This month, our staff is working to design the curriculum for our twelve-month program, Optimizing Weight and Lifestyle, which will begin this September. In the process, we've spent a lot of time thinking about the most effective ways to facilitate lasting behavior change.

As health educators, part of our jobs is share information, impart knowledge, and provide tools and resources to support patients' own wellness journeys. To effectively facilitate meaningful change, though, we must seek to understand our patients' barriers to change. Knowledge may be the foundation of wellness education, but it doesn't always translate to action. Perhaps you know you should incorporate more vegetables into your diet, you know you should move more and sit less, you know there are countless benefits to reducing stress and in many cases, and you know what habits and routines need to shift in order to live a more vibrant and fulfilling version of your current life. But perhaps knowing isn’t the challenge. DOING is where we get stuck.

We invite you to enjoy this month's newsletter with the intention of exploring your own barriers to change. It is through this very introspection and strategic planning that you can shift the notion of "lifestyle change" from an abstract ideal to a tangible reality. 

In great health,

University of Arizona Integrative Health Center

• On Arizona Horizon, Dr. Heidi Rula discusses effectiveness of a whole-person approach to health care and shares information about a three-year Integrative Medicine Primary Care Trial (IMPACT), which will compare outcomes for patients treated using integrative care with patients treated using solely conventional medical care.
• Health Coach, Katie Dalton on Fox 10 Morning Show makes an anti-inflammatory face mask using avocado, coconut oil, cacao powder, honey, and oats and three more DIY hydrating masks from kitchen ingredients on ABC 15's Sonoran Living.
• Check out Katie Dalton's article Optimal Summer Skin in Scottsdale Living Magazine to learn practical strategies for protecting your skin against the the worst environmental culprits, including pool chemicals, air-conditioning, and chemically-laden personal care products.

Have you participated in our Healthy Body Composition class? Nutritionist, Tracy Baginski, will be hosting monthly group meetings for all completed participants to date, with the goal of supporting sustained progress. The first meeting will be held on August 29 from 5:30-6:30 pm. Please RSVP by calling 602-470-5577.

Optimizing Weight and Lifestyle 12-Month Program

• Do you struggle with sustaining a healthy body weight?
• Are you motivated to lower your risk factors for chronic disease or lessen the impact of your existing conditions?
• Do you recognize the value of exercise but are unsure of how to implement it in a safe and effective way?
• Are you looking to cultivate a healthier relationship with food?
• Are you wondering why your daily habits don’t always align with your wellness goals?
• This September, UA Integrative Health Center is offering a 12-month lifestyle transformation course designed to ignite your path to lifelong wellbeing by empowering you with integrative knowledge, tools, and support. Participation is free to all patient members and will utilize two course credits.

Components of this 12 month program include:

• Individualized medical assessments
• Initial 12 weeks of group education sessions led by UAIHC practitioners covering the topics of nutrition, mindfulness, exercise, stress reduction, and motivation for lasting behavior change
• Optional group acupuncture sessions to help reduce stress and facilitate detoxification
• Opportunity to participate in bimonthly group movement sessions focused on improving flexibility, increase total-body functional strength and boost your metabolism.
• Ongoing, monthly support upon completion of 12 week course

Interested in registering for the Optimizing Weight and Lifestyle Program? Informational orientation sessions will be held on Thursday, August 15 from 5:15-5:45 pm and Wednesday, August 21 from 1:00-1:30 pm. To find out if this program would benefit you, please call 602-470-5577 and ask to speak to Tracy Emmons, RN.

• Seasonal Foods will be offered on Thursday, 8/22 from 5:30-6:30. See Class Descriptions to learn more.
• HeartMath is a 3 week series and runs 8/13-8/27.
• Nutrition 101 is a 6 week series and runs 7/16-8/20 and 7/17-8/22.
• Stress Management 101 is a 5 week series and runs 8/8-9/5.
• Healthy Body Composition is a 6 week series and runs 7/17-8/22.
• Chair Yoga, Mat Yoga, and Tai Chi meet in Suite 126 at 3003 N. Central Ave (tower across the courtyard). These 3 courses are ongoing and meet every week, all year.
• All other classes are held inside the clinic.
• Current members, please register at the front desk or call 602-470-5577.
• Access our group class schedule via our Google calendar.
• Check out our Facebook page for daily integrative health tips, articles, and insights! www.facebook.com/UAIntegrativeHeathCenter

By Katie Dalton, ACE

As a health coach, part of my job is helping patients to bridge that gap between intention and action. While there may be no one formulaic way to become “unstuck”, it is absolutely possible to achieve sustainable health behavior through a process of critical, strategic, and often creative thinking. Try spending a few minutes reviewing the list below and think about which point resonates with you the most. Before you stop reading, set an intention to take action on of the suggested strategies or come up with one of your own!  

Compelling goals need strong roots.

• While extrinsic motivators like improving lab results, an upcoming 10K, or the desire to fit back into an old pair of pants can be powerful drivers, lasting change requires something deeper: intrinsic motivation. This internal “reason for change” is created from within. After all, you are the expert of your own existance. You, more than anyone else, know what’s important in your life.
• To get in touch with your intrinsic motivation, try building your vision before you set goals. A wellness vision is a written picture of how you want your future life to look. Ask yourself how you want to live your life, what you want to do, how you want to spend your time, places you want to go and how you see all of the important elements of your life evolving, including your your relationships, career, fitness, health, and spirituality.
• This compelling vision that you’ve created now serves as a compass, directing you through your own journey. Every micro-goal or strategy that you set forth to accomplish brings you into closer alignment with that vision. If you like the idea of making this a visual exercise, try creating a vision board. 

Buildings are built brick by brick.

• The concept of incremental change is one of the most underappreciated aspects of adopting a healthier lifestyle. Micro-goals, or strategies, should be tangible, achievable steps.
• For example, if you know that optimal energy levels are key to living your wellness vision, and you know that in order to increase your energy, your sleep must improve, you can define the specific steps to take for better sleep hygiene. Step #1 may be to set a window of time to be in bed by, Step #2 may be to take the TV out of your bedroom, and Step #3 may be to get your bags together and lunch ready right after dinner each night so you have an extra 20 minutes of sleep in the morning.
• You're more likely to follow through with these strategies if you write them down. Be specific. What will you do? When will you do it? How long will you do it for?      

The most effective solutions are created before the problem arises.

• Imagine how ineffective a fire escape route would be if we waited for a fire to start before planning it? Changing behavior works the same way. Let’s say you’ve set a goal to eat less processed foods, but every time you go to the movies you feel like you’re missing out on the experience if you don’t indulge in a bucket of popcorn or bag of candy. Once you’ve entered the theater, it’s a little late to solve the problem, but if you anticipate the challenge beforehand and bring a small bag of nuts and fruit with you, you can still snack without sabotaging your clean eating plan.

Harness the power of habit.

• It’s estimated that 40% of our daily actions are habits, not decisions. Habits are neurological processes designed to help the brain conserve energy and avoid overstimulation. Habits occur in loops consisting of a cues, routines, and rewards. The cue serves as a trigger for the brain to enter into autopilot mode. The routine is the actual behavior evoked by the cue, and the reward is the prize gained by engaging in the behavior.
• You can “hack” a negative habit and leverage the loop to replace it with a positive one with a simple journaling exercise: Identify the cue, identify the reward, and then brainstorm a positive behavior to replace the undesired routine that is stimulated by the same cue and that provides the same reward. To learn more about using the habit loop, watch this short video by Charles Duhigg, author of The Power of Habit. 

Strengthen the willpower muscle.

• Whether you call it self-discipline, self-control, or self-determination, it’s easy to fall into the trap of thinking that it’s all about mind over matter. The reality is, willpower isn’t something we have or don’t have; rather, it’s a learnable skill, and like any skill, it requires practice to be mastered. Mastering one baby-step change at a time is the perfect way to do this.
• Another method of practicing and strengthening willpower is to improve self-awareness through meditation, which literally increases the concentration of gray matter in your prefrontal cortex, improving the physical willpower capacity. Visit UCLA’s Center for Mindful Awareness to access a series of free guided meditations. 
• Willpower is also a limited resource, which means it needs energy to be sustained. To ensure optimal energy reserves, aim for 7-9 hours of sleep per night, consume plenty of water, spend at least a few minutes each day outside, and engage in some physical activity every day (which also increases gray and white matter in the brain).

Get out of black and white thinking.

• This journey is not about perfection. Going through each day thinking you’re “on” or “off” your health plan is a recipe for a yo-yo lifestyle. Instead, try embracing and leveraging the gray area between black and white by practicing the 80/20 approach: 80% of the time, you make the choices that align with your goals, allowing 20% for intentional treats, breaks, and indulgences.
• For example, if you LOVE chocolate chip cookies but vowed to eliminate them completely, you’re likely to feel like you “totally blew it” if you succumb to one (which could perhaps lead to emptying the rest of the plate?). If you plan in advance to enjoy one or two after dinner on Sundays, it’s simply part of the plan. The result of relinquishing the rigidity of a lifestyle plan is an increase in emotional control, a key predictor in lasting change.

A little self-compassion goes a long way.

• You know that voice inside your head? The one that criticized your reflection in the mirror this morning or regularly evokes feelings of regret, self-doubt, poor self-confidence or self-esteem? Think of someone if your life that you love. Would you speak to them with the same language that this inner voice uses? Try this exercise from the Rick Hanson’s Just One Thing: Developing A Buddha Brain One Simple Practice at a Time: Take a moment to acknowledge your difficulties and then recall being with someone who really loves you (family member, friend, spiritual guide or pet). Feel how much you matter to this being, and imagine he or she is feeling and expressing compassion for you in your difficulties. Be open to this—receiving care primes circuits in your brain to give compassion.
• Self-compassion is about recognizing the impact of self-talk and then reframing it, first by identifying your self-judgments (journaling is helpful) and by then replacing them with positive self-affirmations. Spend some time creating these positive mantras and visualizations so that they’re ready for you to pull out during moments of self-criticism. 

Environment shapes choices.

• Choice architecture is based on the notion that we can design decisions to influence our behavior. In other words, we make the better choice the default choice. Portion control is a perfect example. Simply by using larger water glasses, smaller wine glasses, and a larger salad bowl, you could increase your hydration, decrease your alcohol intake, and up your consumption of dark leafy greens without making any real substantial changes to your dinner. 
• The best places to start modifying your environmental cues are the settings where you spend the most time (often, work and home). Take an inventory of these environments and start brainstorming ideas. Other examples include: extra sneakers in your office to nudge a lunch time walk, pre-portioned snacks in the cabinets to avoid eating straight from the package and exceeding a single serving, or cutting up fresh fruit and veggies at the start of the week to keep in the fridge so a healthy meal or snack is one step closer. 

Support systems matter.

• The ability to leverage your support system is an essential asset to change. We often think of a support system in the form of family, friends, and co-workers offering verbal encouragement, but your network of support comes in all forms. It could be logistical – an arrangement with your spouse to alternate dinner-making responsibilities or child care to accommodate each other’s yoga class, for example. Perhaps it’s a matter of accountability, as you plan to meet a coworker 15 minutes before work every morning for a quick walk.
• Part of optimizing your support system is being able to differentiate between supporters, non-supporters, and saboteurs and strategically filtering your interactions and relationships accordingly. Whenever your network of support involves other people, though, it’s important to communicate the significance of their support and ask how you can best support them in return.
• Your support system isn’t limited to human interactions. Consider all of the messages that are “fed” to your brain every day through emails, TV, newsfeeds, etc.  What steps can you take to more effectively align these interactions with your own wellness goals and values? Examples could include choosing podcasts or Ted talks over morning radio or TV shows or unsubscribing to certain Facebook pages or posts.

Most importantly, have FUN!

• If you treat the process of changing your behavior as a series of dreaded tasks and daunting responsibilities, it will be just that. It is the journey of becoming a healthier person that allows you to experience true health. You can learn to embrace that journey by experimenting with new recipes, finding physical activity that you truly enjoy, sharing your energy with those around you, and remembering to feel grateful for the daily opportunities you have to improve your wellbeing.

By Katie Dalton, BS, A.C.E.

You may have caught wind of a recent Environmental Working Group report, EWG's Guide to Better Bug Repellents, which gained mainstream media attention, featured in a CNN article Buzz off, bugs! How to stay safe during insect season and USA Today's What's worse: bug bites or bug repellent?

Though I'm sure we can all agree on the need for effective protection against insect-borne diseases like malaria, Lyme disease, and West Nile Fever, our increasing understanding of synthetic chemical ingredients in personal care products and their implications on human health certainly does warrant a more thorough assessment of bug repellants. By compiling data from the Environmental Protection Agency, the World Health Organization, and the Centers for Disease Control and Prevention, that's exactly what the EWG aimed to do. 

Here's an brief summary of their findings: 

The following four registered and approved repellent chemicals offer a high level of protection from a variety of biting insects and ticks and have good safety profiles:​

1. Picaridin
2. iR3535
3. DEEt
4. Oil of lemon eucalyptus and its syntheticderivative pMD

The EWG recommends the following Do's and Don'ts for safe and effective bug repellent use:

DO:

• Do wear pants, socks, and shoes, and long sleeves, especially when venturing into heavy brush withlikely bug infestations.
• Take extra precautions to avoid bug bites if you are in a high-risk area for Lyme disease, West Nile virus or other mosquito- and tick-borne illnesses.
• Use nets and/or fans over outdoor eating areas and place nets over strollers and baby carriers.
• Read labels to learn about safe usage and protection from bug species known to infest your area.
• Choose a repellent concentration rated for the time span you’re outdoors, but not longer.
• Use products with the lowest effective concentration of repellent chemicals, particularly on children.
• Consult a physician if you are traveling out of the U.S. or need to use bug repellent daily for prolonged periods.
• Take extra care with kids. Keep repellents away from young children to reduce risk of accidental swallowing.
• Send kids to camp with netting for bunks.
• When using repellent on a child, apply it to your own hands and then rub them on your child.
• Avoid eyes and mouth and use repellent sparingly around ears. Do not apply repellent to children’s hands because they sometimes put their hands in their mouths.
• Use products in lotion, pump or towelette form.
• Try repellents on a small patch of exposed skin before slathering all over. Check for ticks thoroughly after returning indoors and remove ticks properly.
• Wash clothing and repellent-coated skin when your kids come indoors or at the end of the day.

DON'T USE:

• Oil of Lemon Eucalyptus/PMD on children younger than 3 years old.
• More than 30 percent DEET on anyone.
• Any bug repellents on children under 6 months.
• Outdoor “fogger” insecticides. They contain more toxic ingredients than repellents applied to skin.
• Candles. They may not be effective. They emit fumes that could trigger respiratory problems.
• Aerosol sprays in pressurized containers. You’ll inhale chemicals, and you could get sprayed in the eyes and face.
• Repellent mixed with sunscreen. When you reapply sunscreen every two hours as advised, you overexpose yourself to repellent.
• Bug zappers and treated wristbands.

By Kathy Engles, PA-C

Question: I recently read a New York Times article, The Heart Perils of Pain Relievers. Should I be concerned about the health risks of over-the-counter pain killers?

Answer: There comes a time in our lives when due to a variety of circumstances, we will experience acute physical pain and will seek relief. Choosing an appropriate treatment can be confusing especially when considering a group of medications known as NSAIDs- nonsteroidal anti-inflammatory drugs.

NSAIDS are very effective for pain relief but are not without potential risks. Recent research has demonstrated that daily use of some NSAIDS at high doses can increase cardiovascular risk by one third compared to those taking a placebo. Several prescription NSAIDS have been removed from the market for this reason.

Additionally, NSAIDs can damage the protective surface of the gastrointestinal tract and cause erosions or ulcers and can potentially raise your blood pressure or affect your kidneys or liver. This makes it important for you to consult with your healthcare provider if you have any underlying conditions that may increase your risk of adverse side effects. For those without increased risk, the advice is to use the lowest dose of NSAIDS for the least amount of time.

Complementary and alternative approaches offer pain relief as well. Acupuncture is gaining recognition as an efficacious adjunct or alternative treatment of low back pain, joint pain, migraine headaches and menstrual cramps. Mind-body approaches which include breath work, guided imagery, meditation and hypnotherapy can promote relaxation and enhance release of pain relieving chemicals in the brain and potentially transform your perception of pain. Additionally, chiropractic care has been shown to be an effective treatment for back and neck pain. 

For chronic pain, seek care from a pain management specialist, preferably one who incorporates conventional therapies alternative therapies.

By Tracy Baginski, BS, CCN

"There are only two mistakes one can make along the road to truth; not going all the way, and not starting." ~ Buddha

On July 11th the news exploded with bad news regarding fish oil.  The New York Daily News online article led with "Men who take omega 3 supplements at 71% higher risk of prostate cancer".  Other headlines and news anchors echoed similar warnings.  Once again the general public, consumers and medical offices are faced with interpreting the data and answering questions about fish intake and fish oil supplementation. 

The headlines quoted research by Brasky, et al. from the Fred Hutchinson Cancer Research Center which was published in the July issue of the Journal of the National Cancer Institute.  The abstract concludes with "This study confirms previous reports of increased prostate cancer risk among men with high blood concentrations of LCw-3PUFA (long chain omega 3 fatty acids).  The consistency of these findings suggests that these fatty acids are involved in prostate tumorigenesis".

Really?

Given the plethora of positive research findings reporting the many benefits of omega 3’s (over 10,000 and counting), the above report is certainly worth a closer, critical look.

What was the source of the fish oil found in study participants’ blood? No data is available on the diets of the study participants.  In fact, no documentation was provided regarding intake of fish or fish oil supplements in the study group.  It is well documented that some cold water fatty fish and fish oil supplements are indeed contaminated with mercury, PCB's and dioxin-like compounds.  The research did not control for these factors. 

Also, participants included in the current study were drawn from a separate study called 'SELECT' which was designed to look at the relationship between vitamin E and selenium on prostate cancer.  Participants were asked to not take a multivitamin and that if they wanted one it would be provided for them.  Given the study restrictions on supplementation and the very low levels measured in the blood, it is highly unlikely that participants were regularly supplementing.  The ongoing mantra in the media that 'supplements are dangerous' is unwarranted and inappropriate. 

Type of lab test used to assess levels:
The study design used a single plasma phospholipid fatty acids test to assess levels.  This test does not provide a good measure of long term fish consumption and is influenced significantly by a single meal and/or fish oil dose.  Conversely, 48 hours after a meal of dose levels decline appreciably.  Again, the study design did not take this factor into account.   The level of EPA and DHA (the long chain omega 3 fish oil) in the group without cancer was 3.62%, while the level in the cancer group was 3.66%, a small difference. Here at UA Integrative Health Center, our physicians frequently order a lab test called the Omega 3 index, which is a more accurate and stable way of measuring levels of omega 3 and other types of fat in the cell membrane. 

Drawing Conclusions from Studies:
Perhaps the most egregious error is the conclusion that was drawn, as very few studies are able to determine a cause and effect relationship between two variables.  You've probably heard the phrase "correlation does not equal causation".  That applies here to this retrospective study.  For the headlines to erroneously report "...a 71% higher risk of prostate cancer" is not only impossible, it's bad reporting.  

Food for Thought:
There are numerous countries where seafood consumption is much higher than it is here in the United States.  Why aren't rates of prostate cancer skyrocketing in Scandinavia and Japan?  Clearly there are other factors influencing outcome, as numerous other studies have shown a reduction in prostate cancer risk with increased consumption of omega 3's (Lietzman et al., 204, Terry et al., 2001)

It is reported that given a long enough life span, most men will develop prostate cancer and for the majority of these men the cancer is not fatal.    While no man ever wants to hear those words, research shows that the longer the life span, the more likely a diagnosis of prostate cancer will result.   In reality, significantly more men die from heart disease.  And when it comes to heart disease, fish oil’s benefits are well studied and broadly accepted.

The conclusion is summed up nicely by the expert lipidologists at www.lecturepad.org:

"There will always be mixed findings in studies of 'diet' and 'disease' since both predictor and outcome entail so many variables, known and unknown. Higher omega-3 levels are associated with lower rates of death from any cause (Mozaffarian et al, Pottala, JV et al.) , from sudden cardiac arrest (Albert, CM et al.), and with slower rates of cellular aging (Farzaneh-Far R et al.). The risk benefit for fish oils remains very favorable."

Clearly, we still have miles to go to reach the truth about fish oil and prostate cancer.

By Tracy Baginski, BS, CCN

How many times in the past month have you resorted to the ‘drive through’ at the end of the day because you were too tired to think about putting something together at home?  Or perhaps you are one of the estimated 31 million Americans who skip breakfast.  Time, or lack of it, is the most frequently cited reason that so many of us are opting for a bowl of cereal for dinner or skipping meals altogether.  Life comes at you fast, and making time to plan and prepare can seem overwhelming and like one more thing for the ‘to-do’ list

If the thought of cooking your weeknight meals sends you into a panic, you are not alone.  Instead of setting a lofty goal to cook nightly, start with a manageable goal and aim for one or two more home prepared meals each week.  This will give you an opportunity to gradually explore some of the many ideas and recipes that are available.

Here are a few suggestions to help you get started: 

It all begins with a grocery list and a kitchen stocked with the staples to build a “4 part meal”. 

1. Vegetables:  pick up some fresh and frozen mixed vegetable packs.  Get several varieties and purchase organic when possible. Ex:  a mix of onion, pepper, and mushrooms
2. Protein:  whether it’s chicken, turkey, fish, tofu or beans, keep several varieties on hand. Ex: sliced skinless, boneless chicken breast
3. Sauce/liquid: stock several jars of ‘clean’ marinara (ingredients that are easily recognizable and could be found in your grandmother’s kitchen), a tetra box of organic chicken and vegetable broth, and some good quality coconut milk. Ex: good quality glass jar of marinara sauce
4. Herb/seasoning: invest in some spice mixes including Thai, Indian, French, Mexican seasonings to flavor your dish. Ex: garlic, mixed Italian seasonings, basil and a squeeze of Thai hot sauce- Sriracha

To cook, place everything in a crock pot in the morning and cook on the low setting. (Tip:  Get everything together the night before and pile into the crockpot.  In the morning all you have to do it hit “start”).  You’ll have dinner waiting for you when you get home and the house will be filled with the aromas of a home cooked meal.

Alternatively, put into a soup pot at the end of the day and simmer for 45 minutes or until done.  Having everything ready to go is essential, so keep in mind that the most labor intensive part is the slicing.  If you have time, slice the vegetables yourself to preserve nutrients.  If you don’t, then pick up the precut packs.

 If you can, set aside an hour on the weekend to pre-slice your protein and veggies so that they are ready for cooking.  Alternatively, you can even pre-cook your chicken breast with a little seasoning and then add it towards the end of the simmer time.  In fact, make some extra cooked chicken (or turkey, etc.) and freeze for later use.  This 4 part formula yields many tasty results.  Try a quick cioppino stew using a frozen bag of seafood from Trader Joe’s and a zesty marinara, or a quick and easy Indian curry using mixed vegetables, tofu or chicken and some coconut milk.  The combinations are endless. 

If you are not familiar with the website Pinterest then take some time to explore.  This is a great place to browse for time saver kitchen ideas.  Mason jar meals are a fun way to prep and store pre-made meals. Spend a little time browsing for ideas and inspiration. 

Other make-ahead ideas include healthy muffin tin meat loaf, which freeze well for a ready-made lunch or dinner). For a make ahead and take-to-go breakfast idea try the mini frittatas and mix in a little bit of sautéed spinach or mushrooms for added flavor and health benefits. 

When you do it yourself you can adjust the ingredients and seasonings to suit your taste, all while controlling the amount of salt and fat. Plus there’s that added satisfaction you get from creating something tasty from scratch.  Bon appetite!

This recipe is adapted from Beth Hensperger's Not Your Mother's Slow Cooker Cookbook.  If you don't think that summer is a good season for the crock pot then consider this: some days, not only is it too hot to turn on the oven, it's too hot to stand over the BBQ grill!

Ingredients:

• 16 oz. jar Marinara sauce
• 1 coarsely chopped yellow onion
• 3 cloves garlic, minced
• 2 or 3 chopped peppers (either red, yellow or orange bell peppers) into 1 1/2 inch chunks
• 4 boneless skinless chicken breasts and/or thighs
• 12 ounces of mushrooms, sliced (try mixing in some Asian mushrooms like shiitake, enoki)
• 2 Tbs flour or arrowroot powder to thicken (optional)
• 2 Tbs water
• 2 Tbs dry white wine (optional)

Steps:

• Layer half of the marinara sauce and all of the onion, garlic, pepper, seasonings, and chicken in the slow cooker.
• Sprinkle with the mushrooms, then top with the remaining sauce.
• Cover and cook for 2 1/2 to 3 hours on high, or 6 to 7 hours on low.
• As soon as the chicken is cooked thoroughly and the inside is no longer pink, remove it from the cooker and cover it loosely with foil or with a bowl to keep it warm.
• Whisk together the flour and water and add the mixture to the sauce in the pot.
• Turn the setting to high and let the sauce thicken for 15 minutes.
• Serve over the chicken.

After making this recipe numerous times I've found that I enjoy a little more zest and add in a squeeze of Thai hot sauce called Sriracha, and an extra Tbs of dried mixed Italian herbs.

By Katie Dalton, BS, A.C.E.

Unlike many other parts of the country, August is when most Arizonians gravitate indoors to escape the stifling temperatures. For some, that means a schedule shift, setting the alarm and getting out the door just a little bit earlier each morning to squeeze in a walk or bike ride that would be intolerable by late afternoon. For many others, such a logistical adjustment isn’t feasible, and the result is a frustratingly sedentary season.

All healthy behaviors must be adaptable to a variable environment, though, and exercise is no exception. Try following these tips to prevent the summer heat from sabotaging your commitment to a physical active lifestyle.

• Wear a pedometer. Using a device to track your steps is perhaps the most powerful reminder to increase your incidental movement (and if you live in a house or work in a building, that’s where most of your opportunities to move more will be anyway!). Many of our patients have success with the FitBit, which allows you to upload data wirelessly and monitor your progress online.
• Go more often for less time. If the weather is getting in the way of your usual 30 minute walk, how about taking two fifteen minute walks, or three 10 minute walks throughout the day?
• Take a dip. You can do a lot more than just cool off in the pool. Aside from swimming laps, try wearing a flotation belt and getting your heart rate up with some deep water running (running in place in the deep end) or take an aqua-fitness class that incorporates the use of weights. Just remember that most pool-based exercise is non-load bearing so shouldn't serve as a total replacement for weight-bearing exercise, which is critical for sustaining bone mineral density, preventing osteoporosis, and sarcopenia. 
• Become a mall walker. While not for everyone, mall-walking can be a terrific solution to getting your steps in. Check out MallWalkers.info to find shopping malls in your area that open their doors early specifically for mall-walkers. 
• See what your TV has to offer. If you're a subscriber to Netflix or Hulu, be sure to check out the Health & Wellness show categories for free workout and mind-body classes that can be done right from your living room.
• Try something new. The reality is, many people don’t love the idea of working out in a big-box gym (even if it is air-conditioned) but August is a perfect time to step out of your comfort zone and try something new, like a dance class, spin studio, self-defense class, or indoor rock-climbing gym. One of the best ways to find new, indoor spots is to check out discount sites like Groupon and Living Social. Scoring a monthly deal can help lower the financial barrier and you know you won’t be the only newbie too! 

If you do choose to exercise outdoors, proper hydration becomes extra critical during the summer months. Follow these basic hydration guidelines to ensure you’re safely getting the most from your workouts:

• Sip often. Specific fluid requirements will vary depending on the activity, intensity, duration, and weather conditions, but aiming to take a sip of water every 15 minutes is a good place to start.
• Make it cold. You may already prefer it with ice, but research shows that colder water delays a rise in core body temperature during exercise. Keeping your body cooler for longer means a decrease in heat-related stress and fatigue.
• Keep your water close. If you’re walking, biking, running, or hiking, consider using a hydration pack like a Camelbak to keep your water accessible. Filling the pack’s bladder with ice (which will rest against your back) will also help to cool your core body temperature. 
• Recover. It’s recommended to consume 20-24 oz. of fluid per pound lost during exercise. If necessary, you can weigh yourself before and after a training session to calculate lost fluid.
• Replenish lost electrolytes. Sodium and potassium, both critical to bodily function, are two minerals that need to be replaced with vigorous exercise, especially in the heat. One pound of sweat contains 400-700 milligrams of sodium and 300-800 milligrams of potassium. Commercial sports drinks often contain artificial flavors, colors, and preservatives but natural food stores do sell quality, organic electrolyte replacement products. Aim to consume 20-24 oz. of a natural electrolyte beverage per hour of intense exercise. 

*Urine color is a good indicator of hydration status. You should use a clear lemonade-color as your “hydrated” goal.

*Coconut water has become popular in recent years as an alternative to conventional sports drinks, touted as a good source of potassium. It should be noted, though, that research actually points to sodium loss, not potassium, as the primary cause of muscle cramping. Coconut water may be an all-natural product, but doesn’t contain the necessary sodium so on its own, is not a sufficient source of electrolyte-replenishment. 

Sources:

Why you should drink cold water during exercise 

Chair Yoga
This unique class is designed for seniors or for those who have physical limitations or difficulties exercising. Students are led through a series of yoga postures while seated in a chair or using a chair for support, providing options and modifications for everybody. Appropriate for beginners. Taught by Dawn Rutledge

Seasonal Foods This is a hands-on, experiential class centered on preparing meals using seasonal, fresh, local foods. In this year long, 4-class series, you will have an opportunity to roll up your sleeves, don your apron, and get some ideas for incorporating seasonally-based foods into your meals. Recipes and tastings are included. Taught by Katie Dalton, ACE and Tracy Baginski, CCN

Mat Yoga (Level 1)
This is a basic, self-paced class emphasizing the fundamental poses of yoga to reinforce foundation and focus. Appropriate for all levels of student. Taught by Dawn Rutledge

Tai Chi
Tai Chi and Qigong are a gentle series of circular and stretching movements that help relieve stress while increasing one’s natural energy. Benefits of a regular practice include improved blood pressure, circulation, muscle and joint flexibility, balance, mental clarity, and peace of mind. This class is appropriate for all levels and experience, including seniors and those with physical challenges. Taught by Angella Hamilton

Nutrition 101
Our Nutrition 101 class provides a 6 week tour of our foundational program:  The Mediterranean Plate.  This class is designed for anyone who seeks a deeper understanding of the role that foods play in inflammation, healthy aging, and overall health.  We will review the practical, hands-on aspect of gradually transitioning your kitchen (meals and food choices included) into a healthy and delicious food pharmacy.  Taught by Tracy Baginski, BS, CCN

Healthy Body Composition 
Changing habits take time, information, patience, and guidance.  In this comprehensive 6 week program you will learn how to create a lifestyle that supports a healthy, fat-burning metabolism.   Topics covered include:  meal planning and preparation, which foods safely boost metabolism and optimize fat loss, and environmental factors that impact the body’s systems. After the initial 6 week class, ongoing monthly meetings will be held to provide additional support and guidance. Taught by Tracy Baginski, BS, CCN 

Meditation for Wellness
This is a 6 week class that will introduce patients to several forms of Mindfulness Meditation practices. There is a wealth of evidence demonstrating that meditation reduces the negative effects of stress and increases compassion for ourselves and others and is an additional tool to aid in creating health and wellness. Taught by Kathleen Engles, PA-C
  
Mindfulness-Based Stress Reduction (MBSR)
Mindfulness practice is ideal for cultivating greater awareness of the unity of mind and body, as well as of the ways the unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health. MBSR was developed in 1979 by Dr. Jon Kabat-Zinn at UMASS Medical School. This is a manualized, evidence-based, 8-week program. MBSR is highly participatory and deeply engaging experiential learning.  Taught by Dr. Tom Best and Gayle Cordes, LPC, LISAC *Will resume in early Fall

HeartMath
HeartMath is a collection of tools and strategies especially designed to lower stress and increase emotional and physical resilience. HeartMath interventions help to establish a new physiological baseline - a measurable change in heart rate variability (HRV) that you can both see (on a computer screen) and experience. You will learn to sustain this change in the midst of your challenging daily lives. As a result of using HeartMath interventions you may experience better sleep, more energy, improved mood, less stress, less anxiety, more joy, greater mental clarity, improved intuition, improved concentration, more optimism, improved performance and greater overall well-being. These factors naturally enhance physical and mental health. Taught by Tracey Emmons, RN

Stress Management 101                                                     In this 6 week series, we will learn how our bodies react to stress, both short lived and chronic. We'll start by learning to identify the numerous sources of stress in our lives; both physical and psychological by taking a stress inventory. This will be followed by experiential sessions of proven stress management techniques and tools. Armed with this information, you will formulate your own unique plan for stress management. It’s important to understand that you can’t entirely eliminate all the stress from your life, but you can learn to immunize yourself against its effects! Taught by Kathy Engles, PA-C