-3483396164C66EFA0Guest Blogger, Dr. Carrie J. Carlson is an Osteopathic Physician, Board Certified in  Family Practice and currently studying Functional Medicine with the  Institute of Functional Medicine.  A former Avera McGreevy physician for 10 years, she has also worked at the Sioux Falls VA Medical Center  in the outpatient Primary Care Department.  She is interested in “thinking outside the box” when it comes to applying clinical  medicine.  Her hobbies include nutrition, holistic/herbal medicine,  reading, running and potty-training her 3 year old.  Her goals for 2013 include running a marathon, de-cluttering her home, and becoming  a Facebook user.  She is a little overwhelmed by these goals but will  not let them deter her.”Let’s talk about a few diet myths and exercise.


There are many “myths” with dieting.   Recently the New England Journal of Medicine had an article in the January 31, 2013 issue:  “Myths, Presumptions, and Facts about Obesity.”  Briefly, I will summarize a few of the myths, please read the original article if you want more info.   At the end of this article, I discuss my thoughts on exercise, which truly is not a four letter word.

Myth #1:

Small changes in your diet/lifestyle in the long term will help you lose large amounts of weight.

The idea is cutting back by 100 calories a day, you should be able to lose one pound in 35 days.  One pound = 3,500 calories.  But studies have shown, over time, this does not cause continued weight loss.  You need big changes for big weight -loss.  Unfortunately, due to the complexity of our metabolism, it appears this small change theory does not cause big weight- loss over time.    Basically, if you need to lose big, you need to change big.  If you really want to lose weight in this lifetime and change your path away from chronic disease and illnesses, including but not limited to:  diabetes, heart disease, high blood pressure, cancer, joint arthritis, chronic back/joint pain and taking early nursing-home tours.  Yikes.   That list is enough to scare anyone.  But is it enough to scare our brains to not crave salt, fat and sugary foods?  The processed food industry is trying to keep us addicted to those foods.  See an article titled, “The Extraordinary Science of Addictive Junk Food.”  This article, dated February 20, 2013, in the New York Times, gives very revealing information.  Maybe your cravings for chips and sweets are not completely your fault after all?The article is free, research Google for it.  Recently, I gave up Diet Coke, not an easy thing to do.  I think there is a secret ingredient not listed in it, increasing the cravings for it.  Any soda for that matter is highly addictive.  The soda people know this.


Setting realistic weight-loss goals is important; otherwise frustration will lead to less weight-loss.  (For example:  losing #50 vs. #10 is harder and you are more likely to fail.)

They claim there are studies that show just because you had a larger goal does not mean you will fail more often.  Unfortunately, we have become a society of immediate gratification.  We want weight loss now, not in 6 months.  However, if you really need to lose #50 and are ready to make a commitment to it, maybe now is the time for you.  Get some help with it though, join Weight-Watchers or have a Biggest-Loser contest at work.  Losing big amounts of weight might mean getting big amounts of support from your family and friends.

 Myth #3

Don’t lose weight too fast, or you might gain it all back.

Not too surprising here.  But, I wonder how much water loss vs. actual fat loss is taking place with rapid weight loss.  Most people fluctuate up and down every few days a few pounds.  I think this is directly related to your sodium intake (salt).  Whenever I bring up sodium intake to patients, I always hear, “but doc, I don’t use any salt!”  Well guess what?  It’s probably in the can of soup you eat, the pickles and ketchup, the frozen microwaveable lunch meal you bring to work every day, potato chips, and one of the biggest culprits?  Ham and deli meats usually have a ton of sodium in them.   

The original article has more details.  Please review it if you have further questions…

Finally, to wrap up this discussion, let’s get moving people!   And I don’t mean to a warmer climate, like Florida.  Let’s start talking about exercise.  My personal opinion is the more you exercise after age 40, the healthier you will be at age 70+.  My healthiest patients at the VA Medical Center were the ones who had been very active and exercised frequently most of their lives.  (Even if they were #20 overweight.)  But why is exercise so hard to maintain?  Or even start for that matter?  Personally, I think people are just plain exhausted and say to themselves, “I will start tomorrow, or next week, or maybe the first of next month.”   After a long day at work, it feels like one more thing on the “to do list.”  Just move your body, preferably off the couch.   There’s never a better time than now.  Don’t wait for some epiphany, some great moment of time where you say to yourself, “I’m ready to start exercising and this time I’ll stick with it forever.”  That moment might never happen.  Just start, but be careful at first.  It’s easy to get injured when you’re out of shape.  Explore new ways to exercise, like indoor cycling, kettle bells, Yoga or even Zumba.    You might surprise yourself into actually sticking with a plan, a plan that helps with gradual weight-loss, and helps you keep it off.  An exercise plan you love.  This is the key to long-term health:  Find an exercise you love.   Living in a rural state like ours, we don’t all have the access or money to join a gym or fitness center.  You can rent DVD’s at your local library on many different types of exercise.  And you can even watch most anything on your home computer, for free.   Dig out those old Jane Fonda Aerobics videos.  Remember those?  Or Richard Simmons tapes.   Wear whatever you have on.  You don’t need fancy work-out clothes.  Good tennis shoes are helpful.

One last piece of advice:  if you ever watch T.V. late at night and see those inspiring exercise weight-loss Infomercial programs, like P90X and Insanity, don’t order any until you ask me about them.  I own most of them, have tried most, and some are good, some are bad, and some are ugly (unless you have the knees of a 23 year old and/or have passed a cardiac stress test in the past 6 months.)  Seriously.   Good Luck!

Dr. Carrie

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cBeersCraig Beers, PharmD, grew up in Sioux Falls  and is a 2007 graduate from South Dakota State University with a Pharm D degree. He has 5 years’ experience in retail pharmacy and is currently a Clinical Pharmacist with DAKOTACARE. His hobbies include playing soccer, golfing and entertaining his two little boys.

With the struggling economy many people are looking for ways to save a quick buck. This includes shopping around for cheaper prices on medication and taking advantage of transfer incentives like free gift cards. Before you know it, prescriptions are scattered throughout various pharmacies which puts you at increased risk for adverse reactions, medication interactions, poor compliance and potentially increased health care costs.. Soon that gift card wanes in comparison of the hospital bill you receive because of a medication interaction.

Now, this is probably an extreme illustration of what could happen by having your prescriptions at multiple pharmacies, but that doesn’t mean you shouldn’t try to stick to one pharmacy and get to know your pharmacist.

If you stick to one pharmacy and develop a relationship with pharmacists at that facility your overall health will benefit. The pharmacist will have the ability to track all your medications, screen any new medications for interactions and look for any gaps in care. Once you have developed a relationship with them and can trust them, you will feel more confident to ask questions about your medication and healthcare, and the pharmacist will feel more comfortable about approaching you if they have concerns. Pharmacists are widely considered the most accessible health care provider there is and you should take advantage their FREE expert advice whenever possible. After all, when was the last time you were able to walk into the physician’s office to ask a question without being charged?

In this hectic world we live in and limited pharmacy hours I know it may not always be possible to use the same pharmacy every time but whenever possible pick one pharmacy and GET TO KNOW YOUR PHARMACIST!

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Hello South Dakota!  This week we lost 62 pounds for a total of 1,505 pounds lost! We would like to congratulate Janelle, from Mitchell, SD as this week’s winner! Janelle, will be recieving a Be Well South Dakota Prize Package and Subway Gift Card.

Can you believe that we are already into week 8 of our 2013 Pound Pledge?  Where are you at with your pound pledge?  Sometimes we start losing weight, but we never finish. We ditch another diet. We throw in the towel on our exercise efforts. Maybe it’s from outside pressure; sometimes we aren’t ready to lose weight. Whatever the cause, it is not at all uncommon. This doesn’t mean you’re destined for failure. Even if you’ve started and stopped 100 times before, this time doesn’t have to end the same way and bottom line South Dakota…we are all in this together!  HELP US reach our goal to lose 2013 pounds these next 5 weeks and remember these tips below:


Tip #1:  Reward Yourself:  Don’t dwell on what you have NOT accomplished, rather focus on what you have changed.  Maybe you are drinking more water, eating more fruits and vegetables or decreasing your portions!


Tip #2:  Track Your Progress and Portions:  I know we have said this before, but the Be Well team has had tremendous success by tracking our nutrition and you can too!


Tip #3:  Master Emotional Eating or Events:  Whether you have had a bad day, a vacation or some other emotional situation, take control of this by managing your situation and remember how much exercise can really be therapy in many ways!


Tip #4:  Prepare for the Pushers:  You know, the co-worker, spouse or friend that is trying to get you to eat girl scout cookies with him/her!  Don’t let others come in between of you and your goals!


Tip #5:  Remember, It’s About Health:  At Be Well South Dakota, we are reminding you that we encourage a healthy lifestyle and even if you don’t reach your weight loss goals throughout our 12-week program, let’s not forget the long-term goal….a healthier you!


So with all of this said……..who wants to set a weekly goal to lose at least 1 pound this week?  We will be giving out another prize package this next week for those of you who report back to us that you have lost one pound and in addition……..let’s not forget about our grand prize that is at stake….a $200 Scheels Gift Card!!  We wish you the best this next week and we can’t wait to hear from you!



Happy Wellness Wednesday!

Here we are at week 8 for the 2013 Pound Pledge.  How are you doing?  I’ll be honest, last week I was struggling a bit.  I was STUCK! Despite making healthier eating choices and increasing my exercise…the numbers on the scale didn’t budge.  (Okay, okay…I’ll confess they budged, but in the wrong direction.)  Any of you ever struggle with this?

Instead of getting discouraged, I reminded myself the importance of staying consistent. To help me stay consistent with my healthy living goals, I pick small steps that can easily be integrated into my normal daily schedule.  Here are a few examples of the steps I have taken in February:

  • – At work, I am trying to park my car at the opposite end of the parking lot.
  • – Each week I schedule at least 3 gym dates with my husband.  (I write this time in pen on my calendar.)
  • – I am adding a fruit or vegetable at every meal and snack.
  • – I only add cream to my coffee on the weekends.
  • – I set a goal of what I call the “Just 10 Movement”.  For 10 minutes every day I move my body. To keep it simple, I do basic exercises up to 10 reps. Example:  I do 10 push-ups, 10 jumping jacks, 10 sit-ups, 10 lunges, etc.
  • – Track my daily food intake and physical activity at least three days a week.

By being consistent with these small steps, I am gaining the confidence and momentum to continue achieving my health goals.

After all, the gift of good health is the best gift I can give myself and my family.

How about you, what small steps are you being consistent with in your quest for a healthy lifestyle?

PS. Excited to share, by being consistent the scale budged in the right direction today!

Dr. Jill Sternquist is currently practicing at Avera Medical Clinic in Yankton, SD.  Dr. Sternquist attended Sanford School of Medicine at The University of South Dakota, Vermillion and completed her residency of Obstetrics/Gynecology at Creighton University Medical Center, Omaha, NE.

Congratulations, you are pregnant! Maybe you have been preparing your body for months or maybe that little “plus-sign-on-a-stick” is a bit of a surprise after a weekend of cocktails and sushi.  There are several things you should do to make your body the best hostess for your growing bundle of joy.


Of course, like everything, we all know someone who smoked during their pregnancy and everything turned out great.  All doctors know, and evidence only continues to show, that smoking cessation is the single best thing anyone can do for their health, pregnancy included.  Smoking causes increased risk of miscarriage, pregnancy complications and also leads to children with increased asthma, colic and obesity.


My mother tells me that she had a “couple of drinks” while she was pregnant with me, so that should be proof enough that things can turn out ok, right? Well, the truth is, we don’t know what a “safe” amount of alcohol in pregnancy is.  Thus, as a rule, avoid alcohol in pregnancy.  Besides, when you go to have a cocktail after pregnancy, it sounds a lot better to say, “Wow, is has been 9 months since I had one of these” than oh I had 1 or 2 last month.


If the people at Starbucks have your order ready as you approach the register, you may have to temper your habit a bit.  Recent research indicates that women that take in more than 200mg of caffeine a day are at increased risk of miscarriage.  (An 8 oz cup of coffee has 137mg, a soda 35mg, a bar of dark chocolate 30mg).  Remember that caffeine crosses from your blood to your baby’s, so if you have a 6 pack of Mountain Dew, so does your baby.

Medical Conditions

If you have any “chronic” medical conditions, diabetes, high blood pressure, or take any prescription medications on a regular basis, it is worthwhile to meet with your physician prior to attempting pregnancy.   Some prescription medications are not safe in pregnancy and alternatives can be used.  Conditions like diabetes and high blood pressure should be adequately controlled before pregnancy is attempted, to achieve the best outcome.


Ideally, we would all be of an ideal body weight all the time.  But achieving a “normal” weight prior to pregnancy is even more important. On either end of the spectrum, overweight and underweight gals have increased infertility issues compared to normal weight ladies.   There are increased risks of complications in overweight and underweight individuals.

Weight Gain

Current weight gain recommendations are based on pre-pregnancy BMI (Body Mass Index).  If you don’t know yours, there are multiple calculators on the Internet.

Category                     BMI                Recommended Weight Gain

Underweight               <18.5               28-40 pounds

Normal                        18.5-24.9         25-35 pounds

Overweight                 25-29.9            15-25 pounds

Obese                          >30                  11-20 pounds

Most weight gain will occur in the second and third trimesters.  Increased calorie needs are approximately 300 calories a day, which doesn’t correlate to “eating for two”.  Individuals who gain more than the recommended amount are at increased risk for C-section, diabetes and high blood pressure in pregnancy.


We recommend that women continue regular exercise during pregnancy…but wait you haven’t been exercising regularly?  Start a walking program.  Other low impact activities such as swimming or stationary bike can also be used.   Thirty minutes of moderate exercise daily has been shown to decrease the discomforts of pregnancy, decrease risk of diabetes in pregnancy, improve sleep, mood and energy.  Keeping fit during pregnancy also helps during labor.  Women who maintain their routines during pregnancy also return to their pre-pregnancy state quicker and easier.


No, we don’t recommend calorie restriction during pregnancy, but this refers to things you should avoid during pregnancy.  A well-balanced diet including fruits, vegetables, dairy products, proteins and whole grains is recommended.   Avoid raw fish and meats as they may contain bacteria that can cause pregnancy complications.  Avoid shark, mackerel, tile fish and swordfish as they can have high levels of mercury.  Soft cheeses (such as feta, Brie) should be avoided if they are not pasteurized (most products available in stores will have this notation on the package).

DHA (Omega 3 Fatty Acid) is the new supplement added to prenatal vitamins.  These Omega-3’s have been shown to help infant brain development, we thus recommend 12 oz of low mercury fish a week (shrimp, canned light tuna, salmon, pollock and catfish) in pregnancy. Other benefits have been seen and research continues.

Dietary Supplements

Taking a prenatal vitamin or vitamin with folic acid >400mcg is most important before even becoming pregnant.  Folic acid helps prevent birth defects in parts of the baby that are forming the first week after you miss your period.  Additional iron and calcium are also needed during pregnancy, as the growing baby will deplete the mother’s stores.


We do recommend all pregnant women receive the Influenza vaccine.  Pregnant women who get “the flu” are more likely to become severely ill than other individuals.  There has also been a recent increase in pertussis (whooping cough), so the TDap (Tetanus, Diphtheria and Pertussis) vaccination during the third trimester in all expectant mothers.  Fathers and potential caregivers should also be vaccinated to provide protection to the baby until it receives its vaccinations.

Most importantly, relax and remember that you are now caring for yourself and another individual.   Be kind to yourself and your growing baby.

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