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Females reach Peak Bone Mass, which is the greatest amount of bone mass a person will ever have, between the ages of 18 and 25. Studies have shown that having high levels of Peak Bone Mass (which indicates high bone density) during this time becomes important because it decreases the chances of developing osteopenia and osteoporosis later in life. These conditions, which cause brittle bones and increase risk for fractures, tend to occur more frequently after menopause. In fact, during the first few years after menopause, most women experience rapid bone density loss (a loss which continues at a slower pace throughout the postmenopausal years). How do we combat this ‘natural’ loss of bone density over time? Studies have indicated that weight-bearing exercises play a huge role in maintaining and even increasing bone density mass!

Similarly to muscle, bones are a living tissue that adapt to the stress that we put on them, which means the more we use them or exercise, the stronger they become. Ideally, women should perform consistent weight-bearing exercise (strength training in particular) long before menopause begins to benefit our bones the most; however women can experience these benefits to some degree at any age. For instance, one study showed that intensive strength training allowed women in their early post-menopause years to regain bone as they built muscle. They actually gained an average of 1.5% in bone mineral density in as little as nine months with rigorous strength-training regimes — a huge difference from the 2% of lost bone that might have otherwise occurred. Another study conducted by the Journal of the American Medical Associations showed that even women who were in their 70’s “avoided the expected loss of bone and even increased their bone density slightly” after lifting weights twice a week for one year!

So, if weight-bearing exercise is the key, what types of activities does this include and how often should you perform them? Weight-bearing exercise is defined as anything you do on your feet which forces you to work against gravity. Strength training, as mentioned in the above studies, has been found to be the most effective for increasing bone density. However, other activities, such as walking, climbing stairs, hiking, and dancing are all forms of weight-bearing exercises and can benefit bone density as well. While swimming and biking provide health benefits, they are not considered true weight-bearing exercises. Weight-bearing activities should be performed at least 3 times per week for 30-60 minutes at a time.

While the biological propensity of females to lose bone density mass over time, which often leads to the development of conditions like osteopenia or osteoporosis (especially after the onset of menopause), may seem daunting, know that you have the power to prevent this process and/or fight the effects of it! Strengthening your bones by loading your muscles and joints, whether through strength training, walking, dancing, etc. can maintain and even significantly increase bone density. No matter what age in life, it is never too late to start battling this natural process – let us know if we can help you get started at the Rittenhouse Women’s Wellness Center!



Most of us know we need to eat more fruits and vegetables. The United States Department of Agriculture (USDA) is recommending to eat half your plate as fruits and vegetables at every meal. Some authorities claim numbers even as high as 13+ servings per day for optimal health. However, it’s certainly easier said than done. Our busy lives, multiple jobs, children, traveling, social activities (etc.) make it understandable that people today are more susceptible to eat fast foods and quick, convenient treats. Life’s demands can get the best of many of us.

Despite our busy American lifestyles, healthier options have been emerging in our society that can be taken advantage of. Raw food bars, vegetarian options at restaurants, urban gardening, and menus with calorie/nutrient amounts are trending in a positive direction into our culture. Unfortunately, many people still lack the understanding of why fruits and vegetables are essential in our diet. It is hard to adapt these principles without understanding the true reasoning behind all of it. To name a few, did you know that greens alone can do all of the following:

  • blood purification
  • improved circulation
  • cleared congestion
  • promotion of healthy intestinal flora
  • promotion of subtle and light energy
  • lifted spirit and elimination of depression
  • improved liver, gallbladder, and kidney function
  • cancer prevention

Calorie for calorie, dark leafy greens are known to be among the most concentrated source of nutrition of any food. Kale, for example, is known for its antioxidant benefits and aids in expelling free radicals and helping to fight against degenerative diseases. It also has fiber, which helps with satiety and prevents overeating. Greens help to balance the pH of your body. Many modern foods are acidic in nature and can lead to health issues. Greens help to neutralize acidic foods and keep your body at a healthier pH level.

Adding greens back into your diet may feel overwhelming at first. If you do not even know where to begin, try adding one at a time. Do not force it! Let your innate hunger for greens come back naturally by slowly incorporating more greens into your diet. Your body craves what it remembers. Broccoli, bok choy, napa cabbage, kale, collards, watercress, mustard greens, broccoli rabe are some of the many to choose from. Arugula, endive, chicory, lettuce, mesclun, and wild greens taste great raw.

Greens can be made in a variety of methods like steaming, boiling, sauteing in oil or water. Boiling makes green plump and relaxed. Steaming makes greens more fibrous and tight. Raw greens can be refreshing, cooling, and supply live enzymes. Green smoothies and blended salads are additional ways to eat greens. If you are interested in learning more about nutrition and/or the health benefits of greens in your diet, schedule an appointment with a Registered Dietitian today.



Most of us have experienced heartburn at one time or another–or know someone who has.  A tight or burning sensation develops in the center of the chest, usually in response to overindulgence of certain trigger foods, and is resolved with antacids–nothing to worry about, right?  Not necessarily.

Acid reflux occurs when stomach contents, including stomach acid, wash back into the esophagus.  This is caused by weakness of the lower esophageal sphincter, which separates the stomach from the esophagus.  When this happens, people experience symptoms such as heartburn, regurgitation, or trouble swallowing.  Less well-known symptoms of acid reflux can include airway spasm, cough, laryngitis, nausea, and “globus”, which is a constant foreign body sensation in one’s throat.

Many people will experience some “physiologic” reflux which is brief and without adverse consequences.  But for a number of others, reflux can be more persistent, and cause other complications over time if left untreated.  These may include ulcer, esophagitis (inflammation of the esophageal tissue), stricture (narrowing of the esophagus), and Barrett’s esophagus, which increases the risk of cancer of the esophagus.  Asthma and sinus infections have also been linked to uncontrolled reflux symptoms.  Reflux which produces mild symptoms 2 or more times a week, or moderate to severe symptoms at least once a week, needs treatment.  In this situation lifestyle modification, as well as a trial of an antacid medication, is indicated for a period of time. The two types of medications commonly used are H2 blockers and proton pump inhibitors–both are available over-the-counter, but should be taken under a doctor’s supervision so that therapy can be adequately monitored and adjusted as needed.  If reflux symptoms cannot be controlled with a trial of lifestyle changes and medication, then the American Gastroenterological Association recommends endoscopy with biopsy to rule out other conditions and to look for worrisome changes in the esophagus that may result from chronic acid exposure.

Individuals can minimize their symptoms of esophageal reflux by avoiding trigger foods, such as chocolate, fatty or spicy foods, and alcohol.  Acidic beverages such as red wine or orange juice may also exacerbate reflux symptoms.  Remaining upright after eating and elevating the head of the bed has been shown to be helpful, as well as weight loss and smoking cessation (to promote more salivation, which neutralizes the stomach acid).  But the most important thing is recognizing the symptoms of reflux and seeking treatment early to prevent complications from this common condition.



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:

Product

Amount of Calcium    (mg)

Serving

Soy or Rice Milk   (fortified)

300-370

1 cup

Tofu (fortified)

215

1/4 cup

Orange Juice   (fortified)

175-200

1/2 cup

Collard Greens

135

1/2 cup

Dried Figs

135

5 each

Spinach

135

1/2 cup

Soybeans

130

1/2 cup

Bok Choy

100

1/2 cup

Turnip

100

1/2 cup

White Beans

95

1/2 cup

Kale

90

1 cup (raw)

Okra

90

1/2 cup

Oatmeal

85

1/2 cup

Veggie or Soy Patty

85

1 each

Beet Greens

80

1/2 cup

Almonds

75

1 oz.

Dried Beans &   Peas

50-100

1/2 cup

Hummus

65

1/2 cup

Soy Milk   (non-fortified)

60

1 cup

Baked Sweet Potato   (w/ skin)

55

1 medium

Mustard Greens

50

1/2 cup

Orange

50

1

Tofu (unfortified)

20

1/2 cup



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!



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:
    • Use refillable stainless steel or glass water bottles when on the go;
    • Store and heat food in glass, ceramic, or paper; not plastic
  • Food packaging: Avoid BPA Opt for:
    • Fresh or frozen fruit and veggies;
    • Dry beans;
    • Food and drink packaged in glass, not cans;
  • Fish: Avoid mercury, dioxin, and PCBs in fresh water fish and ocean fish:
    • Trim fat from all fish to minimize dioxin and PCBs;
    • 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.;
    • Opt for organic food (especially meat and dairy when possible) or food consistently low in pesticides (Get the list);
    • Use non-toxic strategies to fend off pests inside the home, on the yard, and on your pets;
    • 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;


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.



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!



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.


26/Apr/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.


A Note from RWWC

“Since our founding in 2008, our goal has been to provide primary care for women. Our team of physicians and nurse practitioners are dedicated to providing preventive care, diagnosis and treatment of acute and chronic disease(s) and coordination of care with specialists.”

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