maintain an appropriate weight and prevent weight gain – try to keep these numbers low!

The next place to look on the label is the nutrients listed below the calories – fat, saturated fat, trans fat, cholesterol, sodium, dietary fiber, vitamins A & C, calcium and iron. For the most part, Americans eat too much fat, saturated fat, trans fat, cholesterol and sodium and these are the nutrients you will want to limit, as they can increase risk of chronic diseases. The other nutrients listed – fiber, vitamins A &C, calcium and iron - are generally limited in the typical American diet and are the nutrients that can actually help improve your health and reduce risk of chronic diseases. Use the Percent Daily Values (% DV) to determine whether or not a food is high or low in any of these nutrients. A general guide is: 5% or less DV is considered low – look for foods that are low in total fat, saturated fat, cholesterol and sodium; 20% of more is considered high – look for foods that are high in fiber, vitamin A & C, calcium and iron. Looking at the label below, macaroni and cheese is high in the nutrients fat, saturated fat, sodium, and calcium and moderate in cholesterol. It is also low in dietary fiber, vitamin A, vitamin C, or iron.   The % DV’s are based on a 2,000 calorie/day diet. You may need more or less calories each day depending on your gender, age, physical activity level and weight goals.

Using these tips in conjunction with healthy eating habits and portion control will help improve your diet on a day-to-day basis. It can also make navigating the grocery store a more simple and enjoyable experience, knowing that you are able to make the best choice for your dietary needs.

Spot Training – Is There Such A Thing?

October 28, 2011

With the surging interest in body creams, surgical procedures, and exercise gadgets out there professing to eliminate fat in specific parts of the body, such as thighs or under the arms, it is no wonder that clients come to personal trainers and exercise specialists expecting to “correct” their problem areas. Exercising a specific area of the body with the expectation that this will eliminate fat in that particular location is called Spot-Training. Spot-Training does not take into account a person’s scientific make-up, and it is virtually impossible to eliminate fat in a specific area of the body with an exercise-only strategy. To combat these problem areas, other factors must be considered and addressed along with fitness, such as hormonal imbalances and diet.

Every person’s genetic make-up is different, and exercising (whether cardio, strength training, etc.) burns fat in places where a person’s physiological make-up dictates that it burns fat first. For instance, in 1984 a study was performed with 13 male subjects who completed a total of 5000 sit-ups over the course of 27 days. At the end of the study, scientists took measurements to examine how much fat was lost and where it was lost. If Spot-Training existed, it would make sense that these men would lose all the fat in their abdomens. In actuality, they lost fat equally from three measurement sites: glutes, upper back, and abdomen (Katch, F.I., P.M. Clarkson, W. Kroll, et al). In another study, a group of women doing mostly leg exercises for nearly 9 hours each week lost an average of 5.7 pounds. However, none of this weight came off of their legs; instead, 2.9 pounds came from their trunks and 2.8 pounds came from their arms (Nindl, B.C., Harman, E.A., Marx, J.O., Gotshalk, L.A., Frykman, P.N., Lammi, E., Palmer, C., & Kraemer, W.J.). Both of these studies demonstrate that regardless of the type of exercise performed, fat is lost throughout the body and not just in the particular area an exercise may focus on.

While exercising properly is a highly important part of staying healthy and lean, it is not the only factor to consider when trying to lose fat in certain areas of the body; diet and balancing hormonal levels plays a major role in the storage of fat as well. According to Charles Poliquin, a world premier Strength Coach who has worked with Olympic athletes, carrying fat in certain areas directly correlates with certain hormones. For instance, a large amount of fat in the triceps relates to the hormone, androgen, whereas a significant amount of fat in the hips relates to insulin levels. If a client carries fat in her glutes, estrogen levels may be out of balance. These hormonal imbalances can be addressed through a proper nutrition plan.

In order to properly address those problem areas that clients want to correct, an approach that combines exercise, assessing any hormonal imbalances, and creating a proper dietary plan specific to a client’s needs is key. This total body approach which includes output (i.e. exercise) and input (i.e. nutritional intake) speaks to the core of our philosophy of total wellness at Rittenhouse Women’s Wellness Center. Please contact us to set up your fitness appointment so you can get started today with a plan specifically tailored to fit your fitness and dietary needs and goals!!

Functional Exercise: A Total Body Approach

September 29, 2011

Aristotle once said, “The whole is more than the sum of its parts.” Applied to fitness, exercise should focus on enhancing one’s total health, not simply aesthetics. To achieve total health, you must first understand that the human body exists and moves through three dimensions. Instead of dividing the body into individual elements by focusing on exercising specific muscle groups, you should add a Multi-Planar approach and incorporate Functional Movements into your routine. By taking this approach one can better improve strength, joint integrity, coordination, and thus, total health.


The body does not move one-dimensionally; rather it moves three dimensionally in the Frontal (coronal), Sagittal, and Transverse planes. The Frontal plane divides the body from front to back, the Sagittal left to right, and the Transverse from top to bottom. Here are some examples of exercises in each plane:


Frontal : Shoulder Press                                                                                                        

Sagittal: Chin-Ups                                                                                                                    

Transverse: Bench Press


As a trainer, I observe many fitness routines that include exercises in one or two of the planes but not all three. Not only can this produce an unbalanced musculoskeletal structure, it can also lead to overuse injuries.


In order to maintain a balanced approach to total health and avoid injury, you should introduce Multi-Planar, Total Body Functional Movements to your routine. Total Body Functional Movements train muscles in a way that “makes everyday activities easier, safer and more efficient and improve a person’s ability to function in the real world” (Kennedy, Carol. “Functional Exercise Progression.”) For instance, performing a Lunge together with a Dumbbell Bicep Curl is a Total Body Movement because it involves the upper body, lower body, and core; it is also Multi-Planar because it requires work in the Frontal, Sagittal, and Transverse planes. Because of the complexity of this move, a higher demand is placed on the neuromuscular system, which more effectively improves overall strength and coordination than if the exercises were performed independently of each other. We would love to help you enhance your work-outs! Give us a call to set up a fitness appointment so you can learn how to start adding these Multi-Planer, Total Body Functional Movements to your routine today!

Can Convenience Foods Be Nutritious?

September 29, 2011

We like everything in life to be quick and easy--immediate gratification. The same is true of our meals; we need foods/meals that are quick to pack those early morning lunch bags and throw together those busy work-week dinners. So is it possible to have a wallet-friendly, convenient, nutritionally balanced meal for the whole family? Food companies are constantly coming out with quick food options that are registered dietitian approved.

     Convenience foods have a track record of being loaded with sodium, fat, sugar and low in fiber and vitamins/minerals. In addition, they are notoriously associated with being overly processed. However, below is a variety of healthful foods that are convenient.

  • Low-sodium jarred pasta sauce paired with whole wheat pasta
  • Canned beans- black, pinto, navy, red, or garbanzo can be cooked in minutes
  • Low sugar instant oatmeal travels well, keeps you full and is especially good in the winter
  • Frozen veggie burgers-quickly pan cooked with olive oil on a whole wheat bun
  • Individual cups of hummus-High protein and perfect for lunch bags, can dip with veggies

Some foods that are convenient are not always processed and can be good time savers:


  • Dried fruit—cranberries, raisins, and mangos can be put in oatmeal, yogurt or eat alone for a great, fibrous snack.
  • Pre-made, packaged whole wheat pizza crust—add low fat cheese, tomato sauce and some sliced veggies for a healthful pizza.
  • Precooked shrimp
  • Bagged Spinach for salads
  • Nuts
  • Cubed or string cheese

Convenience Tips:


  • Do not be afraid of frozen meals. Choose lower sodium meals with large servings of vegetables. Often they can be more healthful than meals you might cook at home.
  • Purchase a grill pan—It is a quick way to cook, reduces fat content while cooking and makes for easy clean-up.
  • Join an organic food co-op- Members share the cost of weekly organic foods that can be delivered to their house.

The Importance of Vitamin D

September 06, 2011

Vitamin D has been in the news a lot lately. It plays a major role in calcium absorption but recent research suggests it may do much more. Scientists have discovered vitamin D receptors on almost all tissues of the body meaning it may have a much larger effect on our health and development of disease than previously thought. This discovery has prompted increased interest in vitamin D and lots of buzz in the media about the potential benefits. First, it is important to understand where vitamin D comes from and if you may be at risk for deficiency. 

Vitamin D is the only vitamin that is also a hormone. It is sometimes called the “sunshine” vitamin because it is synthesized in the skin from direct exposure to ultraviolet B rays. This process requires direct sun exposure; indirect rays or light through a window does not contribute. Ten to 15 minutes of sunshine three times a week can be sufficient to prevent deficiencies. Your body’s vitamin D production can be hindered by being further from the equator, air pollution, cloud cover, and sunscreen use.

If you have been told your vitamin D levels are a little low don’t worry – you are in good company. A lot of women in our area have insufficient or deficient levels of vitamin D. This could be due to our latitude, responsible use of sunscreen to protect our skin, tall city buildings blocking direct sun rays, and working long hours inside. Other risk factors for low levels of vitamin D include advanced age, obesity, and having darker skin.

Vitamin D also occurs naturally in a few foods such as fish, oysters, and eggs. Because of this limited representation in the typical American diet, many foods are fortified with vitamin D. Vitamin D is often added to milk and other dairy products, soy milk, and breakfast cereals. Sometimes this is not enough and you may need to add a vitamin D supplement. Recommended daily value for adults under 70 is 600 IU a day; those over 70 require around 800 IU a day. You may be directed by us to take a higher dose for a period of time if your levels are low. Safety research supports an upper limit of a dose of vitamin D to be 10,000 IU daily. This does not mean that you should take 10,000 IU a day but that doses above that may be harmful. A dose of 1,000 to 2,000 IU a day is much more reasonable. If you are purchasing a vitamin D supplement look for vitamin D3, or cholecalciferol, over vitamin D2, ergocalciferol.

We have known for some time about vitamin D's role in helping the body absorb calcium, in maintaining bone density, and in preventing osteoporosis. New research suggests it may also help protect against chronic diseases such as certain types of cancers, cardiovascular disease, high blood pressure, autoimmune diseases, and mood disorders. It is important to remember that further research is needed in these areas to confirm these associations and determine what the role of supplementation might be. There is a lot more work to be done in this area and taking mega-doses of vitamin D is not recommended and may be harmful.

Muscle Confusion: Why Changing Your Fitness Routine Is Important

September 06, 2011

As a personal trainer, I hear clients tell me all the time that they started a new work-out routine and saw improvements in strength, energy levels, and overall fitness during the first 4-6 weeks. However, after performing the same routine past this initial period, they notice they are no longer seeing results and express frustration at the lack of progress. The client has hit a plateau, and this phenomenon is one of the most significant reasons why people give up exercising. In order to avoid this common pitfall, it is important to understand how to continually alter your fitness routine by applying the principle of Muscle Confusion.


Muscle Confusion, sometimes more properly called Periodization, is essential if you want to make continual gains in your muscle composition and strength, which in turn will increase resting metabolism and decrease body fat. The human body is quite skilled at adapting to its surroundings and by performing the same exercises at the same amount of weight and with the same number of repetitions during every workout, your muscles become accustomed to the workload and simply maintain rather than improving. According to the “Fitness Professionals Handbook,” Muscle Confusion or Periodization is “nothing more than a systematic variation in a resistance training program.” Basically, in order to see peak results you need to change your workout program regularly so your muscles do not have time to adapt to the work you put them through.


So how do you keep your muscles guessing?! Here are some easy ways to alter your workout routine:


     1)Increase Intensity – Some examples of this include increasing the amount of weight you’re lifting, keeping the same resistance but increasing the number of repetitions, and/or reducing rest time between sets.


      2)Change Exercises – Don’t perform the same exercises all the time and make sure your muscles are experiencing a wide array of activities


      3)Switch Equipment – Instead of a Bicep Curl with dumbbells, try a Bicep Curl with a resistance band or try a Push-up with your own body weight versus a Chest Press with a barbell.

     4)Vary The Days You Work Muscle Groups – If you work out your Lower Body and Abs on Monday, Chest and Triceps on Wednesday, and Back and Biceps on Friday, try to switch up the days you work these muscle groups. For instance, try Chest and Triceps on Monday, Back and Biceps on Wednesday, and Lower Body and Abs on Friday.

     5)Change The Order Of Exercises – Perform the same routine for a few weeks, however switch up the order in which you perform those exercises during your routine.

Not only does Muscle Confusion help you build lean muscle mass and improve strength, it also helps prevent you from getting bored doing the same routine several days a week! If you need assistance in introducing this principle into your workouts, contact us to set up a Personal Training appointment as we are always here to help!  


Filling Up on Fiber

September 06, 2011

Think you should be eating more fiber? You’re probably right. The average American gets about 15 grams of fiber each day, which is 10 grams less than the recommendation for women and 23 grams less than the recommendation for men. This translates into about 25 grams/day for women and 38 grams/day for men aged 19-50 years. Fiber is found in all plant food sources, such as vegetables, fruits, legumes, nuts and seeds. It is the part of the plant that your body cannot break down and does not digest. Fiber plays an important role in digestion by promoting normal bowel movements and relieving constipation. It also keeps you healthy by reducing the risk of certain diseases and conditions, such as heart disease, type 2 diabetes, and diverticulitis (inflammation of the intestine). It is classified into two different categories: soluble fiber and insoluble fiber. Soluble fiber partially dissolves in water, while insoluble fiber does not dissolve at all. Soluble fiber is found mainly in oatmeal, psyllium, nuts and seeds, legumes, beans and peas, lentils, apples, pears, and strawberries. Soluble fiber forms a gel when mixed with water in the stomach and small intestine. This type of fiber has been associated with lowering low-density lipoprotein (LDL) or “bad” cholesterol and can help reduce inflammation and blood pressure. Soluble fibers can also help slow the absorption of sugar during digestion, which can help keep glucose levels normal in people with type 2 diabetes. Insoluble fiber is found in whole-wheat flours and bread products, barley, couscous, brown rice, bulgur, whole grain cereals, wheat bran and seeds. Insoluble fiber helps moves food along in your digestive tract and adds bulk and softens stool, which can help in relieving constipation. A diet high in fiber has also been associated with weight loss and maintenance. Think about it? Foods high in fiber take a longer time to chew, which gives your body more time to register when it is actually full. It makes a meal feel more filling and slows digestion so that you feel fuller longer. High fiber foods also tend to be nutrient rich and energy dense – so you’re getting more food for fewer calories!Adding extra fiber to your diet is not difficult. Remember, however, if you are planning on increasing the fiber in your diet, start slowly. Add more high-fiber foods over the course of a couple weeks – try by starting to add more fiber to one of your meals each day. If increased too quickly, you may experience some intestinal gas, bloating and cramping. Adding it in slowly gives your gut bacteria a chance to adjust to the change. And remember, whenever you increase your fiber intake you should also increase your water intake, as fiber absorbs water. In order to achieve the greatest benefits, eat a wide variety of high fiber foods. Avoid refined or processed foods (canned fruits and veggies, pulp free juice, white breads and pastas, non whole grain cereals), as the processing has stripped the foods of most its original fiber content. Choose whole fruits and vegetables rather than consuming fruit and vegetable juices. Make the majority of your grain choices whole wheat or whole grain (look for the first ingredient to be either one of these choices). Increase your intake of raw vegetables for snacks and eat more vegetarian dishes, substituting vegetables and legumes for meat more often.

Fiber content of select foods
Almonds – 1 ounce, 3.5 grams of fiber
Apple, with skin – 1 medium, 4.4 grams of fiber
Artichoke, cooked – 1 medium, 10.3 grams of fiber
Banana – 1 medium, 3.1 grams of fiber
Barley, cooked – 1 cup, 6 grams of fiber
Black beans, cooked – 1 cup, 15 grams of fiber
Bran flakes – ¾ cup, 5.3 grams of fiber
Broccoli, boiled – 1 cup, 5.1 grams of fiber
Brown rice, cooked – 1 cup, 3.5 grams of fiber
Brussels sprouts, cooked – 1 cup, 4.1 grams of fiber
Carrot, raw – 1 medium, 1.7 grams of fiber
Lentils, cooked – 1 cup, 15.6 grams of fiber
Pear (with skin) – 1 medium – 5.5 grams of fiber
Peas, cooked – 1 cup, 8.8 grams of fiber
Popcorn, air popped – 3 cups, 3.5 grams of fiber
Raspberries – 1 cup, 8 grams of fiber
Rye bread – 1 slice, 1.9 grams of fiber
Spaghetti, whole-wheat, cooked – 1 cup, 6.2 grams of fiver
Split peas, cooked – 1 cup, 16.3 grams of fiber

How easy is it to get to 25 grams of fiber/day?
Breakfast: ¾ cup bran flakes with skim milk and 1 sliced banana (8.4 grams fiber total)
Snack: 1-cup raspberries (8 grams fiber total)
Lunch: Turkey on 2 slices rye bread with light mayonnaise, tomato slices and lettuce. ½ cup baby carrots (5.5 grams fiber total)
Snack: 3 cups air popped popcorn (3.5 grams fiber total)
Dinner: ½ cup brown rice, 1-cup teriyaki broccoli, 4 oz pork chop (7 grams fiber total)
Total for the day: 32.4 grams (12.4 grams over the recommendation for women!)

BMI vs. Body Fat Percentage

July 31, 2011

How many times have you said to yourself, “I want to lose weight?” You start an exercise routine or intensify a current routine in order to shed pounds, rather than focusing on changing your actual body composition. Losing weight will simply reduce your BMI, but decreasing your Body Fat Percentage should be the main focus.

BMI, which stands for Body Mass Index, measures whether a person is healthy, overweight, or underweight. To calculate your BMI, use the following formula:

Weight (in pounds) x 703

Height (in inches)²

The following table displays BMI ranges:


Weight Status

Below 18.5


18.5 – 24.9


25.0 – 29.9


30.0 and Above


BMI can often be misleading. For instance, a female athlete whose body is mainly composed of lean muscle mass and whose weight may be “high” due to her body composition could find that her BMI falls in the Obese range. On the other hand, someone whose BMI falls within the Normal range can still have a high percentage of fat mass, which indicates poorer health. This is why Body Fat Percentage better indicates overall health.

Body Fat Percentage measures the amount of fat that makes up your body. There are several ways to determine this, such as handheld devices and skin caliper testing. In order to calculate pounds of fat mass, multiply your total weight by your Body Fat Percentage; the rest of your weight is lean tissue. For instance, if someone weighs 150 pounds and has a Body Fat Percentage of 20%, she carries 30 pounds of fat and 120 pounds of lean tissue mass on her frame. The following ACSM (American College of Sports Medicine) chart describes Body Fat Percentage ranges for females based on age:


Fitness Category







Well Above Average

14.5 - 18.9

15.5 - 19.9

18.5 - 23.4

21.6 - 26.5

21.1 - 27.4


Above Average

19 – 22

20 - 23

23.5 - 26.3

26.6 – 30

27.5 - 30.8



22.1 - 25.3

23.1 - 26.9

26.4 - 30

30.1 - 33.4

30.9 - 34.2


Below Average

25.4 - 32

27 - 32.7

30.1 - 34.9

33.5 - 37.8

34.3 - 39.2


Well Below Average






When trying to lose weight, keep in mind that it’s more important to pay attention to how much body fat you’re losing rather than focusing solely on what the scale says! Ask a fitness professional to measure your Body Fat Percentage every 4 weeks to track your progress!  

Protecting Your Skin in the Sun

July 31, 2011

No matter how diligent I try to be about applying sunscreen I always seem to end up with a burnt patch. I miss a spot, wash it off (the back of my hands and forearms are common causalities), or get caught up in the activities of the day and forget to reapply. Though new labeling guidelines starting next year will help us form a better understanding of what our sunscreen is and isn’t doing for us, sometimes the best option to protect our skin is to keep it covered up. But not all clothing is created equal.

The degree of protection clothing offers you is designated by a UPF rating, or Ultraviolet Protection Factor, a measurement of the amount of UV radiation the fabric prevents from reaching your skin. A UPF of 30-49 is considered very good protection, 50 and above is considered excellent by the Skin Cancer Foundation. Tightly-woven dark-colored fabric offers the most protection from the sun. Light colors, tight fitting items where the fibers are stretched, and wet clothes offer less protection. A white T shirt has an average UPF of 7, this goes down to only 3 when it is wet. If you can see through a fabric when you can hold it up to the light, then UV rays can get though to your skin. A good choice for a beach cover up would be a long-sleeved, dark denim shirt which has an average UPF of 1,700. You can also buy clothing specially treated with a chemical sun block to provide more protection, look for UPF labeling on these garments.

If dark denim is not the beach look you are going for this year, a wide-brimmed hat can offer protection roughly equivalent to an SPF of 5 for your face, ears, and neck and looks very chic paired with dark over-sized sunglasses. Look for a brim 3 inches or wider.

Clothing and accessories should be used to augment, not replace, the protection provided by sunscreen. You should still regularly use a sunscreen with SPF of 15 or higher and try to remember to reapply often.

For more information on new sunscreen labeling guidelines that will take affect summer 2012 visit www.fda.gov/sunscreen.

Tips to Help Prevent Osteoporosis

July 31, 2011

A diet that contains enough calcium, vitamin D, and other vitamins and minerals is key to maintaining bone health and preventing osteoporosis.  Eating a diet that follows MyPlate will help assure that your bones will be strong and healthy.

     In order to ensure the absorption of calcium in the body, it’s also important to consume enough Vitamin D. Imagine Vitamin D is the key that unlocks the door to let calcium into your cells for absorption. The RDA for Vitamin D is about 600 to 800IU’s daily. Foods that contain Vitamin D include fortified milk and bread products, fish such as salmon, mackerel, sardines, and tuna.

     Vitamin D can also be obtained from sun exposure, because it is made in the skin. Sun exposure of about 10−15 minutes at least two times weekly to the face, arms, hands, or back without sunscreen is enough to provide adequate vitamin D.

     Calcium absorption can also be affected by phytic or oxalic acid found in some high-calcium foods. These foods can bind calcium and may decrease the amount of calcium absorbed. These foods include: Spinach, collard greens, sweet potatoes, rhubarb, and beans.

Calcium Rich Food Sources:

Plain, Non-fat yogurt—340mg for 6oz

Ricotta Cheese, part skim—335mg for ½ cup

Fat-free/skim milk—306mg for 1 cup

Feta Cheese—210mg for 1.5oz 

Can I get enough Calcium without consuming dairy products?

      The answer is Yes!! With a little extra effort a vegetarian/pescatarian/vegan or lactose-free diet can provide enough calcium on a daily basis. As women we need at least 1,000-1,300mg of calcium on a daily basis to fortify our bones throughout our entire lives and prevent osteoporosis.

     Calcium sources not from dairy products: Many vegetables are good sources of calcium, including:

Broccoli—45 mg for ½ cup (C), cooked

Kale—100 mg for ½ C, cooked

Spinach—120 mg for ½ C, cooked

Pinto beans—about 45 mg for ½ C

Kidney beans—about 40 mg for ½ C

Fortified ready-to-eat cereals—about 250mg for 1 oz

Soy Beans—130mg for ½ cup

In addition, calcium fortified foods are a great idea such as soy milk, orange juice, tofu, cereal and bread. Each serving of these foods has approximately 200-300mg of calcium, but check the nutrition label for exact calcium content.

Healthy Eating at Summer Parties

June 29, 2011

Summer is here and it’s time for outdoor parties and BBQs. While lots of fun and a summer tradition, these parties can often be a challenge for those who are trying to make healthier eating choices. Here are a few tips to keep your healthful eating on track and still enjoy your summer parties:

1.Italways recommend that people have something to eat before attending social gatherings where there may be enticing foods. Many of these foods may be the kinds of choices that you would not normally include in your own healthy meal plan, which may makes them seem even more tempting. You don’t want to arrive at the party hungry, as your first instinct may be to head straight for the buffet table. Have a substantial snack 1-2 hours before the party, focusing on high fiber foods such as a small bowl of oatmeal and skim milk, an apple with peanut butter, or low fat yogurt with nuts and fruit. That way you have already taken the focus off the food before arriving and will be able to make better choices once you are there.

2.Always make it a point to sit down when eating, if possible. Eating while standing up, especially around the buffet table, can lead to greater intake and larger portions than if you were to eat sitting down. Try to find an area to comfortably enjoy your meal, rather than walking around and continually grazing.

3.If possible, bring a healthful side dish that that fits into your meal plan. It’s okay to let your host know that you are making healthy changes to your eating habits (it may even encourage them to offer more healthy dishes themselves!). Most times, those hosting a party would be delighted to have others contribute by bringing their own dish. Make a whole grain pasta salad or hummus dip with veggies (see recipe below for a great summer side dish).

4.Plan ahead of time how many alcoholic beverages you are going to have, if any, and stick to that goal. Alcohol contributes empty calories that can add up quickly. Also, choose low calorie mixers, such as seltzer water and diet beverages. Stick with water instead of sodas and fruit drinks, which can also add more unnecessary calories.

5.Make one plate and don’t feel like you have to try everything. Remember the plate model and portion sizes – aim for 50% of your plate to be fresh or cooked vegetables or fruits – this does not mean potato salad or coleslaw drenched in mayo. Opt for raw vegetables with a little bit of low fat dip, salads, or vegetables from the grill such as: corn, zucchini, or Portobello mushrooms. The other 25% of your plate should be a lean protein and the rest preferably should be a whole grain.

6.Focus on friends rather than food. Talking and catching up with friends (away from the buffet table) is a great way to enjoy the party, leaving the focus away from the food.

7.Make this one of your exercise days to offset the extra calories you may be eating. If there are any type of games at the party, join in – even something as simple as playing horseshoes can burn some extra calories.

8.Opt for fruit for dessert – or pick one dessert to sample and have a small piece of it. It will be much more satisfying than trying to sample a small bite of every single dessert there.

9.Go in with a game plan and try to stick to it as best as possible. You may hit all your goals or you may miss a few, but if you don’t manage to do everything you wanted to do, don’t be disappointed in yourself and then give up on your healthy eating plan. Make notes of what your had trouble with and look them over before the next party. You will be more likely to overcome them in the future than if you punish yourself for not doing everything you expected.

Super Simple Hummus Dip


2 cans chick peas, drained and rinsed

Juice and zest of 1 lemon

¼ cup extra virgin olive oil

¼ cup water

½ teaspoon salt

¼ to ½ teaspoon red pepper flakes

¼ cup finely chopped parsley



1.Combine chick peas through red pepper flakes in a food processor. Blend until smooth.

2.Stir in parsley and spoon into serving dish. Sprinkle with a little paprika to garnish. Serve with raw veggies for dipping, such as carrots, celery, and bell peppers.


Maintaining Your Fitness Routine While on Vacation

June 29, 2011

Summer is here, which means that many of us will be taking time away from work to relax, recharge, and explore somewhere new and exciting. Whether you’re headed across the globe or just a car ride away, taking a vacation means that your typical routine is shaken up a bit. While this may do wonders for your frame of mind, it often means that your workout schedule suffers as a result.

1: Try to find a hotel or other lodging situation with a gym or fitness room. While this may not be up to par with what you use at home, even a small space with treadmills, exercise balls and free weights can be enough to help keep you fit while you’re away. Many hotels and motels, even lower-budget ones, includes some sort of workout facility available to use for their guests. Spending a little bit of time there every day will ensure that you don’t fall off the fitness wagon while you’re enjoying your trip.

2: Swimming is a wonderful and relaxing way to burn calories and build strength. Doing laps in the hotel pool or going for a dip in the ocean will complement any other form of exercise in which you partake during your vacation.

3. Walking on the beach also burns more calories than walking on flat ground. (Some experts suggest that you can burn twice as many calories walking in soft sand!). Grab some water and go for a stroll – you’ll be surprised at the resistance sand offers.

4. Bringing along a few workout DVDs to play on your computer or television is a safe way to be certain that you’ll be active- even in the potential absence of a gym or pool, or in the event of bad weather. This way, you can spend free hours in your room ensuring that you stay toned and energized. DVDs are much easier to pack than other workout materials, and don’t require extra time or travel to access.

5. Exploring your vacation area on foot, walking to and from meals, and going for hikes is not only a great way to take in your new surroundings, but it helps to offset any extra calories you might be eating. Find walking paths or ask the front desk of your hotel where the best places are for walks, hikes, and strolls.

Taking Care of Your Skin this Summer

June 29, 2011

The heat and humidity of summer can wreak havoc on your skin. Increased exposure to the sun leads to sunburns and soreness in the present and can be a cause for wrinkles, toughness, and potentially deadly skin cancers in the future. Humid air creates the right conditions for acne and oily skin. Despite all of this, your skin need not suffer as a result of the weather.

Sunscreen: you’ve heard it before, and it bears repeating. No matter your age or skin type, everybody needs to wear sunscreen every day – and this becomes especially important during the summer. Remember to put enough on: the recommended application for adequate protection is 35 to 40ml per person per session (a handful). Sunscreen should be applied liberally enough to all sun-exposed areas that it forms a film when initially applied, and it should be the last product applied to the face before going out. A minimum SPF of 15 is recommended for all skin types; for young children and those with very fair or sun-sensitive skin, a higher SPF is recommended. Insect repellent can reduce sunscreen’s effectiveness by up to thirty percent, so take care to use a higher SPF and reapply sunscreen more often if combining it with insect repellent. Remembering to reapply sunscreen every two to four hours and immediately after swimming is crucial.

Wearing sun-protective lip balm is an important step in taking care of your lips that most people overlook when getting ready to go out. This not only protects against soreness and chapping, but also reduces the potential for the lips to be a possible site for dangerous melanomas.

Going easy on makeup is a good way to help prevent acne flare-ups in the summer. The combination of heavy makeup and sweat can clog pores and lead to break outs. Instead of using foundation all over your face, apply makeup lightly only to specific areas, and remember that the bright light of summer often accentuates makeup’s visibility, leading to an unnatural look.

Keep exfoliation light. While peels and scrubs are key during the winter and spring to keep skin radiant, be cautious of exfoliation as summer approaches. New, fresh skin that is revealed through exfoliation is actually more sensitive to the sun. Keep exfoliation to once a week or every other week and do it at night rather than in the morning. That way, your skin can recuperate a bit from exfoliation while you sleep.

Managing Your Medical Records

June 02, 2011

Whether you have been relatively healthy your whole life or have been juggling a few chronic medical conditions, everyone can benefit from keeping a home record of their medical history. Though our office Electronic Medical Record system is able to keep an up to date account of your medical history, you want to be prepared for when medical emergencies happen on vacation or if you find yourself moving out of town or out of state. After all, you are your first and best healthcare advocate. Whether you want to store your information in a computer file or Google document or prefer to write things down in a dedicated notebook, every home medical record should contain the following:

- Current and previous medical conditions and any past surgeries, including when and why they were done.

- A current account of your family medical history including your siblings, parents, and grandparents.

- Allergies you have to any medications or foods.

- A list of current medications, don’t forget to include any vitamins or supplements.  You should also keep a separate list of medications you have taken and did not like or did not find helpful so that these can be avoided in the future.

- Dates of any adult vaccinations – you need a tetanus booster every ten years so this is one that people often lose track of.

- Dates and results of screening tests like PAP smears, mammograms, and colonoscopies. This will help ensure you do not fall behind on important cancer screening tests. Also, some insurance plans will not cover these tests if they are done too soon so knowing the dates can keep you from having to foot the bill.

- Any blood work and imaging tests (X-rays, CT scans, MRIs, etc) and when, where, and why they were done (i.e. what symptoms you were having that prompted the testing).

- Names of previous doctors you have seen and the practice address and phone number in case records need to be obtained at a later time

It can be useful to obtain and keep a copy of blood work or imaging studies for your own records but keep in mind lab and radiology reports are written by health care professionals for health care professionals. Many times the significance of results needs to be interpreted in the context why the tests were ordered. Variation from the range of normal does not necessarily indicate a serious problem and there are many things that may be incidentally discovered on CT scans and MRIs that don’t mean anything negative to your health. Please be judicious with what and how you Google and if you ever have questions about previous blood work or imaging results please let us know! We would be happy to answer any questions you have.

The Halo Effect of Organic Foods

June 02, 2011

In recent years “organic” foods have made their way into our lives, and even chain supermarkets. And most Americans purchase organic foods at least occasionally. However, the nutritional content of these foods may not vary greatly from conventionally produced foods.  In addition, consumers typically consume larger portions of these foods merely because they are labeled “organic.” Research on the nutritional differences between conventional and organic products is ongoing at this time. However, so far, few differences have been identified and were not across all products.
Organic foods are produced under the USDA’s National Organic Program regulations. These regulations include specifications about how the foods are produced and the process practices required for a food to be certified organic, however these regulations do not claim nutritional or food safety benefits for organic products.  This continues to be an ongoing debate among nutrition experts. However, the term “organic” comes with what experts are calling a “halo effect.” The “halo effect” is how we as consumers perceive the nutritional content of a certain food, and extrapolate the same nutrition content to other foods with the same label.
This “halo effect” results in consumers perceiving an organic food to be more nutritious, and letting their guard down when it comes to being careful about counting calories - ultimately leading them to overeat or feel entitled to indulge.  Research shows that consumers are more likely to claim that “organic” labeled products taste better, are lower in calories, lower in fat and higher in fiber. In most studies, no organic products were present, but merely labeled as “organic” to test consumer’s perception.
There are still benefits to our population for eating and purchasing organic foods such as reduced nutrition pollution, improved soil organic matter, lower energy use, reduced pesticide residues in food and water and enhanced biodiversity. Some organic foods may contain more phytochemicals such as antioxidants compared to conventionally grown products. Organic food purchases can often integrate small to medium sized farms into high-value food markets. Overall facilitation of organic foods can be considered creating a healthful, sustainable food system.
So what can you, as a consumer, do to buy/use the best products on the market?
1.    Read the Nutrition Label - The Nutrition Facts panel was designed for the consumer to make better nutrition-related decisions. This is the best way to differentiate between organic, local and conventional food items.  Become familiar with nutrition and ingredient labeling as a means of choosing healthy products that will help in meeting your daily Food Guide Pyramid needs.
2.    Reduce Your Calorie Intake - In order to make sure you are not experiencing the “halo effect” with organic food - first guess the caloric value of a food, and then double it. You’ll end up being more accurate on calorie intake and you might even eat less.

5 Moves for a Toned Body in 2 Weeks

April 28, 2011

You've been procrastinating on your workout plan for Memorial Day — this just might be your last minute strategy for success! (Repeat this circuit 3x a week, with cardio, for best results.)

Inchworm — Works abs, chest, arms. Bend forward, place hands on floor in front of toes, and walk hands forward, until you reach plank position. Do a push-up, then inch back to start. (Keep belly button pulled in.) Do 8 to 12 reps.

Side Plank — Works abs, Oblique’s, butt, hips, thighs. Lie on right side with legs extended, hips and feet stacked; prop yourself up on your right forearm, elbow under shoulder, and place left hand on your waist. Slowly lift hips off the floor as high as you can, hold for 15 to 30 seconds each side.

Lunge Twist — Works calves, hamstrings, butt. Stand with arms at shoulder height, palms down. Step forward with right foot, crossing it in front of left. Lower into a curtsy-like lunge (right knee shouldn’t go past toes) while twisting torso right. Untwist, push off right foot, return to start. Do 8 to 12 reps; switch legs and repeat.

Squat Shoulder Press — Works butt, thighs, shoulders, back. Stand with feet hip-width apart holding five-pound weights in each hand, arms bent, palms facing in. Bend knees and squat, pause, then stand and press arms straight up over shoulders. Do 8 to 12 reps.

Wood Choppers — Works obliques, back, shoulders. Stand with left foot in front of right, holding one weight with both hands, arms extended so weight is by right hip. Rotate arms up and across, (don’t twist torso) pause, then return to start. Do 8 to 12 reps; switch sides and repeat.

Erica Umosella received her Bachelor of Arts in Health and Exercise Science with emphasis in Physical Education from Rowan University. She also earned a degree as a certified personal trainer and nutritional consultant from the National Personal Training Institute of Philadelphia. For more information on Erica, click here.

Our Team Approach to Weight Loss

April 28, 2011

Though the actual work of weight loss is largely an individual effort, having a solid team behind you can mean the difference between success and setbacks. Our Weight Management program has assembled all of the professionals needed to comprehensively address the complexities of obesity and weight loss. The Weight Management team at RWWC includes a physician, a psychologist, personal trainers, and registered dieticians and was designed with your health and long term success in mind. Because we are all under one roof, we are able to work closely together to design the most effective weight loss plan for you based on your lifestyle, goals, and underlying medical conditions.

Having a physician as part of the weight loss team is something that is lacking in most commercial weight loss programs and gives our patients an advantage. From the very beginning of your weight loss journey, I will evaluate you for underlying medical conditions that may make weight loss more difficult, such as obstructive sleep apnea and underactive thyroid. I can also identify medications, including over-the-counter preparations, which may be increasing your appetite or otherwise impeding your success.

Through a comprehensive social history, family history, and blood tests I will be able to assess your risk for developing weight-related diseases and fully evaluate your cardiovascular risk, ordering stress tests or other further heart evaluations if needed. This information is communicated to the rest of the team to allow our personal trainers to better design a safe fitness program for you and to alert our dieticians to any areas that may need particular focus, such as cholesterol or salt intake.

In our Weight Management program you will work closely with all of our professionals. Frequent visits to the center will help us quickly identify problems, fluidly make corrections to your plan, and proactively address the inevitable plateaus.

Weekly Weight Management meetings are held with the team members to discuss your progress and revise your goals. A summary e-mail will be sent to you with reminders of what to work on for the next week along with words of encouragement.

The reasons for weight gain are multiple, complex, and individual. Our multifaceted team allows us to get to the root of your weight gain and devise a truly personalized plan to help you realize your goals for a healthier you!

Are You Drinking Too Much Alcohol?

March 31, 2011

I am often concerned that patients are drinking too much, yet find the conversation about alcohol difficult. Many women are unaware that the maximum per day that a women should drink is one drink a day (one beer, glass of wine or one shot) The safe amount for men is two drinks per day. The reasons for this gender differences include women’s lower body size, percentage of body weight composed of water, and differences in metabolism.
I often get the impression that when women think of alcohol abuse or alcoholism they think of the homeless person on the street who is drinking at 10 am. They don’t think of women who drink a half bottle of wine each night or a few martinis as having a problem.
Women suffer from the health consequences of excess alcohol at much lower levels of alcohol consumption. We all know that excess alcohol affects the liver and can lead to permanent liver damage. Alcohol is also associated with a linear increase in breast cancer incidence, so the more you drink the higher your risk.Alcohol is also associated with cardiomyopathy (a degenerative disease of the heart muscle), brain shrinkage, pancreatits, colon cancer and other gastrointestinal cancers.
If you think you may be drinking to much, start with this survey http://www.alcoholscreening.org/Home.aspx
. If you want to cut back on your drinking, the first thing is to remove alcohol from your home. If you are having problems cutting back, they are many programs and private counselors that we can recommend.

Spring Fever

March 31, 2011

We are approaching that time of year when many of us experience spring fever….a time when we feel energized and want to do many things from outdoor activities to spring cleaning within the home. At the Rittenhouse Women’s Wellness Center, I work with two groups of people: those wanting to pursue weight management and those wanting psychotherapy. From the weight management point of view, spring is a time when many of us prefer to exercise through outdoor activities which can nicely complement a healthy diet in pursuit of weight loss. Physical exercise is very helpful in maintaining a positive mood and outlook on life, so much so that the American Psychiatric Association is now recommending exercise as a strong treatment for the reduction of depression. An increase in social activities, which also may occur in the spring, is also useful in combating depression, or simply emerging from the winter blues! However, individuals who suffer from depression or bipolar illness are best advised to avoid excessive activity which might interfere with regular sleep patterns. Both individuals troubled by depression or bipolar illness are best served when they respect their need for regular sleep patterns. So the solution is simple: enjoy the springtime and the expanded activities that it often offers. If you want to begin an exercise program, this is the right time to start. Just remember to pursue your activities in moderation to avoid physical or emotional strain.

Portion Control for Weight Loss

March 31, 2011

Portion sizes are the key to losing and maintaining your weight. Nowadays portion sizes have increased significantly, especially in restaurants and with processed, pre-packaged foods which aim to give you more food for your dollar. Learning about what an actual portion size looks like, as well as learning to read a food label, can be helpful in discerning the amount of food you should be eating throughout your day. You may consider starting a food diary to keep track of the amount and types of foods you eat each day.

In the beginning, it may be helpful to actually measure out your portions for each meal using measuring cups and spoons, and a small kitchen scale, but there are also common household items that you could use to get an idea of a proper portion (see list below). The “plate model” can also be a useful guide, with the idea that you fill half of your plate with fresh or cooked vegetables or fruit while limiting your proteins and starches to one quarter each. You can even purchase plates that mark off sections for each portion.

For times when you are in a hurry or on the go, pre-portioning foods ahead of time can be helpful. For example, at the beginning of each week, you could make plastic baggies of the appropriate portions of nuts, baby carrots and celery, cheese cubes and crackers, or cereal to use as snacks throughout the week.

Remember to be aware of the amount of condiments and dressings you are using as well, as the calories in these can really add up. Portion sizes for alcohol and other caloric beverages should also be taken into account. The recommended serving of alcohol is 1 drink per day for women and 2 drinks per day for men. One drink is equal to 5 oz. of wine, 12 oz. of beer or 1.5 oz. of distilled alcohol. Each of these provides about 100 calories or more so watch your intake when watching your weight. Mixed drinks typically provide even more calories per serving.

Once you have a good idea of what an appropriate portion size is for different types of foods, you will find it easier to estimate your portions when eating out. Generally restaurants serve at least double the amount of an appropriate portion, so divide your entrée in half and take home the rest, share with a friend, or go with an appetizer portion instead. When purchasing food or drinks with a food label, it is always important to first look at the serving size. More often than not, there is more than one serving in the product.

At first you may be surprised by how small a portion really is. But do not worry; you can eat multiple portions of each food group throughout the day. Focus on eating slowly and enjoying each bite of food. When having dinner, make your plate and put the rest away immediately so you won’t be tempted to have seconds. Serving your meals on smaller plates is a visual trick that will help you get used to the appropriate portion sizes.

The Food Guide Pyramid (http://www.mypyramid.gov/) can help you figure out the daily number of servings of each food group you should be eating for a balanced diet.Here are examples of appropriate portion sizes for each group:

Grains (try to make half of this group whole grain choices)

  • 1 mini bagel (Starbucks bagels, for example, are more like 4 servings of grain)
  • ½ cup cooked pasta, rice or oatmeal (the size of a cupped palm)
  • 1 slice of bread, ½ English muffin, 6” inch tortilla
  • 1 cup of cereal


  • 1 cup of cooked vegetables
  • 2 cups of raw leafy greens
  • 1 small baked potato (the size of a computer mouse)


  • 1/2 cup of fresh fruit or 1/4 cup of dried fruit
  • 1 small apple or orange (the size of a tennis ball)
  • 4 ounces of 100% fruit juice


  • 1 cup of milk (always choose low fat or skim versions)
  • 6 oz. of yogurt
  • 1 oz. of hard cheese (the size of a domino)
  • ½ cup ice cream (the size of a tennis ball)


  • 1 oz. of steak, chicken, or fish (typically at a meal, you would have about 3 oz., the size of a deck of cards or woman’s palm)
  • 1 oz. of nuts or seeds or 1 tbs. of peanut butter (the size of half a walnut shell)
  • 1 cup of bean soup
  • 1 egg
  • 2 tbs. of hummus (the size of a walnut shell)


  • 1 tsp. of mayonnaise or 1 tbs. of Italian dressing
  • ¼ medium avocado

Training with Intervals

March 31, 2011

Spring is here and summer is just around the corner. You know what that means… Bathing suit season is approaching! I am going to tell you how you can achieve the body you want by summer.

Interval Training is the best way to burn fat in the shortest amount of time, which is only one of many advantages achieved through interval training.

Running at a higher intensity for shorter periods of time results in a metabolism boost for several hours after. This means more calories are burned even at rest, which aids in weight loss. Now who does not want to burn calories after your done working out?

Some other Benefits of Interval Training:

  • Strengthens both the heart and lungs
  • Reduces blood pressure
  • Creates a general feeling of well-being and decreases the chance of depression and anxiety
  • Breaks up the boredom of long, steady runs
  • Your body becomes more efficient at dealing with lactic acid build up
  • Cuts your workout time in half

The calorie bursting plan takes just 20-30 minutes but outperforms workouts that last twice as long. The secret is alternating high intensity intervals with easier recovery periods. Women who have switched up their cardio routines to intervals have lost three times more body fat during a 15-week period than those who worked out for 40 minutes at a steady pace. Studies have shown that bursts of high intensity activity increases levels of fat burning compounds in the body.

What to Do

Pick a cardio machine and warm-up at a steady pace that is at moderate intensity. After a 5 minute warm-up, increase the pace or resistance to a level that is a bit more challenging. This is the recovery period that will be done in 90-second increments. After the 90 seconds, increase the intensity or incline to a challenging 30-second burst. Once you have figured out the two speeds or resistance levels that are best for you then continue the workout changing the speeds or resistance levels in 90- and 30-second increments. Be sure to give yourself about 5 minutes at the end of your workout for a cool-down.

Whether you are a beginner or a seasoned runner, or anywhere in-between, if you are looking to get fit faster, lose weight, look/feel good, then interval training is the quickest most efficient way to go.


  • 5-minute warm-up
  • 90 seconds (slower speed)
  • 30 seconds (very fast speed)
  • (Repeat the 90/30 intervals up to 10 times, but start with less. Once you reach 10 and it becomes easier, increase the speed to make it more challenging)
  • 5-minute cool-down

Managing Springtime Allergies

February 28, 2011

Spring is on its way! Along with budding trees and flowers comes pollen — a common trigger for allergies. Limiting the frequency and duration of your exposure to pollen can prevent or decrease symptoms and reduce your need for medications. For those who suffer from spring allergies here are a few tips to make the season more enjoyable.

Limit outdoor activities when pollen counts are the highest, between 5am and 10am.

Pay attention to pollen reports, available with the daily weather report and online, and stay indoors when counts are high. Dry, windy days are more likely to have large amounts of pollen in the air than damp, rainy days when most pollen is washed to the ground.

Keep windows and doors closed to keep pollen from drifting into your house. Likewise, keep your car windows rolled up and sunroof closed when you drive and adjust your ventilation system to re-circulate inter-compartment air instead of drawing air from outside.

Pollen can accumulate on your clothes and hair while you are outdoors. Remove your shoes at the door and change out of clothes you’ve worn outside. Shower to rinse pollen from your skin and hair. Your pet’s fur presents a similar problem. Though it is certainly not practical to bathe your dog every night, try to keep pets off of the furniture and out of your bed so that you will limit your exposure.

Wash bedding often and always machine dry. Pollen may collect on laundry if it is hung outside.

Rinse out your nasal passages once you are inside for the day or before you go to bed. If you can’t get the hang of a neti pot, pick up a reusable nasal irrigation kit available at most pharmacies.

For more information on Dr. Rowbotham’s practice, click here.

On Setting Goals and Staying Motivated

February 28, 2011

Let’s face it — many people forget about their New Year’s fitness resolutions by February. Perhaps results did not come quickly enough, or the “daily grind” has sidetracked them from their goals. However, goals don’t happen overnight. Working to create a healthy lifestyle that includes a fitness routine is an ongoing process for everyone — it doesn’t have to be an “all-or-none” situation.

Here are some tips for getting started and staying motivated…

Plan Ahead — The best results come from a well-planned strategy.

  • Discover 20-30 minutes 3-5x a week when you know that you can make time for yourself. Stick to your schedule, but also allow for a little wiggle room or variation. If you can’t make it to the gym on a certain day, look up some exercises online and work with what you have at home. Something, even 10 minutes, is better than nothing.
  • If you’re a morning person, lay out your exercise clothes and gym bag the night before. If you plan on going after work, pack your gym bag the night before and leave it by the door so you don’t forget it.
  • Think about how good you will feel after only 30 minutes of exercise.

Get Psyched — Visualize how you will look and feel as you become more physically fit.

  • Take measurements. The scale is only one way to measure progress. Make sure to measure your chest, waist, and hips every month or so, as these will show the most amount of change as you build muscle.
  • Stay realistic. There is no quick fix or magic pill for fitness! Getting into shape is a science — if you complete the formula (consistent exercise + healthy eating) you will get steady results. Just be patient and remember that every healthy decision you make will lead you closer to your goal.

Hire a Trainer — If you know that you have someone who is waiting for you at the gym you will most likely show up.

  • A trainer can show you the best routines for the fastest results and push you in ways that you cannot push yourself.
  • A trainer will show you the best routines for YOU, which you will be able to carry with you for the rest of your life.

Always dig deep and train hard and realize that your goals ARE attainable. Stick with your plan and before you know it, you’ll be exactly where you want to be.

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Common Misconceptions about “Healthy” Foods

February 28, 2011

Most consumers associate certain foods with being “healthy” or “good for you,” but do not realize that even the healthiest foods can be unhealthy if the portion size is too large or it’s prepared with added sugars. We continue to eat and drink these foods and beverages because they are associated with being “healthy," but never glance at the nutrition label. These misconceptions are common since we are exposed everyday to mixed messages through advertising campaigns and nutritional trends in the news telling us what’s “healthy” and “good for us.”

Here are a few of the most common misconceptions that I’ve come across when working with patients on healthy eating, weight loss and increasing energy.

“If I have a 16oz glass of orange juice for breakfast, I’m getting Vitamin C and it counts as a fruit serving.”

It’s true that food manufacturers pump orange juice will added vitamins, however, even 100% fruit juice can be very high in calories (due to natural sugar). Of course it’s important to get your fruit servings in each day, but it’s much better to eat a variety of fresh or frozen fruit. If one of your fruit servings needs to come from fruit juice, it should be 100% fruit juice and only about 4-ounces (a half cup). One suggestion is to use a small juice glass to be sure to get the correct serving size.

“Low fat dairy products are associated with weight loss, so I can choose any low fat yogurt for a healthy snack.”

Low fat yogurts are not all they’re cracked up to be. When manufacturers take the fat out of yogurt so they can label it “low fat,” sugar is added for flavor. This added sugar, if not burned off through exercise, is stored as fat. Yogurt is an excellent source of protein and calcium, but there is no need for the added sugar, especially when there are many delicious low-sugar options to choose from. When looking at the nutrition label, the “Total Carbohydrates” line should read < 20 grams per serving. Dannon Lit ‘n Fit and Stoneyfield Probiotic are great examples of low sugar yogurts.

Greek yogurt is an even better way to get a healthy serving of protein and calcium. The 0% fat Greek yogurt is great as a snack or for breakfast. Add in a serving of fresh fruit or nuts (for healthy fats and extra fiber) for an even healthier and filling option.

“Dried fruit has too much sugar; I was trying to stay away from it.”

Another common misconception is that dried fruit is loaded with sugar should be avoided for weight control. The opposite is true. Dried fruit – in the correct portion size (about 1oz or the inside of the palm of your hand) – is a great source of vitamins, minerals and fiber. Fiber helps to keep you feeling full by helping to control your blood sugar and preventing overeating. Try adding dried fruit to your morning oatmeal or as a snack with mixed nuts.  You’ll feel full and energized from these healthy choices.

“Granola/trail mix is high fiber and all the ingredients are healthy, so I can eat as much as I want.”

Granola/trail mix can be high in fiber; however some of their major ingredient – carbohydrates, sugar, salty nuts and chocolate pieces – can make them a very calorie dense food choice. Trail mix should be unsalted, with no candy mixed in, and contain dried fruit. Appropriate serving size of granola is typically 1/4 - 1/2 cup, and trail mix is 1/2 cup. If in doubt, simply refer to the nutrition label and look at the ‘serving size.’ Mix the correct portion with yogurt or milk as a great breakfast or snack and use trail mix as an afternoon snack in the office.


Overcoming the Winter Blues

February 01, 2011

Ever notice that in the winter, perhaps between November and March, you just feel sort of in the dumps? Maybe your motivation is lowered, you feel sad, things don’t seem as pleasurable as usual and your interest in work, socializing and entertainment seem to lose steam? Perhaps you also feel more moody, sad or irritable and even want to cry at times? If so, maybe you are having a bout of S.A.D… or Seasonal Affective Disorder. It isn’t totally clear what causes this, but there are several ways to treat it.

First of all, realizing your own vulnerability towards depression at this time of year is a good first step to solving the problem.

Some interventions that may help include the following:

Buy a full spectrum light. These can be found online (Northern Lights is a great brand). Try to use it in the morning before dawn. This can help extend the daylight so that your spirits lift.

Increase exercise. Often the cold weather discourages us from exercising. However, if we actively combat this tendency by self consciously increasing our exercise, we might find that the depression lifts.

Psychotherapy. If the depression really begins to interfere with work or socializing, psychotherapy can be helpful.

Medication. In some instances using anti depressants in combination with  some of the other interventions listed will also be helpful, especially if initiated at the beginning of the winter in November.

Nutrition. There is evidence that proves that good nutrition can also improve your mood.

In any event, don’t despair too much because inevitably winter ends and spring will emerge once again!

For more information on our psychologist, click here.

Strength Training Benefits for Women

February 01, 2011

Burn Calories While You Rest

Anaerobic exercise (i.e. resistance/strength training) helps build lean muscle mass, which aids in burning fat and losing weight because it increases one’s Resting Metabolic Rate. Raising this rate means that females will burn more calories at rest on a daily basis. Furthermore, studies have proven that strength training is more effective in building fat-free muscle mass than aerobic exercise like running or biking.

Develops Strong Bones

Females who strength train put load on their bones and their joints. This load aids in a process called bone modeling, which helps prevent fractures and osteoporosis.

Improves Self-Esteem

Strength training helps empower women, giving them confidence to live a more active and injury-free lifestyle. Femininity and strength can co-exist and studies have shown that resistance training helps females have a healthier relationship with their body.

Staying Fit During the Holiday Season

October 26, 2009

Like it or not — here come the holidays. Sticking to your exercise program can be extremely challenging during this time. It is so easy to miss a workout when you are busy with family, friends, and festivities. Although we have several weeks before the holidays begin, now is the time to plan! If you are prepared with some strategies you can avoid gaining weight and stick to your workouts.

Plan ahead

The most difficult part of an exercise program is not the exercising itself, but the planning. Planning ahead of time to fit exercise into your day will help you to be successful and compliant. Acknowledge that the holiday season will probably affect  your exercise routine. This way you can calmly make adjustments when necessary. During this time of year consider removing something from your schedule instead of trying to squeeze exercise in. For example, instead of an office party or a manicure, plan for a 30 minute workout. Set out your exercise clothes ahead of time so you don’t have to get them together at the last minute. Put exercise on your “to do” list most days of the week. Whether or not you already have well-established exercise habits, be sure to make exercise a priority in your daily life.

Be realistic

Keep in mind that most people eat more than usual during the holidays. However you don’t have to indulge everyday. Minimizing when you indulge and sticking with your exercise regimen can help to keep you in check. Be flexible when your days get busy by mixing up your routine. If you have obligations that will interfere with your regular schedule, try to wake up an hour earlier to do a quick 20-30 minute workout. Also, keep in mind that you don’t have to over do it with hour long exercise sessions. Exercising for 20-30 minutes with an elevated heart rate (swimming, jogging, kickboxing) most days of the week should keep your metabolism humming.


Give yourself a gift this holiday season and hire a personal trainer. A trainer will have the expertise to guide you through the most effective workouts while keeping you motivated. Many trainers have reasonable package deals and holiday specials. Just make sure that your trainer has a respected certification such as ACE, ACSM, or NASM to name a few.

Try Something New

Instead of blowing off your workout — try something new. There are many ways to get into shape. Kickboxing, team sports, swimming and power yoga are all great ways to burn calories. You can try walking briskly during half of your lunch break as well. You may be surprised at how good it makes you feel. If the weather is bad and you cannot get out — try an exercise video. Exercise videos can be very effective and can be done in the privacy of your own home or office.

Keep a Journal

Keeping an exercise journal can help you to stay motivated and organized. You are  more likely stick to your workouts if you make daily journal entries and follow through with them. You can set goals for yourself each day or once a week. When you accomplish your goals, it will motivate you to continue and progress with your fitness plan and may even reduce your desire to over-indulge.

Keep in mind that during the busy holiday season nobody is perfect. There are going to be temptations and erratic schedules for everyone. If you exercise most days and indulge in moderation, you will do great! This way you will be able to enjoy yourself while staying healthy. After all, that’s what the holiday season is all about!

Healthy Living is the Best Revenge

August 08, 2009

A study published in the August 10/24th issue of the Archives of Internal Medicine supports that healthy living reduces disease. Over 23,000 people aged 35-65 were studied for an average of 7.8 years. Participants who never smoked, were not obese (BMI<30), performed at least 3.5 hours of physical activity per week and followed a healthy diet had a strong impact on preventing chronic diseases. Participants with all 4 factors at base line had a 78% lower risk of developing a chronic disease including diabetes, heart attack, stroke and cancer than participants without a healthy factor.

Nail Salon Dryer Lights and Skin Cancer

July 17, 2009

The UV Lights at Your Local Nail Salon May Cause Skin Cancer. 

The lights used to quickly dry your nails at your local nail salon may cause skin cancer. As published in the April 2009 issue of the Archives of Dermatology report that 2 healthy middle aged women developed skin cancers on the dorsum of their hands, both women had no risk factors for skin cancer and reported exposure to UV lights at nail salons. My advice use the dryer.

Study Reveals Way to Make Medical Abortions Safer

July 08, 2009

A study published in the July 9th issue of the New England Journal of Medicine reveals a way to make medical abortions (not surgical) safer. The data comes from Planned Parenthood Centers throughout the country. By switching medication administration from the vagina to the mouth the rate of infections after medical abortions declined 73%. Subsequent addition of routine antibiotics further reduced the rate of infections by 76%. Women seeking medical abortions should insist on only oral medications and a prescription for antibiotics or testing for sexually transmitted diseases to reduce their risk of infection.

What is FMD? Information you need to know from Rittenhouse Women's Wellness Center

June 27, 2009

There was a great article in today’s WSJ about a medical condition called Fibromuscular Dysplasia. This condition is more common in women then men and is thought to occur in up to 5% of the population. It can cause high blood pressure, headaches, abdominal pain and even heart attacks, stokes, aneurysms, and sudden death.

What is Fibromuscular Dysplasia (FMD)?

The word “dysplasia” simply means abnormal cellular development or growth. In people with FMD, the dysplasia involves the walls of one or more arteries in the body. Areas of narrowing, called stenosis, may occur as a result of abnormal cell development. If enough narrowing causes a decrease in blood flow through the artery, symptoms may result. Many people with FMD do not have any symptoms or signs on physical examination and are diagnosed by accident during a radiology scan for another problem.

FMD is most commonly found in the arteries that supply the kidneys with blood (renal arteries). Up to 75% of all patients with FMD will have disease in the renal arteries. The second most common artery affected is the carotid artery, which is found in the neck and supplies the brain with blood. Less commonly, FMD affects the arteries in the abdomen (supplying the liver, spleen and intestines) and extremities (legs and arms). More than one artery may have evidence of FMD in 28% of people with this disease.

What causes FMD?

The cause of FMD is not yet known, but several theories have been suggested. A number of case reports in the literature have identified the disease in multiple members of the same family including twins. There is a very strong likelihood that there is a genetic basis for the development of FMD. However, a relative may have different artery involvement, different disease severity, or not develop FMD at all. In fact, not all individuals with FMD have a family member with the disease. In a series from France, about 11% of family members had FMD.

FMD is also more commonly seen in women than in men resulting in the theory that hormones may play an important role in disease development. This theory is further supported by the fact that most women are premenopausal at the time of diagnosis. However, with better imaging available, an increasing number of patients are now being diagnosed later in life. In small population studies, one’s reproductive history (the number of pregnancies and when they occurred) as well as the use of birth control pills did not correlate with the development of FMD.

Other possible causes of FMD include abnormal development of the arteries that supply the vessel wall with blood resulting in inadequate oxygen supply; the anatomic position of the artery within the body; and tobacco use. It is likely that many factors are involved in the development of FMD. This area requires further research.

What are the signs and/or symptoms of FMD?

Many people with this disease do not have symptoms or findings on a physical examination. The signs and/or symptoms that a person with FMD may experience depend on the arteries affected and the degree of narrowing within them. The two most common areas affected by FMD are the renal arteries (arteries carrying blood to the kidneys) and the carotid arteries (arteries carrying blood to the brain). Common manifestations related to the artery involved are shown below.

FMD of Renal Arteries (Kidney):

  • High blood pressure [>140/90 mmHg]
  • Abnormal kidney function as detected on blood tests
  • Flank pain from dissection or infarction of the kidney
  • Kidney failure (rare)
  • Shrinkage (atrophy) of the kidney

FMD of Carotid Arteries:

  • Bruit (noise) heard in neck with stethoscope
  • Swooshing sound in ear
  • Ringing of the ears
  • Vertigo (room spinning)
  • Dizzyness
  • Headache
  • Transient ischemic attack
  • Stroke
  • Neck pain
  • Horner’s syndrome
  • Dissection

People with carotid FMD have a higher risk for intracranial aneurysms (abnormal dilations of the arteries in the brain). An intracranial hemorrhage (bleeding in the brain) may occur if an aneurysm ruptures. FMD involving the mesenteric arteries (arteries that supply the intestines, liver and spleen with blood) can result in abdominal pain after eating and unintended weight loss. FMD in the arms and legs can cause limb discomfort with walking or arm use (intermittent claudication), cold limbs, weakness, numbness or pain.

Who has FMD?

Anyone can have FMD. However, it is much more common in women. Most women are typically diagnosed between the ages of 25-50. Some types of FMD are more common in children or teenagers (See Pediatric FMD). And there are an increasing number of individuals who are being diagnosed later in life (after age 60).

How common is FMD?

It is difficult to determine how common FMD is in the general population. This is due to several reasons. Individuals with mild disease are often asymptomatic and so the disease often goes undetected. Most studies examining the prevalence of FMD have looked at specific patient populations in whom individuals may have already suffered from serious consequences of the disease. Since the disease is often not diagnosed, it is likely that FMD is more common than previously thought.

How can FMD be diagnosed?

There are a number of methods that can be used to detect FMD. These include computed tomographic angiography (CTA) and magnetic resonance angiography (MRA), ultrasound, and catheter based angiogram. The experience and expertise available at your medical institution will play an important role in what diagnostic options are available to you.

In the most common form of FMD (medial fibroplasia), a characteristic “string of beads” appearance is seen in the affected artery. This appearance is due to changes in the cellular tissue of the artery wall that causes the arteries to alternatively become narrow and dilated. A less common, but more aggressive form of FMD may cause an area of severe concentric narrowing of the blood vessel (intimal fibroplasia) or long smooth narrowing.

How to Choose a Sunscreen

June 26, 2009

Have you wondered what to look for in a sunscreen?

The sun contains both UVA and UVB rays. UVA rays are linked to melanoma, the deadliest form of skin cancer as well as causing lines, wrinkles and aging of the skin. UVB rays cause sunburns. Currently sunscreens in the US only have ratings for UVB rays. SPF 15 blocks about 93% and SPF 30 blocks about 97% of UVB rays. Several ingredients block both UVA and UVB including zinc oxide and titanium dioxide. Both of these ingredients are physical blocks, and are very gentle to the skin. Chemical blocks include avobenzone, oxybenzone and mexoryl. There are some concerns that these chemical sunscreen break down in the sun. The envirnment watch group performed a review of almost 900 sunscreens their recommendations are below.

Recommended products from popular brands


Blue Lizard

Blue Lizard Australian Suncream Lotion, Sensitive, SPF 30
Blue Lizard Australian Suncream Lotion, Baby, SPF 30+
Blue Lizard Australian Suncream Lotion, Face, SPF 30+



California Baby

California Baby Sunscreen Lotion No Fragrance, SPF 30+
California Baby Sunscreen Lotion Natural Bug Blend, SPF 30+
California Baby Sunscreen Lotion Everyday/year-Round, SPF 30+
California Baby Sunblock Stick No Fragrance, SPF 30+
California Baby Sunblock Stick Everyday/year-Round, SPF 30+




CVS Sunscreen with Zinc Oxide, SPF 45+



Jason Natural Cosmetics

Jason Natural Cosmetics Sunbrellas Mineral Based Physical Sunblock, SPF 30+



Kiss My Face

Kiss My Face Face Factor Paraben Free, SPF 30
Kiss My Face 100% Paraben Free Sunscreen with Oat Protein, SPF 30




Neutrogena Sensitive Skin Sunblock Lotion, SPF 30




Olay Complete Defense Daily UV Moisturizer, Sensitive Skin, SPF 30
Olay Complete Defense Daily UV Moisturizer, SPF 30




Skinceuticals Physical UV Defense, SPF 30



Solar Sense

Solar Sense Clear Zinc, for Face, SPF 45




Walgreens Sunblock with Zinc Oxide for Face, Nose & Ears, SPF 45+


Major brands that have no recommended sunscreens

Aubrey Organics (6), Avalon Natural Products (8), Aveeno (21), Banana Boat (41), Biore (1), Biotherm (11), Bull Frog (9), Burt's Bees (2), Cetaphil (2), Clean & Clear (2), Coppertone (41), Cover Girl (4), Dove (4), Dr. Scholl's (2), Elizabeth Arden (12), Eucerin (5), Garnier (3), Gillette (1), Hawaiian Tropic (10), Jergens (2), Juvena (2), La Roche-Posay (5), Lancome (28), LORAC (5), Lubriderm (1), Maybelline (1), Murad (9), Nature's Gate (7), Nivea (4), Paradise Gold (4), Phisoderm (2), Pond's (2), Purpose (2), RoC (6), Skin Simple (1), Target (.method) (1), The Body Shop (3), Vichy (2), Zia Natural Skincare (3)

Please call us at 215-735-7990 with questions.

What caused Michael Jackson's Death?

June 25, 2009

Michael Jackson died suddenly today. It is known that he hadn't been feeling well and his personal physican was at his home this morning and tried to resuscitate him. Michael apparently had a sudden cardiac arrest. This simply means that his heart stopped beating. SCA (sudden cardiac arrest) is a common cause of death accounting for more than 325,000 deaths each year in the United States. The most common cause is underlying coronary heart disease, which often goes undiagnosed. Other causes can be underlying structural heart disease, drug overdoses, airway obstruction, drowning and pulmonary emboli. These medical conditions commonly cause an irregular heart beat called ventricular fibulation where blood is not pumped effectively. This causes a rapid loss of conscienceness. This rhythm can be reversed with a defibulator which delivers an electrical current to the heart. However, it must be done quickly, basic cpr is not typically effective. Stress, and drugs such as alcohol, amphetamines or cocaine can also contribute to the problem. A definitive answer is not likely until toxicology and autopsy reports are released.

Red Yeast Lowers Cholesterol

June 15, 2009

A recent study published in the June 16, 2009 issue of the Annals of Internal Medicine shows the efficacy of Red Yeast Rice in lowering cholesterol. 62 patients with elevated cholesterol levels and the side effect of myalgias while on statin therapy were randomized to 1800mg twice daily of red yeast rice or placebo. Patients were followed for 24 weeks. Red yeast rice significantly decreased LDL and total cholesterol compared to placebo and did not increase the incidence of myalgias over a 24 week period.

Effects of Calcium on Body Weight in Overweight Patients

June 15, 2009

A Study Published in the June 16, 2009 edition of the Annals of Internal Medicine showed that calcium supplementation in overweight and obese patients have no effect on weight. Overweight or obese (BMI>30) patients were split into two groups, one group took 1500mg of calcium carbonate a day for two years, the other group was given a placebo. After two years there were no differences between the two groups in terms of weight or body fat.

VelaShape Featured in Vogue Magazine

May 28, 2009

Vogue Editor Feels “Newly Taut” In Her Jeans thanks to VelaShape

 In an article on achieving body perfection, beauty editor Catherine Piercy explores the latest surgical and non-surgical fixes for body flaws: liposuction, injections, skin tighteners, and cellulite treatments. 

“The treatment that really gets my attention, though, is VelaShape,” says Piercy.  She received VelaShape treatments “...with zero downtime and little risk...I decided this is the one I must try.”  

The result? There was some bruising which faded after a few days, but overall, she says “I feel tighter if not thinner, and those painstakingly precise measurements show a 2.5 cm reduction of my waist, thighs and lower back.  Just enough to have me feeling newly taut in my jeans.”

VelaShape is a non-invasive medical device based on el?s™ technology - a combination of heat, light, suction and massage - and is specifically designed to improve skin texture, reduce the appearance of cellulite and target localized fat deposits. Experience the most popular non-surgical alternative to liposuction with VelaShape!

Say no to vitamins says Dr.Saltzman

May 28, 2009

I tell my patients all the time, don't waste your money on vitamins. No large scale study has proven that they have any beneficial effects. A recent study published in May 2009 supports this. Researchers in Germany gave half of the studies participants moderate doses of vitamins C and E and had them exercise. They then measured sensitivity to insulin as well as indicators of the body's natural defenses to oxidative damage. The group taking vitamins had no improvement in insulin sensitivity and almost no activation of the body's natural defense mechanism against oxidative damage. It seems that the vitamins block our bodies own mechanisms to combat free radicals.

In the News This Week

April 29, 2009

What are swine flu symptoms?

Flu symptoms

The flu is characterized by a collection of symptoms that can often occur suddenly, including:

1.Fever (higher than 100° F)
A fever occurs when your body temperature increases in response to illness or injury. Your temperature is considered elevated when it is higher than 100°F.

Body chills that are not related to a cold environment can be a sign of the flu.

A headache associated with the flu may appear suddenly, and be related to body aches or nasal congestion you're experiencing.

4.Extreme tiredness
It's normal to feel tired at the end of a long day or when you don't get adequate sleep, but unexplained tiredness can be a sign of the flu.

5.Dry cough
Know your cough. A productive cough (coughing up mucus) is common with a cold, while a non-productive or dry cough (with no mucus) is associated with the flu.

6.Sore throat
Swelling in the throat can lead to a sore throat.

7.Runny nose
Runny nose may also occur but is more common in children than adults.

8.Muscle aches
While it is normal to feel body aches from physical overexertion, body aches that are sudden and unexplained can be a sign of the flu.

9.Stomach symptoms
Stomach symptoms such as nausea, vomiting and diarrhea are more common in children than in adults

10.Chest discomfort
Chest discomfort is often severe with the flu.

Swine Flu Philadelphia

According to the CDC, the swine flu is spreading in the United States and internationally. Today, the CDC reported additional confirmed human infections, hospitalizations and the nation’s first fatality from this outbreak. The more recent illnesses and the reported death suggest that a pattern of more severe illness associated with this virus may be emerging in the U.S. Most people will not have immunity to this new virus and, as it continues to spread, more cases, more hospitalizations and more deaths are expected in the coming days and weeks. As of this morning a total of 91 cases have been reported in the US, with 51 cases confirmed in New York. I suspect this is a low number as it takes time for test results to come back and some states had not submitted results yet. There has been one fatality, a 23 month old boy from Mexico, it seems as if he was taken to the hospital too late. When he arrived he was already in critical condition. So far it appears that given the modern medical care in the U.S., patients who come down with the virus should fare much better than patients in Mexico.It's unclear what will happen with this outbreak, the best case would be that it would die out in a few weeks, however the virus could mutate and become more virulent and cause widespread serious illness and death. If you come down with a fever and severe cold symtoms call you doctor or report to the emergency room. Don't wait until your breathing is compromised to seek medical attention. 4/30/09 10:28am

Antioxidant found in berries prevents wrinkles and sun damage

Another study presented this week supports the use of antioxidants in preventing wrinkles and premature aging of the skin. Using a topical application of the antioxidant ellagic acid, found in berries, nuts, pomegranates, researchers at Hallym University in the Republic of Korea markedly prevented collagen destruction and inflammatory response – a major causes of wrinkles -- in both human skin cells and the sensitive skin of hairless mice following continuing exposure to UV-B, the sun's skin-damaging ultraviolet radioactive rays. So continue to eat a diet rich in fruits and vegetables, avoid the sun, apply a high spf sunscreen and use an antioxidant serum. See http://www.nbcphiladelphia.com/health/tips_info/Before_Botox__Try_Berries_Philadelphia.html

Are you sneezing and itching?: An Update on Seasonal Allergies

Have you been experiencing itching eyes and nose, runny nose, nasal congestion, sore throat, cough, difficulty sleeping…it could be seasonal allergies. With the warm weather starts the spring allergy season which is a result of allergies to tree pollen. How to feel better, limit your time outside, keep windows closed and shower off after outdoor activities, rinsing your nasal passages with saline also helps. If you are still having symptoms, try an over the counter antihistamine, or see your doctor for a prescription for a steroid nasal spray.  http://cbs3.com/video/?cid=6091

A Closer Look: Nutrition

Sustainable Weight Loss Leads to Long-Term Health, Disease Prevention
August 2008

Fad diets might help you to fit into your favorite dress for a party coming up in a couple weeks. But such diets don’t often contribute to your long-term health – especially if you can’t keep the weight off.

Many people try drastic methods to drop pounds fast. Regardless of whether it is a disciplined low carbohydrate, high fat diet, or a high carbohydrate, low fat diet, studies prove that a person is equally as likely and able to lose the same amount of weight due to the reduced caloric intake of fad diets. A study published in the American Journal of Clinical Nutrition found that when 100 women went on a 12-week trial of an energy-restricted high-protein, low-fat diet or a conventional high-carbohydrate, low-fat diet, their weight loss did not significantly differ. In addition, the same study found that diets high in meat protein did not have harmful effects on the kidneys or bones.

Still, such extreme diet regimens have a slim chance of remaining sustainable if they differ too greatly from a person’s regular eating habits and preferences. Instead, one must consider making easily maintained adjustments to his or her diet and eat in moderation to lose weight in a gradual, healthful and sustainable manner. Sustainability is central in ensuring a healthy diet and weight that prevents diseases such as diabetes and cardiovascular disease.

“Whole grains, fruits, vegetables, monounsaturated fats, fish and lean meats should be the mainstay of a healthy and sustainable diet,” says Dr. Leslie Saltzman, Medical Director of the Rittenhouse Women’s Wellness Center. Dr. Saltzman discourages drastic deprivation of essential nutrients, as required by many fad diets.

Indeed, weight loss maintained over time is a major contributor to the prevention of diabetes, obesity, cardiovascular disease and other sometimes fatal illnesses. A study of almost 70,000 women published by the Archives of Internal Medicine found that women who follow a diet rich in fruits, vegetables, legumes, fish, poultry and whole grains had less heart disease after 14 years of follow-up. This study compared those who stuck to this heart healthy diet with those who had higher intakes of red and processed meats, sweets and desserts, french fries and refined grains. The latter group of women had more cases of heart disease. A similar study also found that diastolic and systolic blood pressure in people with hypertension was reduced through the consumption of diets rich in fruits, vegetables and low-fat dairy products.

Preventing Diabetes

A diet rich in whole grains, monounsaturated fats, fruits, vegetables, fish and lean meats is also necessary in the prevention of type 2 diabetes. A cohort study published in the Archives of Internal Medicine found that a diet high in red and processed meats, refined grains, and other characteristics was associated with an elevated risk of type 2 diabetes in women in a 14-year follow-up. This particular study found that red meats, especially processed meats such as bacon and hot dogs, cause an increased risk of type 2 diabetes. In addition, a study published in the American Journal of Clinical Nutrition found that diets with a high glycemic index and low in whole grains (i.e., white bread, white rice, rolls and certain types of potatoes) have been associated with an increased risk of type 2 diabetes. These high glycemic foods require more insulin output from the pancreas in order to turn carbohydrates into glucose that can be used by the body’s muscles. This process is very taxing for the pancreas’ beta cells that release insulin, thus leading to cases of type 2 diabetes.

Ultimately, it is clear that diets rich in whole grains, fruits, vegetables, monounsaturated fats, fish and lean meats ensure long lasting health and wellness. Please contact Rittenhouse Women’s Wellness Center at 215-735-7992 if you would like to set up a nutrition consultation and receive advice on establishing a healthy eating regimen right for your lifestyle and unique health needs.

A Closer Look: Emotional Well-Being

How to Better Manage Stress
August 2008

Many Americans tirelessly seek to strike balance and achieve health and happiness in their lives. However, a majority of recent studies have found that stress is a significant threat not only to emotional well-being, but also to physical well-being.

According to a 2007 release by the American Psychological Association, one third of Americans are experiencing extreme stress, and 48% of Americans believe their stress has increased within the last five years. Many people are finding it difficult to manage their work, family and social commitments, which has led 54% of those surveyed to name stress as the cause of arguments with friends and family.

Of those who experience stress, 77% have reported physical symptoms including fatigue, headache, upset stomach, muscle tension, change in appetite, teeth grinding, change in sex drive and dizziness.

Fortunately, there are ways to cope with stress and help improve your health and overall well-being. First, you must identify harmful behaviors you may have to cope with stress and then you must begin to replace these harmful behaviors with more helpful coping behaviors. The following is a list of the most common harmful coping behaviors and the most helpful coping behaviors.

Harmful Coping Behaviors

  1. Ruminating - Concentrating thoughts or an extended period of time on a particularly stressful event. i.e., Driving the whole way to work with thoughts of a heated argument between you and a loved one.
  2. Avoidance - Inhibiting or suppressing thoughts and feelings creates additional anxiety. i.e., Trying not  to think about those 10 pounds of weight you’ve put on ends up leaving you feeling more self-conscious and frustrated for ‘letting it get to you.’
  3. Compulsion - Repetitive and excessive activity used to neutralize intrusive thoughts. i.e., Worrying that the car door is unlocked, then pressing the lock button repeatedly.
  4. “Shoulding” - Placing expectations on yourself and others. i.e., “I should give my mother a call” versus “I’d like to give my mother a call.”
  5. “Catastrophizing” - Creating the illusion that an incident is far worse than it is and predicting a disastrous outcome. i.e., “I just made a mistake in this project! I’ll never be able to finish it on time and then I’ll surely be fired!”

Helpful Coping Behaviors

  1. Acceptance - Accepting the event has occurred and that there are some things you cannot change.
  2. Take Action - Recognize what cannot be changed and concentrate on what you can do now.
  3. Evaluate the Action - Reserve judgment for behaviors, not people. i.e., A mathematical error is just an error in calculation; it does not mean the person who made the mistake is stupid.
  4. De-catastrophizing - Put each event in perspective and realize when it may not be so cataclysmic to your life in the long run.
  5. Practice Unconditional Love of Self - Everyone makes mistakes and it’s important to maintain respect for yourself even when you’re not performing at your best.

If you would like more advice and guidance on coping with stress, please call the Rittenhouse Women’s Wellness Center™ at 215-735-7992.

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