The care of your feet is as important as the care of the rest of your body. Although few medical doctors limit their practice to feet alone, podiatrists and chiropodists are trained to deal With foot problems. Different countries have various requirements for their training and different diplomas are awarded. In some countries certain types of surgery can be done by these specialists, and in others treatment is nonsurgical.

Some people go to these practitioners without a referral horn their physician. However, you should tell your physician that you have been to a foot specialist and relate any special problems that were encountered. It is extremely important that you tell every physician or nonphysician if you suffer from diabetes mellitus or peripheral vascular disease. Also, remember to tell the practitioner about the medications that you are taking, especially if they include anticoagulants (blood thinners).

Your feet are very important for full enjoyment of life. Many people ignore foot care, and consequently their ability to enjoy mobility is greatly impaired. Maintaining your independence should be one of your major goals. The ability to walk easily, in comfort, and without assistance is crucial to self-sufficiency. The condition of your feet can make the difference between your being able to manage alone and needing institutional care. Furthermore, the condition of your feet reflects the general state of your health, and it may affect it seriously.

It is common for the elderly to develop toenails that are thick, hard, and difficult to cut. Nail care may be unmanageable if you have poor eyesight or other physical disabilities that interfere with the proper bathing of your feet and cutting of your nails. There are a number of causes of thick toenails, including the aging process itself, repeated injury to the nails, various types of inflammation, and a poor blood supply. Debris can collect under the nails and increase their hardness. Infections, especially fungus infections, may compound the problem.

Treatment is usually best supervised by either a podiatrist or chiropodist or a physician especially trained in foot care. Cleaning and removing the debris that collects around the nails and trimming them periodically is very important. Occasionally, your whole nail may have to be removed if it is very thick, hard, and misshapen.

Another problem that causes pain and disability is callus formation. This area of hardened skin occurs because there is an abnormal amount of pressure on part of your foot, usually from shoes that do not fit properly. The first step in treating a callus is to remove the cause of the pressure. This usually means changing shoes and finding ones that fit correctly. Special inserts and supports can be fitted into shoes to take the pressure off the affected areas.

Treating your calluses by yourself can be dangerous. Cutting them with knives and razor blades is very hazardous. Commercial callus-removing preparations sometimes destroy the surrounding skin and lead to infection. Treatment is best carried out by a foot specialist, who may surgically shave the excessively hardened callus in stages. He will also help you select proper shoes to help avoid the return of the callus.

To keep your feet in good condition, a number of principles should be followed. It is very important that your shoes are properly fitted and correct for your normal activities. Narrow-toed shoes should be avoided. Many older women have been used to wearing high-heeled shoes for years. Your legs may be more comfortable in a heel, even in your later years. A low heel is acceptable, especially if the shoes have wide toes. For those with relatively few foot problems, ordinary shoes may be suitable.

Some people with severe foot problems may need to have special shoes made. This is best done under the supervision of an occupational therapist, chiropodist, podiatrist, orthopedic surgeon, or rehabilitation expert irt order to avoid unnecessary expense. The shoes should be purchased from a reputable, experienced footwear firm, and one that will service your shoes after you purchase them. Sometimes shoes can be modified so that they are easier to put on. For example, regular laces are often difficult to tie if you have arthritis or poor eyesight, so elastic laces or a Velcro® closure can be substituted by a shoemaker.

If your feet are swollen, the fitting of shoes may be difficult. Excess pressure on swollen feet can be dangerous. If you suffer from swollen feet, your physician can recommend treatment. The swelling may be the result of varicose veins or heart failure. Avoid stockings with tight bands at the top which can exaggerate foot swelling.

It is very important to cut your toenails properly. Nails should be cut straight across, and they should not be cut too short. Sometimes it is easier to cut your nails after bathing your feet because the nails will be softer. Wash and dry your feet carefully every day or two, and inspect them for breaks in the skin and reddened areas.

Many older people suffer from a poor blood supply to their feet. If you have diabetes mellitus, this may be even more exaggerated, particularly if you smoke. Infection around nails or between toes is also common, especially following a foot injury or the improper cutting of nails. Infections can be very dangerous if you have a poor blood supply or diabetes mellitus. Seek medical attention immediately if you notice an infection. If not treated effectively, toes and feet can suffer from gangrene, which could result in the loss of a leg.

Never put your feet in very hot or very cold water. The temperature of water should be tested with your hand first. Using electric pads and hot water bottles on your feet is not recommended. You may have a poor sense of temperature, and your feet could be burned without your realizing it.

A common foot disorder, bunions, can cause pain and disability. Some people seem to be more prone to this deformity, which eventually leads to a painful protrusion at the side of the big toe. Very narrow shoes worn during your formative years may have aggravated the condition, but some people develop bunions even though they have always worn properly fitting shoes. At a younger age, surgery is usually recommended for bunions. In most cases it relieves the deformity and improves many of the symptoms of pain and inflammation in the region of the protruding bone. However, as you grow older, the chances of improving the condition with surgery gradually decrease, and the relative risks of foot surgery increase.

If you are otherwise in good health and do not suffer from diabetes mellitus or diseased blood vessels and your bunions are causing great discomfort, ask your physician to refer you to an orthopedic surgeon. For many older people, however, it is probably better to have a special shoe molded to the misshapen foot to relieve the pain and irritation rather than undergo surgery.

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Among the substances either found in foods or added to them that can affect your health is salt (sodium chloride). Most of us were brought up to eat and desire too much salt in our diets. From an early age, you probably enjoyed many commercially prepared and packaged foods, which contain great amounts of salt. I am often amazed at how people will sometimes grab the saltshaker before they have even tasted their food. Junk foods, such as potato chips, crackers, and pretzels, as well as prepared and smoked meats, have enormous quantities of salt and other sodium-containing substances.

High blood pressure (hypertension) is one of the major medical problems in Western countries. As you grow older, your blood pressure may increase. It appears that one of the factors determining the level of your blood pressure is the amount of salt that you consume. Even if you do not have high blood pressure, you should make a major effort to decrease the amount of salt in your diet. It will probably have a beneficial effect on your blood vessels as well as your heart. Learn to read labels on food products and avoid those products that show a high salt and sodium content. Develop the taste for other spices in your cooking. Stay away from junk foods, which not only have little food value and contain excessive amounts of salt, but are almost always fattening.

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There is no doubt that most of us would like to live out our later years in our own homes or apartments. We are all aware that nursing homes and hospitals are necessary for the poor, sick, and lonely, but we assume, as we often do about illness and death, that these are things that happen to others and not to ourselves.

Most of us have had to make numerous decisions in our lives about where we are going to live. Many people have lived in several places, either in one city or town or in many geographic locations. You may be near members of your family, or you may be far removed from them. At some point, you may have to examine whether your living arrangement is the best one for you now and in the future.

Some changes in living arrangements may be precipitated by illnesses, whereas others are made by changes in social, financial, and family needs. The alterations that follow an illness are more difficult to deal with because usually there has been no planning or forethought about them. Other changes may have been considered for many years before the move finally occurs. Usually, you move because you want to, rather than because you have no alternative.

If you are having difficulty maintaining yourself in your own home, you and your children may raise the possibility of moving into a nursing home, retirement community, or even a hospital for long-term care. The latter becomes an issue only if you have become too ill or dependent to look after your most basic needs. The decision to move into a retirement community or nursing home must be based on many factors. You may resist the thought of relocating your life and giving up the comfort, privacy, familiarity, and individuality of your own home, which cannot be supplied even by the best institution.

On the other hand, your home may have become a prison if you feel isolated and are physically or emotionally impaired. Perhaps some of your friends have died or left your neighborhood, and perhaps your family is scattered in distant places. The chores of shopping and housework can become overwhelming if your physical capabilities begin to fail. Your fear of illness or accident may become so great that you might not risk going outdoors. A sudden illness for which no one can be contacted may be so frightening a prospect that you may begin to fear being alone.

Ideally, with close family and friends nearby, you may be able to stay in your home or with a family member. In many cities and towns, community services can assist you at home. Meals on Wheels and visiting nurses, therapists, homemakers, and physicians may be enough to allow you to keep your home. Senior-citizen centers can assist you in remaining social and active and also help your family, who may be looking after you. With this type of care, you will probably be happier at home.

If you feel imprisoned at home, however, moving into a retirement community, home for the aged, or nursing home may be a welcome solution to your problem. The institution may not only satisfy your physical needs, but it may offer also a creative outlet.

In most communities there are more nursing homes than any other type of facility for the older person who can no longer live at home. Some nursing homes divide the type of care required for their residents between those who are more independent and those who are more needy. However, in many instances all the residents are in fairly close quarters, and this has disadvantages, of course.

If you are physically well and active, a retirement home or community may be more suitable. You may have to move from your old neighborhood or town, so the difficulty in maintaining contacts with friends and family has to be weighed against the benefits. Many older people and especially older couples are choosing to move to retirement communities in warmer climates. Here, too, you might be leaving family and friends, although these communities usually foster a strong neighborhood spirit. During times of crises it may be difficult to arrange for assistance and the comfort that a nearby family gives. Children often become disturbed by the thought that should an illness ocur, they will not be able to help their parents. If you choose this type of living arrangement, try it out first if possible without making a firm commitment. Explore the facilities for both recreation and work. Speak to as many residents as you can, and make sure that the medical care is of high quality. When you move, ask your physician to forward your medical records to your new physician. Ask your doctor to keep a copy of your file in his office. If you return for a visit, you may still want or need his medical advice as well.

If you move into a nursing home or retirement home in your vicinity, you or your children should explore the residence as thoroughly as possible. The type and quality of nursing homes vary according to regional, financial, social, and political factors. Unfortunately, some homes are badly supervised and poorly run. Others maintain an exceptionally high quality of care. Municipal homes vary in quality depending on the locale, but they may have more stringent regulations than commercial institutions. Many philanthropic organizations and religious groups support and organize homes for the aged. In my experience, they provide a consistently higher level of care than commercial nursing homes. Because they are sponsored by nonprofit organizations, their degree of commitment and responsibility is frequently greater than nonaffiliated nursing homes.

If you require a great deal of skilled nursing and medical care, you may have to move to a facility capable of supplying long-term care. There are many types of skilled nursing facilities, depending on where you live. They vary in quality but usually give adequate care as well as provide some outlet for emotional needs.

Once you decide to move into a nursing or retirement home, find the best and most suitable one for you. You may need to rely on your family or health care professionals to assist you in making a decision. Depending on where you live, there may be a great deal of choice or little choice at all in finding a suitable home. If many residences are available, inspect them yourself or with a member of your family. Do not be afraid to speak to residents and their families, and ask the medical and nursing supervisors about the care that is given and the attitude of the staff.

It is important to determine the type of medical care you will receive. It is preferable to have a physician whose commitment to the home is permanent and stable, rather than having a “rotating’ physician. You should be assured of the availability of your own physician too. An inspection of the kitchen is important; ask to eat one meal with the residents if possible. Social and recreational facilities are crucial. Ask the residents what programs are available and how often and how well they are arranged.

Your family should not be afraid to ask about the care that you will be given and what kind of access they will have to members of the social service and nursing and medical staff. It is important that at the time of admission you and your family feel comfortable that the decision is the best one for all concerned. This cannot always be achieved, however. Your children may feel guilty and you may feel resentment. You could seek professional assistance to help ease you and your children through this difficult transition period.

Although many people feel that by entering a nursing or retirement home, they are on their last journey in life, the opposite is often the case. In well-run, creative facilities, your life may become more active and interesting than when you were living at home alone. Many good residences provide activities that may rekindle interests that were dormant for many years. I have met many older people who embarked on new paths of expression and creativity after they had moved into such residences. You can make of it what you would like. You may have to work hard to adapt in the beginning, but you can adjust and continue to lead an interesting and satisfying life

*20\166\2*

Most communities have at least one health-food store. In addition to food products, many of these shops also sell vitamins and other food supplements. Many people are attracted to them because they think the products are of higher quality or “purer” than those found in local stores or supermarkets.

Some aspects of health-food stores may be helpful if you are trying to maintain a balanced and nutritious diet. Unlike in most supermarkets, small quantities of food can usually be purchased. The shops carry items that do not contain as many additives and preservatives as commercially prepared products: this reduces their shelf life. Of course, not all food additives are harmful; however, some found in many commercial foods may be unnecessary.

Decreasing the amount of salt and sugar in your diet is desirable as you grow older. When you read the labels of many commercially prepared cereals and breads, you will find that they often contain excessive amounts of both. Health-food stores may have cereals and breads that contain little or no salt and sugar. But be aware that “sea salt” and honey have many of the same deleterious effects as table salt and refined sugar. Do not assume that you can eat unlimited quantities of these products just because they are sold in health-food stores.

There should be a place in your diet for whole-grain cereals and breads, nuts, and dried fruits, such as dates, figs, prunes, and apricots. These can usually be purchased without unnecessary additives. You can also find cheese, yogurt, and other dairy products without salt, sugar, and preservatives. These may be more appropriate for your diet than similar products sold elsewhere.

One product that I often recommend is granola-type cereal. You can also buy the ingredients separately and mix them yourself. They are a useful source of the B complex vitamins and natural fiber and do not contain sugar, salt, or preservatives. They make a tasty and nutritious breakfast cereal and can also be used in cooking and baking. Peanut butter without sugar, salt, corn syrup and hydrogenated oils is also a good source of vegetable protein.

The vitamins and various food supplements sold in health-food stores are usually not necessary to ensure your good health and nutrition. Sometimes they may even be harmful, particularly when taken in large quantities. Their quality control may be below standard, and they may contain substances that you cannot tolerate.

Judiciously buying small quantities of good-quality cereals, nuts, breads, dried fruits, juices, and dairy products can be economical, but some products are more expensive in these stores. Examine the products and the labels carefully and choose those items that are economical and useful to ensure a well-balanced diet. Many supermarkets now carry products similar to those sold in health-food stores to be competitive. Compare the ingredients and prices. You may find that you can buy an equivalent product at a lower price, or that the health-food store product suits your needs better than other available products.

*15\166\2*

During the past several years, there has been a growing awareness of the importance of dietary fiber (roughage). The portion of vegetables and whole grains that is not digested is what is usually referred to as fiber. Because these substances are not absorbed by the body, it was previously assumed that they did not play an important role in our health. In fact, for many years the commercial preparation of foods placed a great deal of emphasis on removing fiber from foods. Therefore, we have been used to eating low-fiber diets.

It is now becoming clear that a lack of fiber in your diet may have a deleterious effect on your health. The most common symptom that results from a low-fiber diet is chronic constipation. Many older people are addicted to various forms of laxatives because of a lifetime of eating a low-fiber diet. A low-fiber diet has been implicated in diverticular disease of the colon, malignancies of the intestine, gallstones, and diabetes mellitus. Whether or not it will cure all your ills, you should gradually increase the amount of fiber in your diet. It should be done slowly, because if you have been used to a low-fiber diet for many years, a sudden increase in the amount may cause irritating and loose bowel movements and flatus (gas).

The best sources of dietary fiber are whole-grain cereals that have not been overprocessed and bran. Commercial cereals that contain an adequate amount of fiber have become more readily available. Read the labels carefully and look for the amounts of dietary fiber in the product.

Bran, a very important source of fiber, can be sprinkled on cooked and dry cereals and added to muffins and other homemade baked goods. Use it instead of bread crumbs in meatloaf and hamburgers, and cover poultry with it before broiling. Replace white bread with whole-wheat bread. This is an easy way to increase the amount of fiber in your diet. Raw vegetables and fruits are a welcome addition to any diet that has been low in fiber. If you have required laxatives for years, you will find that with a properly balanced high-fiber diet you can reduce or eliminate them. The other beneficial effects may be difficult to prove, but in all likelihood your general state of health will improve if you increase your fiber intake.

There is usually little interference between food and medications. Some drugs, such as tetracycline or erythromycin, may impair your appetite or make you nauseated. Others, such as quinidine, may give you diarrhea. This may impede your normal eating habits. Ask your physician or pharmacist whether or not your medications should be taken before, during, or after meals. Some medications work best on an empty stomach, whereas others may cause nausea if taken without food.

Many medications can interfere with the metabolism or absorption of important nutrients. Diuretics may increase your need for potassium, which is found in citrus fruits and bananas. Large and frequent amounts of mineral oil may interfere with your absorption of vitamins A, D, E, and K. Some antibiotics may disrupt the normal workings of your bowel. Antacids can interfere with the absorption of phosphorus and may interfere with normal calcium metabolism and lead to weakened bones.

It is not always certain what the effect of different drugs will be on your diet and metabolism. It is important to clarify with your physician what precautions should be exercised when you are taking medications. He may recommend certain dietary supplements in order to ensure adequate nutrition.

The choice and variety of foods seem unlimited. By using simple principles, you can prepare attractive, nutritious, balanced, and tasteful meals. As a guide, each day you should try to have the following:

serving during each meal of a whole-grain cereal or whole-grain bread or pasta product.

glasses of low-fat milk or its equivalent, such as yogurt, milk shake, custard, ice cream, cheese, or other low-fat milk product.

2 servings of high-quality protein, such as beef, fish, poultry, eggs, or vegetable protein from nuts and legumes, such as peas and beans. Try to avoid fatty meats such as pork, although occasionally they can be eaten.

2 servings of fruit, including one with a high content of vitamin C.

2 servings of vegetables, preferably fresh, which should include salad greens. Cooked vegetables should be slightly boiled, steamed, or baked. Avoid overboiling because the vitamins are lost in the water.

8 glasses of liquids, including water, juices, soups, and watery fruits.

Tea and coffee in moderation.

One serving of bread is one slice, and one serving of cereal is about one-third to one-half a cup. A serving of fruit usually means one whole small fruit or one-half cup, depending on its form. A vegetable serving is one-half cup. A serving of meat or other protein is 3 ounces.

It is best to divide your meals over five or six small portions per day. This can include a few in-between snacks of low-salt crackers, cheese, and fruits. Avoid all types of pre-prepared foods whenever possible, and stay away from junk foods.

With this as a guide, you should be able to have a well-balanced and appetizing diet.

*11\166\2*

I used to tell my patients to watch their alcohol intake. Then a patient told me, laughing, “Yeah, I watch my alcohol intake. I watch it being poured into my glass, I watch it as I lift the glass to my mouth and drink it.” Now I say limit your alcohol intake. In modest quantities alcohol is good for you. There is a huge amount of research, some of it conducted by various governments (including the United States), showing that up to 1¹/₂ ounces of pure alcohol per day (that is about two drinks) significantly lowers your bad cholesterol levels, and spread out over a few hours, not taken on an empty stomach, and not prior to driving, lengthens your life expectancy by several years. On the other hand, alcohol contains plenty of calories, so use it sensibly.

Be realistic—Most of us, including me, are not going to follow any plan perfectly. The more strict you are with yourself, the more likely you’ll be to abandon the plan altogether. As I’ve said before, just making the effort can do wonders for your body and your overall health.

These diet pills, which are actually brain stimulants, are so popular that variations of them are sold in supermarkets under brand names such as Dexatrim. One common amphetamine-like drug, a central nervous stimulant called benzedrine, was first used as a nasal inhalant to ease breathing. It was discontinued, however, when it was found that people were taking it out of the inhalant and using it for the wrong reasons.

Benzedrine, dexedrine, and other amphetamines, commonly known as speed, work by cutting the appetite. But when you stop taking them your appetite returns, often with a vengeance, resulting in a greater weight gain than the original loss. Amphetamines also have potentially serious side effects, including heart palpitations, elevated blood pressure, sleep disturbances, trembling, nervousness, anxiety, agitation, and panic attacks. They may even precipitate heart attacks.

And the risks are not confined to prescription-only drugs. Many over-the-counter weight-loss pills at your pharmacy contain a substance called phenylpropanolamine as their main ingredient. Over the years, I have seen numerous patients develop high blood pressure and heart arrhythmias after exposure to this
substance.

Taking these drugs (prescription or over-the-counter) is of no value for long-term, healthful weight loss, and may also lead to dependency. Kitty Dukakis, wife of 1988 presidential candidate Michael Dukakis, created quite a stir when she admitted to having been hooked on amphetamines for over 20 years. I have even seen children stoned and ill from weight-loss pills (which they take for the high). Do yourself a favor and don’t get started on any of them.

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This diet qualifies for entry into the Single Food Diet Sweepstakes, and states right up front that you should only stay on it for 7 days with the goal of experiencing the gratification of quick weight loss. Then the author suggests that you go off the diet for 2 weeks before trying it for another 7 days. Why the on-off approach? Because, in the author’s own words, “The New Cabbage Soup Diet is not appropriate for long-term use. It is not intended as a substitute for good long-term eating habits. The diet may be used for up to a week, but after a week the reader should switch to a normal nutritionally balanced diet [italics mine]

. . . The reader should not use the New Cabbage Soup Diet too frequently even with 2-week or longer intervals in between uses.” When the diet’s own author admits this right up front, you know that there are serious problems with the diet. If nothing else, it’s meant to be a quick fix that teaches you nothing about proper lifelong eating habits. So even though cabbage is one of my favorite foods (I eat a bowlful a week), I suggest you avoid this diet.

Cabbage soup diets have appeared under various names, including the Fat Burning Soup Diet, the New Mayo Clinic Diet, and the Scared Heart Hospital Diet. Just to set the record straight, there’s nothing especially fat-burning about eating cabbage soup, and this diet is not associated with the Mayo Clinic or any of the many hospitals that go by the name of Sacred Heart.

*139\29\2*

Most diets end in failure. We’ve all known people who have undergone dramatic weight losses only to pile the pounds back on, often with interest! Most of us have tried following stringent diets and then gone off them (with a vengeance!) because they were too difficult, too boring, or simply didn’t work within our lifestyles. Obviously, with Chitosan, things will be different. That difference plays itself out by allowing people following my Fat Blocker Program to avoid the standard pitfalls of dieting.

What are they?

To answer that question, I’ve made a list of the 11 most common dieting pitfalls and I have shown you how Chitosan, together with my Fat Blocker Program, can help you avoid or minimize them.

Exercising too little-Exercise is essential to weight loss, weight maintenance, and general good health. The Fat Blocker Program includes an excellent plan that makes it easy to start getting in shape: Take small steps! You’ll find yourself increasing your exercise almost

automatically. Eventually, chances are you’ll reach or get close to ideal exercise levels—and then you’ll stay there.

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Walking is one of the easiest and most convenient of all forms of exercise. It requires no equipment other than a good pair of walking shoes and some comfortable clothing, and it can be done almost anywhere. It doesn’t even demand good weather. In many areas of the country where snow and low temperatures are common, mall walking has become a great sport. And for years walkers have been eating up miles and miles worth of pavement in the comfort of their own homes by using treadmills. So for many people, especially former no exercisers, walking is the sport of choice.

One of the best things about walking is that you can incorporate it into your daily routine pretty seamlessly. For example, you could walk instead of driving to work. You could take the dog out for a walk, which it would love, instead of sending it outside by itself. A friend of mine had his golden retriever trained to go for a run every evening when he returned from work. If he got home and didn’t want to go jogging, the dog would drive him nuts until he did. “We used to run 3 miles every evening,” my friend told me. “I would run 1 mile and the dog would run 2!”

Walking, at any pace, is better than sitting, but in order to get cardiovascular benefits you must do more than just stroll. Walking briskly can be just as effective as running or bicycling the same distance—it just takes longer. For starters, take yourself out for a walk around your neighborhood. Before you go, do 5 minutes worth of jumping jacks or pushups to warm up, or walk at a slow pace for the first few minutes. Then begin walking briskly. Make sure you keep up a good pace (see the talk-sing test above) and walk for as long as you care to. Try to do a little more each day. And try to find interesting places to walk. (Many cities have walking guides or books that will suggest good walks.) After a while, you’ll forget about how long you’ve been walking, lost in the interest or beauty of your surroundings. Soon, 30 minutes will seem wholly insufficient.

As you come to the end of your walk, slow down to a strolling pace for 5 more minutes, finally finishing your workout with some stretches. Do this walking routine at least 4 times a week for the next few weeks. Once you find that it’s easy for you to keep going for a half hour or more and you’re feeling fine, move up to the next level, wogging.

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