This month we embrace a new change of seasons as we welcome the summer solstice. For many of us, that means adapting our routines to the warmer temperatures, weekend barbeques, beach days, and family vacations, all the while relishing the year's longest days. Like every new season, summer offers endless opportunity to redefine our commitment to our health and wellbeing. Please enjoy this month's articles and tips with that in mind. 

For some extra inspiration, here's an excerpt from The Spiritual Meaning of the Summer Solstice by Grove Harris:

"Honoring the solstice can remind us just how precious each day and season is, because the truth of its passing away is also acknowledged. Gifts need to be appreciated, not taken for granted. Some will use their religious ritual to raise energy for healing, for re-aligning and redressing environmental wrongs, or for strengthening the sense of being part of nature, not set apart and individual, but interconnected in a larger whole, including the past, present and future. Such is the power of participating in the turning of the wheel of the year."

In great health,

University of Arizona Integrative Health Center

This month we welcome a second Mind-Body practitioner to our integrative care team!

Jillian McManus is a Licensed Clinical Social Worker specializing in individual and relationship counseling. Her approach focuses on resolving barriers and addressing lifestyle factors that impact ideal functioning and personal fulfillment based on a holistic approach to wellness. Her areas of expertise include anxiety and depression, stress management, population health management, education and training, sleep disturbances, addictive behaviors, women’s issues and work-life balance among others. 

Jillian is a doctoral candidate at Arizona State University (ASU) with the Doctor of Behavioral Health program, and currently serves as the Director of Organizational Health and Development, at ASU. She describes her philosophy around patient care by reminding patients “that we heal through our connections, rather than in isolation. Maintaining our wellbeing is a lifelong journey often with both highs and lows. The challenges can be simplified when we stop and ask for directions on that journey. Making those connections and having someone shine a light on a new path can make all the difference.”

• HeartMath is a 3 week series and runs 6/11 - 6/25. 
• Nutrition 101 is a 6 week series and runs 5/21 - 6/25. It will start again on July 16.
• Stress Management 101 is a 6 week series and runs 6/6 - 7/11.
• 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.
• See Class Descriptions below to learn more.
• 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 Kathy Engles, PA-C

Question: I’ve heard a lot about the health benefits of being more mindful. Aside from starting a regular meditation practice, how can I incorporate the act of mindfulness into my everyday life?

Mindfulness means that our  attention is being directed towards the present moment. We are not lost in thoughts of the past or future but anchor our attention, without judgment to the present. It is a skill that is cultivated through loving discipline and can be applied to innumerable activities one of which is eating.

Mindful eating provides the opportunity to direct your attention to the taste, textures and sensations of food and will enhance your ability to connect with your bodily reactions to the activity of eating. Mindful eating can increase your enjoyment of food. It slows down the pace of your meals and allows you to be more in tune with signals from your brain indicating that your stomach is full.

Here is an exercise in mindful eating:

1. Take one bite of an apple slice and then close your eyes. Before chewing starts, try to focus your mind on the apple. Notice anything that comes to mind about the apple: texture, temperature, taste.
2. Slowly begin chewing paying attention to this process. Your mind will inevitably wander off, this is normal. Gently direct your thoughts back to your chewing.
3. Now you may notice that you find yourself wanting to swallow the apple. See if you can stay in the present paying attention to the transition from chewing to swallowing.
4. As you prepare to swallow, notice how the apple is moved by the tongue to the back of the throat. As you swallow the apple, follow it until you can no longer feel any sensation of the food remaining.
5. Take a deep breath and exhale.

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

Millions of people all over the world are experiencing the physical, mental, and spiritual benefits of a regular yoga practice. In fact, according to Yoga Journal, the total number of Americans who practice yoga has grown by nearly 30 percent in the last four years, reaching an estimated 20.4 million U.S. adults.

There are over one hundred types practiced in the U.S. alone, in settings that range from boutique studios, big box gyms, and community centers to workplace wellness programs, schools, outdoor donation-based classes, and even one’s own living room. While everyone is drawn to yoga for different reasons, some of the most common motivators include:

• Improved flexibility
• Increased muscle strength
• Improved respiration, energy, and vitality
• A more balanced metabolism and better weight management
• Cardio and circulatory health
• Improved athletic performance
• Pain management and injury prevention
• Mental clarity, calmness, and feelings of centeredness
• Stress reduction
• Better body awareness
• Improved balance
• Reduced insomnia

Even though the mind, body, and spiritual benefits of yoga are compelling, the exact mechanisms of how are relatively unknown. By examining changes in gene expression, a new study offers some fascinating insight.

In this study, which was published in April 2013 in the journal PLOS ONE, researchers from Oslo examined a small group participated in a weeklong yoga retreat, consisting of meditation, yogic postures and yogic breathing exercises. What they found was fascinating: a change in expression of 111 genes in circulating immune cells. In comparison, other relaxation techniques like walking meditation and listening to music changed the expression of just 38 genes.

The researchers state, "These data suggest that previously reported effects of yoga practices have an integral physiological component at the molecular level which is initiated immediately during practice and may form the basis for the long-term stable effects."

Considering starting a yoga practice? Here are some tips:

• Take a class! It may seem tempting to build your comfort level and confidence with instructional DVDs at home, but in-person instruction truly is the best way to learn the various postures and breath work in a safe and effective manner.  Use the Yoga Journal Directory  or findyoga.com to find a class near you. Lastly, ask your studio which classes they recommend for beginners. If you're a member of our clinic, come to our Monday evening basics class or our Tuesday chair class!
• Cut yourself some slack. It’s normal to feel nervous or self-conscious when trying something new, but remember that each person in a yoga class has felt the exact same way at one point. Remember that yoga is not a competition. It's about bringing your attention inward and comparing yourself to those around you can shift your focus in a way that becomes counterproductive.  Let the instructor know you’re a newbie and he or she will help you to make the appropriate modifications.
• Learn from those around you. One of the great things about being in a class is learning from your fellow yogis (in a patient, self-compassionate way, of course). Fight the urge to hide in a corner by situating yourself so that there are others on all sides of you. This way, there is always someone to follow regardless of your position on the mat. 
• Experiment. There are many different disciplines of yoga that are taught and practiced today. Some of the most popular forms include Hatha, Vinyasa, Ashtanga,  Kundalini, and Bikram. Although each style provides a host of shared benefits, they are each unique, which means that it may take some experimenting before you find the style that resonates with you.
• Practice from home. If you’re comfortable with a home or on-the-road practice, check out www.myyogaonline.com to access hundreds of streaming yoga classes, some of which are free. There are also excellent meditation and Pilates classes available.

Sources: 

Rapid Gene Expression Changes in Peripheral Blood Lymphocytes upon Practice of a Comprehensive Yoga Program

By Tracy Baginski, BS, CCN

June 21st may be the first official day of summer, but for most of us here in the Grand Canyon state it’s Memorial day that kicks off the summer season. The kids are out of school, the snowbirds are gone, and the pool water is finally warm enough for a grimace-free swim. For most Arizonans, the thought of turning on the kitchen oven to prepare a meal is unthinkable.  It’s official: salad season has begun.

After years of being considered a ‘diet food’ or first course, salads have come into their own. Restaurants are now featuring creatively prepared salads that move far beyond the once ubiquitous iceberg-lettuce-with-cherry-tomato variety. 

Here are a few ideas to spur out of the bag thinking with regards to your salad prep:

Themes

• Ever considered creating a salad using an ethnic theme? Sure, you have probably had a Mexican style salad tossed with some black beans, corn and cilantro. But what about an Indian version, replete with a little curried chicken? Or an Italian version, mixed with pepperoncini, mozzarella chunks and fresh basil. Greek style salads are delicious and full of flavor from garlic, oregano, olives and feta cheese. Any of these can make the transition to a full meal by adding a little protein.
• For a tasty version of a south of the border salad, check out this version from Epicurious. 

Layer it Up! Salads can easily transition from side dish to main event if you think in terms of ‘layers’.

• Start with the foundation: a variety of organic seasonal mixed greens. Not sure what is in season? Check out the "Articles and Guides" section at www.epicurious.com for information on what is fresh in your area. While you are there search for and save recipes in their secure, on line virtual recipe box.
• Next, add your favorite vegetables, either chopped or shredded (have you tried broccoli slaw?).  Aim for a variety of colors to take advantage of the phytonutrient spectrum of nutrients contained in each.  Did you know that tearing Romaine lettuce the day before you eat it quadruples its antioxidant content?  For more interesting facts about the plants we eat look for Jo Robinson’s new book Eating on the Wild Side, due out next month.
• Herbs. Sprinkle on some fresh, chopped herbs for added flavor. Cilantro, parsley, mint and basil all make a wonderful accompaniment to your salad dish.In addition to flavor, using herbs and spices provide immune boosting properties. Learn more in Bharat Aggarwal’s book Healing Spices.
• Protein. Here’s a great place to used leftovers. Cooked chicken, turkey, fish or some tofu can round out the salad meal.  Vegetarian or not, beans can provide added protein, fiber and flavor to a salad, not to mention their positive effect on blood sugar and satiety. 
• Some salads lend themselves to a touch of sweetness from either fresh or dried unsulfured fruit. Berries, orange segments and diced green apple work well. Tip: to prevent the apple chunks from turning brown, cut only what you will use and then toss in a little bit of fresh lemon juice. Top with a sprinkle of slivered almonds, pine nuts, walnuts or hemp seeds.
• The dressing. Here is where you can have a big impact on your health and wallet: skip the bottled dressing and whip up a batch of your own, homemade dressing. It’s quick, easy and delicious.  Choose a health promoting oil like a high quality olive, walnut, avocado or flax oil, mix with your favorite vinegar, and add a blend of herbs and seasonings and a little lemon juice, mustard, and/or crushed garlic. 

The possibilities are endless!

By Tracy Baginski, BS, CCN

Slaw Ingredients

• 1 Chinese, Red or Green Cabbage
• Optional:  Add bag broccoli slaw
• 1 bunch green onions/scallions, chopped
• 1 small bunch cilantro; chopped
• Garnish with toasted pine nuts or almonds

Dressing Ingredients

• 1/2 cup white vinegar
• 1/4 cup or less of either Agave or Honey
• 1 Tbsp. Soy Sauce or Tamari
• 1 Tbsp. Sesame Oil
• 1/4 cup Extra Virgin Olive Oil
• Sriracha or Hot Sauce to taste
• Salt & Pepper, if needed

Directions

• Gently heat dressing ingredients in a pan until combined, pour over chopped slaw ingredients. 
• Toss, marinate 1 hour for crunchy cabbage.
• Put toasted nuts on before serving.

Variations

• Protein: add very thinly sliced, cooked chicken breast or cooked shrimp
• Vegetables: shredded peppers, seeded/peeled cucumber, radish
• Herbs: Add chopped cilantro, and/or a little mint
• Nuts:  toasted pine nuts, almonds
• Grain: cooked, drained brown rice pasta

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

It’s something that city-dwellers, beach-goers, campers, and backyard-enthusiasts can all appreciate. Kids, adults, vegetarians, carnivores, foodies, picky-eaters (and everyone in between) look forward to it on holiday weekends with friends, lazy summer days, and even busy weeknights. We can all agree that there is nothing more quintessentially summer than firing up the grill.

Should we be concerned, though, about the health implications of grilling food? Yes, but it doesn’t mean at the sacrifice of your barbecuing traditions. Let’s first arm ourselves with evidence-based knowledge so that we can take the precautionary steps that will allow us to still enjoy that juicy burgers, fresh fish, and perfectly seasoned kebabs!

What you should know:

• There are three harmful compounds formed when grilling meat: Heterocyclic amines (HCAs), Polycyclic aromatic hydrocarbons (PAHs), and Advanced Glycation End Products (AGEs)
• HCAs form when protein (amino acids and creatine) found in meats are cooked at a high temperature.
• PAHs form as a result of the fat and juices from meat that are grilled over an open flame dripping into the fire. As a result, PAHs, then present in the flames, can adhere to the meat’s surface.
• According to the National Cancer Institute at the National Institutes of Health, HCAs and PAHs resulting from the cooking of muscle meats are carcinogenic in animals. Although a definitive link is a bit more difficult to measure in humans (due to high variability in determining exposure levels along with other environmental sources), epidemiologic studies have established an association between meat cooking methods and increased risks of colorectal, pancreatic, and prostate cancer.
• According to the U.S. Department of Health and Human Services, these chemicals are "reasonably anticipated to be human carcinogens."
• AGEs are contained in the browned areas of grilled meat and are formed as a result of a sugar molecule combining with fats or other compounds at high temperatures.
• AGEs have been linked to atherosclerosis, diabetes, and increased levels of C-reactive protein (a measure of systemic inflammation and a strong risk factor for heart disease).

Does this mean you need to stop grilling altogether? Of course not! Just follow these safe-grilling tips to minimize your exposure to and consumption of HCAs, PAHs, and AGEs:

• Be sure to clean your grill prior to cooking in order to remove any charred debris that could stick to your food.
• Add vinegar or lemon juice to your marinade before grilling. This helps change the acidity of the meat, making PAHs less likely to adhere.
• Add spices to your meat before grilling. Seasoning with antioxidant-rich spices like ginger, rosemary, and turmeric can help prevent formation of HCAs.
• Save marinades or sauce with sugar (like barbecue sauces) until the last 2 minutes on the grill, as these make the meat char more easily.
• Chose lean cuts of meat. Less fat will reduce flames and smoke.
• Wrap meats and fish in foil to prevent dripping into the flames and PAH formation.
• Chop meat in small pieces. Meat that cooks faster will form fewer chemicals.
• Consider pre-cooking meat in the oven prior to tossing it on the grill. Less time on the high-heat grill means a reduced chance of HCA formation.
• Flip meat frequently to lessen HCA formation.
• Avoid eating charred areas of meat to avoid HCA and PAH exposure.
• Grill more fruits and veggies!

Get your grill fix with these delicious veggies:

• Corn on the cob (non-GMO)
• Portabella mushrooms
• Green or purple cabbage
• Zucchini and summer squash
• Asparagus
• Green beans
• Eggplant
• Tomato, onion, and bell pepper kabobs

And don’t forget about fruit, which make guilt-free, crowd-pleasing desserts:

• Peaches
• Pineapple rings
• Apples
• Watermelon
• Bananas
• Cantaloupe
• Figs

Resources: 

Chemicals in Meat Cooked at High Temperatures and Cancer Risk

α-Hydroxyaldehydes, products of lipid peroxidation

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

Question: Can I exercise my way to flatter abs?

This is a great question, and one that always receive a little extra attention as we head into the summer months.

A smart approach to exercise does play a role in achieving flatter abs, but not in the way you may think. If you’ve ever parked yourself on the living room floor for nightly sit-up routine, attended an abs-class at the gym, or purchased any piece of exercise equipment that promised you a six-pack in just 10 minutes per day, read on…

There is no such thing as spot reduction. To achieve a “toned” look, whether around your midsection or anywhere else on your body, you must gain lean body mass and lose adipose tissue. In other words, you could perform sit-ups all day long and have rock-hard abdominal muscles, but as long they’re covered by a layer of fat, your six-pack won’t be visible. The right combination of consistent exercise is necessary to achieve not only the caloric burn during exercise, but the metabolic boost post-exercise that allows for an increased resting metabolic rate. 

Tips:

• Include higher-intensity intervals into your  cardio exercise 2-3 times per week. Note: this will actually take less time!
• Focus on total-body strength training 2-4 times per week (as opposed to training different body parts on different days). 
• To be super-efficient, incorporate movements that simultaneously build strength and give your metabolism a boost. Examples include burpees, squat - front to press dumbbell, kettlebell swings, and squat jumps. 

Sit-ups and crunches are overrated. Why? A traditional sit-up or crunch requires repetitive torso flexion but consider the functional, real-life purpose of a strong core: to support posture and stabilize the spine to provide a foundation for virtually all other movement. For some people, flexion-based core exercises can even be dangerous, as overloading the spin can contribute to disc damage. Even if you remain uninjured, though, you’re much better off spending your time and energy on core movements that improve your functional stability. 

Tips:

• Instead of sit-ups and crunches, try front pillar  bridges, lateral pillar bridges, and overhead squats. 

Your core is more than your abs. Your core is the epicenter of movement, but it includes more than the transverse abdominis “six pack” muscles. A functionally strong core consists of stable shoulders, a stable torso, and stable hips (which is why it’s possible to have “ripped” abs but still have dysfunctional movement and an increased risk of injury). 

Tips:

• Be sure to train all three regions by adding the following movements to your next warm-up session:
• Shoulders: Y’s and T’s 
• Hips: Glute Bridges
• Torso: Pillar Bridges 

Flat abs are (mostly) made in the kitchen. Efficient, functional exercise is critical, but no matter how hard you work, you simply can’t out-train a poor diet. The key is to focus on eating clean (i.e. unprocessed), nutrient-dense foods, which are rich in vitamins, minerals, antioxidants, phytochemicals, and fiber. 

• Try adding more green, fibrous cruciferous vegetables like broccoli, Brussels sprouts, cabbage, kale, asparagus, bok choy and collard greens.
• Ensure that you’re getting enough Omega-3s, which fight systemic inflammation and support fat loss. Try eating oily fleshed, wild caught, cold water fish 2-3 times per week or taking a fish oil supplement (or vegetarian omega 3 supplement). Click here to learn more about fish oil supplementation.
• The more color, the better! Aim to fill your grocery cart with fresh (ideally organic) produce that is green, orange/yellow, red, blue/purple, and white.
• Check out the Anti-Inflammatory Food Guide Pyramid for more information.

Hydrate, hydrate, hydrate! Aside from improved energy levels, mood, and mental clarity, drinking enough pure water is critical for every metabolic function in your body, including digestion and nutrient absorption (which, in turn, are vital for a healthy body composition).  Chronic dehydration can also cause fluid retention, which can give the appearance of “puffiness” in the abdominal region.

Tips:

• Aim to consume ½-1 oz. of water per pound of your own bodyweight each day.
• Carry a BPA-free water bottle with you throughout the day.
• Up your intake of water-rich fruits and vegetables, including lettuces and dark leafy greens, zucchini, tomatoes, watermelon, strawberries, celery, broccoli, grapefruit, cantaloupe, pineapple, raspberries, blueberries, apples, and cherries.

Don’t forget about hormones.  Aside from the obvious impact that stress has on our motivation and likelihood to engage in healthy-eating and fitness behaviors, it also effects your levels of the stress hormone, cortisol. Persistently elevated cortisol levels can negatively impact your appetite and cravings, and decrease your bone density and lean body mass (effectively slowing your metabolism down). Elevated cortisol has been shown to be specifically linked to belly fat.

Tips:

• Build your resilience to stress by practicing deep breathing exercises, yoga, and meditation, engaging in fun activities, cultivating gratitude, and spending time outdoors.
• Aim to get 7-9 hours of sleep per night (Chronic sleep deprivation is another contributor to elevated cortisol levels).
• Eat every 3-4 hours to avoid dips in your blood sugar, which can also increase cortisol.

Fortunately, this holistic approach to movement, nutrition, and stress means that flat abs certainly won't be the only benefit you will reap! 

Sources:

www.coreperformance.com

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

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 Don Fiore

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. Taught by Tracy Baginski, BS, CCN *Will resume July 17 (5:30-6:30 pm)

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