"Wellness is a new concept in health care," explained Dede McGuire, wellness program director for Care New England, one of Rhode Island’s major health care providers. "It’s also become a trendy term. Businesses are sprouting up with shingles using the word ‘wellness.’ Medicine has shifted its focus to prevention and keeping people well. Partially this is because of what we’ve learned, and partially it’s economics. Wellness is not an eight-week program where goals are reached and everyone goes back to their old habits. It’s about lifestyle behaviors. Approximately, 60% of all visits to doctors are for problems linked to lifestyle behavior choices."

McGuire noted that women’s health issues have taken on more importance to society and the economy as women have entered the workforce. "The incidence of female cardiovascular disease has risen," she said. "High pressure, stress, grabbing food on the run and not taking care of our bodies lead to illness. Women are carrying beepers and cell phones and are always on call. Our expectations of ourselves are even greater than what others expect of us."

The Wellness Center blends traditional and alternative medicine with education. "It incorporates all aspects of traditional medicine, alternative medicine, behavioral health, exercise psychology and nutrition," said Dr. Steven Joyal, former medical director at the center at Beechwood and Laurel-mead. "More patients are seen at alternative medicine practitioners than at conventional practitioners. Alternative medicines include massage therapy, stress reduction and herbal treatments."

Dr. Joyal sees wellness as a type of empowerment. "When you stop smoking, eat a reasonable diet and exercise, you empower yourself to know you are doing the right thing," he explained. "You begin to have a good body image and feel better about yourself. It doesn’t matter how many times you’ve failed in the past. If you keep trying, you will eventually succeed in the end."

The First Cornerstone of Good Health: Exercise

"There is an incredible amount of data showing the value of exercising daily, " noted McGuire. "At a minimum, everyone should exercise at least three times a week–walking, biking, climbing the stairs instead of taking an elevator." Dr. Joyal observed, "The single best thing to do for yourself is exercise; and the single most important thing to do to improve your physical appearance is weight training."

Men and women tend to exercise differently. "Men generally need more cardiovascular exercise in their routine while women need more resistance training," Dr. Joyal said. "We used to think that 20 minutes of continuous cardiovascular exercise was necessary. Now the emphasis is on the total amount of exercise. Three 10-minute segments are as good as a half-hour continuous session."

Dr. Joyal explained that people can change the rate at which they burn calories. "Muscle burns calories even at rest," Dr. Joyal said. "The higher the proportion of muscle, the higher the metabolic rate for men or women. Weight training is critical because it adds muscle mass and improves the metabolism which is ultimately responsible for the success or failure of any weight loss effort. Weight training will not produce bulky musculature in women. Muscle can’t turn into fat, they are completely different things. Weight training also builds bone density in young women while helping older women maintain their bone mass preventing osteoporosis and fractures. Bone density peaks when a women is in her 20s or 30s."

While Dr. Joyal concedes that resistance machines are safe and easy for beginners, the unsupervised and those undergoing rehabilitation, he believes that the best tool is the simple dumbbell. "Free weights may improve balance and force you to work unilaterally exercising the right and left side evenly and stabilizing the muscles," he explained. "The neurological system works harder to maintain balance and posture particularly during lunges and squats. These exercises transfer better to the outside world. When a bag of groceries is lifted, one limb is being used in an unstable three dimensional environment."

Warm up time is not the same for everyone. "More advanced athletes need a longer warm-up than sedentary people," Dr. Joyal said. "The warm-up should let you break a sweat without being hard on the joints. It should be specific to your later exercise. Warming up increases the elasticity of the muscle, tendons and ligaments and protects the joints. Stretches should be done only after warm-up."

Massage therapy may supplement an exercise program. "Massage therapy has crossed over from sports therapy and exploded in popularity," Dr. Joyal noted. "By breaking up adhesions and scar tissue, it speeds healing of chronic overuse injuries like tendonitis and promotes recovery after exercise."

McGuire, however, warned that abuse of exercise (overexercise) as well as eating disorders may lead young women to develop osteoporosis. "A young woman who has developed amenorrhea (the cessation of her menstrual periods) has a clear problem," she said. "Stress fractures are another warning sign of bone density loss."

The Second Cornerstone of Good Health: Nutrition

While exercise is the single best thing you can do for yourself, Dr. Joyal noted that the two tactics next in importance are stopping smoking and eating a reasonable diet. "Numerous studies have shown weight loss is all about calories," he said. "Be cautious at looking at new diet fads, particularly any kind of extreme diet such as the Pritikin diet, the protein power plan, zone diet, ketogenic diets and the liquid protein diet. The truth is that any abrupt change in diet will cause weight loss as long as you are eating fewer calories."

Dr. Joyal explained the pitfalls of these new diet fads. "The Pritikin diet with its low protein and high carbohydrates may be particularly bad for diabetics," he said. "High protein diets (those in which 40% or more of daily calories derive from protein) work well initially, but the rapid weight loss is all fluid. You are only dehydrating yourself. Fad diets work short term; they are not long-term solutions. The dieter may put back all the weight and more."

Dr. Joyal does not advocate a vegetarian diet. "Our genetic code is 20,000 years old, while our reliance on grain is only 5,000 years old," he explained. "Instead, eat nutrient-dense, calorically sparse foods such as vegetables, fruits, chicken, fish and wild game. Whole grains are fine. Oatmeal is a terrific food with only minimally processed grain. Avoid calorically dense foods like cakes, candy, cookies and soda. Pasta is still a starch, usually made from processed white flour and a concentrated source of calories."

Fats represent an area of broad misunderstanding. McGuire specifically cited 20 to 30 grams of fat a day as a minimum necessary level for adults. Dr. Joyal explained, "While fats elevate cholesterol, and it is important to limit consumption of saturated fats, it is not intelligent to eliminate fats completely. They are needed for essential fatty acids. Restricting dietary fat in infants can actually result in growth retardation. Mother’s milk is high in fat, babies grow best on a high fat diet."

Dr. Joyal distinguished between three types of fat in the diet, saturated, polyunsaturated and mono-unsaturated with only saturated fat raising serum (blood) cholesterol levels. "Eggs can be eaten in moderation even by people with heart disease," he said. "While they are high in dietary cholesterol, that cholesterol is primarily polyunsaturated. Polyunsaturated fat actually lowers serum cholesterol, lowering both the good cholesterol (HDL) and the bad cholesterol (LDL). Mono-unsaturates like olive oil do not affect serum cholesterol. The overall strategy is to raise HDL levels and lower LDL levels."

Dr. Joyal recommended three methods for raising HDL levels: stop smoking; exercise; and drink a glass of red wine or red grape juice daily. While noting possible benefits in moderate alcohol intake, he dismissed the benefits of cooking with garlic or taking dietary garlic supplements. "Garlic is effective in a limited way only if several cloves a day are eaten raw," he said.

McGuire stressed the importance of calcium for women whether from milk or some substitute. "Roughage and enough water is also important," she added. "The best source of water is water, not coffee, tea or colas that contain caffeine. For roughage, you can grab a fast salad just as quickly as a burger. Dietary supplements like Ensure or Carnation Instant Breakfast make a good quick meal or snack, but don’t try to live on them.

"Try for a diet that is realistic in your lifestyle. When you prepare your evening meal, make an extra portion for lunch the next day. If your diet is unrealistic, you are just giving yourself another goal to fail at." McGuire is unhappy with the body mass indexes being used to measure body fat. "If it’s high, women, especially young girls, are immediately set up for developing an eating disorder," she noted. "Clearly there is more to good health than a body mass index."

The Third Cornerstone of Good Health: Stress Reduction

Dr. Joyal noted that the mind does influence the body in measurable, documentable ways. "Stress lowers the immune system and worsens chronic illnesses," he said. "It has even been linked to cardiovascular disease by increasing the stickiness of platelets, an important component of blood. Emotional states affect perceptions of illness and chronic pain. Many people suffering from chronic illness or pain have symptoms of depression. When that depression is lifted, their sense of pain is lessened."

McGuire explained that stress management is an attitude. "If you can, turn off your beeper at five p.m.," she advised. "Take a walk, listen to music, talk to a friend, try yoga, rollerblading, biking or go to a counselor if you need to. Read something unrelated to your work-life to relax your mind. Cut down watching television or reading the newspaper. If you are listening to the radio, stick to music only. Take some time each day away from your children. If the kids are older, let them spend some time in their rooms. Get your husband to share the responsibilities. Lunchtime can be time for a walk. A lot of companies mark routes around their office building. Use a pedometer and set a couple of routes of your own. Put on your sneakers and take off your beeper." McGuire, however, sees the trend toward fitness centers at work as a mixed blessing since the work environment is never completely left behind.

"The relaxation response has been well documented scientifically," she noted. "When you relax, physiological changes occur in your body effecting your blood pressure, respiration and heart rate. A mantra or catch phrase of a few words repeated and said out loud can promote relaxation or meditation. Mindfulness is another important meditation technique. Let your mind focus only on the moment, only on what you’re sensing at the moment–your breathing, how your body feels, your body temperature. Stay completely non-judgmental. Another technique is to scan your body, relaxing one muscle group at a time. Meditation may be done to music. Positive thinking and prayer can also help change or achieve focus during stressful situations."

McGuire explained that any personality type may be retrained to lower stress levels and stress responses. "More than half of those hospitalized for cardiovascular disease have "Type A" personalities which anger easily and engage in aggressive behavior," she said. "The blue dot method may lessen and eventually prevent the stress response. A blue dot is stuck to all the places that normally provoke a stress reaction. If traffic provokes tension and anger, the blue dot may be placed on the rear view mirror. The driver is reminded to relax whenever he sees it. It’s important to set priorities and live with them. Decide what’s really important. Are the few minutes you’re detained by traffic really important?"

Dr. Joyal also sees the importance of exercise in managing stress and promoting relaxation. "The key thing is to just get up and exercise. Walking is a low-intensity activity–start slowly and build to a faster speed. Swimming has the drawback of not being a load bearing activity–it won’t build or maintain muscle mass. Yoga is good for both flexibility and balance. Tai Chi builds spatial and postural awareness."

Sleep deprivation may be related to stress. "If you find yourself saying, ‘I need to get more sleep,’ then you probably do," Dr. Joyal said. "The chronically sleep-deprived live shorter lives. Some people may need only six hours of sleep a night while others need 10."

A Healthy Woman and a Healthy Baby

Don’t wait until you’re pregnant to see an obstetrician. The most important time for an engaged couple to discuss pregnancy with an OB-GYN doctor is before they try having a baby. Any couple having unprotected intercourse is "trying" to have a baby whether or not it’s in their plans. Statistically, 15% of these couples will achieve a pregnancy each month. Even among married couples, 40% of all pregnancies were not planned, noted Dr. Donald Coustan, head of OB-GYN, at Woman & Infants Hospital in Providence, RI. "Very early in pregnancy, very important things are happening to the baby," Dr. Coustan explained. "Organs form during the first two months. After this time, birth defects have already happened and it is too late to prevent them. Couples who skip pre-conception counseling are missing an important opportunity to prevent problems. Pre-conception counseling is primarily about risk assessment."

Nutrition is also discussed. All women who might become pregnant need to increase the folic acid in their diet to prevent neural tube defects such as spina bifida. Couples with a family history or a previous child with neural tube defects need larger doses of folic acid. Women on diets and vegetarians may need vitamin supplements.

Women with a strong family history of diabetes, obesity, or previous large or still births should be screened for undiagnosed diabetes. Women who have never had rubella, German measles, should be immunized before pregnancy to prevent the severe birth defects rubella causes. Hepatitis B immunization is also recommended. Women with a history of IV drug use, blood transfusions or multiple sexual partners particularly need to be screened for HIV.

Certain common medications like the popular acne drug, accutane, cause birth defects. Some high blood pressure medications are also linked to birth defects. At the pre-conception counseling, the doctor will change these medications to comparable ones that are baby-safe. Ethnicity of the bride and groom are also important as different ethnic groups are prone to different genetic diseases. An individual may be a carrier of a genetic disease without showing any symptoms of that disease. While most individuals in particular ethnic groups are not carriers, generally, both parents would have to be carriers for the disease to show up in their child.

Women remain susceptible to cervical, ovarian and breast cancer all their lives. Each decade, the risk of breast cancer increases. Women should have breast and internal examinations yearly. Young women should have gynecological care before they become sexually active to prevent unwanted pregnancies and sexually transmitted disease.

Prevention isn’t always enough: If any of the following warning signs appear, see a doctor immediately even if an examination isn’t due: frequent urination; pain on urination; loss of hair; fever and chills; change in nature of periods or cessation of periods; heavy thirst; unintended weight gain or loss; thoughts of harming self or others; chest pains that last more than five minutes; unusually terrible headache; blood-tinged sputum, vomit, or stool; loss of function on one side of body; or persistent pain anywhere.

Health Through Herbs

"Herbal treatments have gained acceptance based on usage in Europe." Dr. Joyal explained. Donna Bainton, the center’s resident herbalist warned that not all herbs are completely safe for all people. "I am concerned about the misinformation about herbs that is being circulated in the press," she said. "If you are on medications, ask your doctor or call the Care New England Wellness Center for a consultation before taking herbs. The most common side effect is allergic reactions. The body may refuse to accept the herb and try to eliminate it through vomiting, fever or diarrhea. If your body reacts allergically to an herb, it will not lead to any lingering side effects. Herbs leave the body completely and quickly. Herbal teas are a good way to test for allergies. Use only organic herbs to avoid concentrating pesticides."

Herbal treatments may assist a wide variety of health problems ranging from stopping smoking to persistent yeast infections. Public interest in herbs has resulted in Care New England introducing its own brand of quality, combination herbs premixed by Bainton. "Like food, herbs are best used in combinations, not singly," Bainton explained. "Don’t try to balance herbs yourself. Buy them in combination or get professional advice. The amount of the active part of the plant that is contained in the bottle may be very small. It varies tremendously from brand to brand. Herbs need to be used in ‘prescription’ type dosages. If a little is good, more is not better.

"Herbs should not be taken over long periods of time. You should get results within three months. St. John’s Wort may be used for up to two years to relieve mild to moderate depression, but should not be used by anyone already on an anti-depressant medication. Herbal combinations for stress and hawthorne berries to strengthen heart muscles may also be used longer term."

Wedding Stress: "Six months before your wedding, try taking Stress X, an herbal combination of B vitamins complex, valerian, passion flower and hops," Bainton advised. "Then six weeks before, if possible, switch over to the formula that includes St. John’s Wort. Three days before the wedding, begin using ‘rescue remedy,’ or ‘calming essence’ made from a combination of five flowers which may be placed on the tongue or drunk in an herbal tea, or in water. Rescue remedy does not interact with other medications and is available in tablet form for those who can’t use alcohol. It’s great before you walk down the aisle. It will keep you calm but still focused, while controlling tears and stomach jitters. As you notice it wearing off, it’s okay to take a little more.

"A variety of flower essences drawn from over 200 essences and used in combinations of up to six flowers are also effective for emotional balance. Each tiny bottle is individually formulated for specific types of anxiety or depression. Four drops are used four times a day until the bottle is finished. Results begin within 48 hours."

Toothache, Cramps, Acute Stress or Insomnia: "Adults can use rescue remedy under their jaw for toothache or on their abdomen for cramps. Kava (kava kava) may be extremely effective in handling acute stress from trauma or sudden grief. It works in only a few hours but should not be used for more than six to 12 weeks. Kava tea or chamomile tea blends which sometimes contain valerian may also treat insomnia. If you are using kava in a tea or capsule or making a powdered drink, use it while you are at home, never before driving. A side effect of kava is vivid dreams. Some people have the opposite reaction to kava and might be kept awake by it."

Yeast Infections: "Stress aggravates yeast infections," Bainton said. "Candida yeast has been linked to digestive problems, mood swings, PMS, skin problems, irritable bowel syndrome, chronic fatigue, fibromyalgia and some serious emotional problems making it important to treat. Acidophilus in liquid or capsule form–both of which need refrigeration–unsweetened cranberry juice or cranberry concentrate capsules and caprylic acid are used for treating yeast infections. Limit sugar and dairy products. Especially limit chocolate. Take for two to six weeks. These products in combination may be taken for up to three months."

Preventing Infections: "Echinacea and goldenseal minimize the symptoms of colds, but Echinacea should not be used for more than eight to 10 days," Bainton warned. "Take it three times a day if you know you’ve been exposed to colds or flu. Echinacea and goldenseal should not be used by anyone with auto-immune diseases. They might substitute the Chinese herb astragalus instead."

Chronic Fatigue: "Chronic fatigue may improve when balanced herbs and nutritional support are used along with a combination of exercise, meditation and stress reduction," Bainton noted. "Ginseng and gotukola may help stamina; ginkgo biloba may improve the oxygenation of the blood; and hawthorne berries may help the heart. Full body massage and chair massage also help relieve stress."

Beauty: "For improved hair, skin and nails use a complex that includes horsetail, silica, B complex, trace minerals and an alfalfa base," Bainton recommended.