The September 2, 2015, chat with GEHA's panel of health-and-wellness experts has concluded. The transcript is available below and will remain online for several weeks.

For more information about GEHA, please visit the GEHA health home page or the GEHA dental home page, or give us a call at (800) 821-6136


El Paso, Texas (Connection Dental Federal (FEDVIP) Standard): For a 66-year-old male with a low DHEA level, would you recommend supplementing with oral DHEA?
Katherine Lurk, PharmD, BCPS: DHEA is considered a prohormone because it is converted by the body into testosterone and estrogen. DHEA, along with testosterone and estrogen, tend to decrease with age, so it is not unusual that your level has declined. The claimed benefits of supplementation, including strengthening the immune system, slowing the aging process, improving energy, mood, and memory, and building bone and muscle strength, are unclear. Additionally, there are side effects associated with supplementation, including hair loss, high blood pressure, irregular heartbeat, insomnia, and unfavorable changes in cholesterol levels.

Consider the symptoms you are experiencing due to the low DHEA level to help determine whether supplementation is necessary. Additionally, consider following up with your doctor for evaluation of your testosterone level.

Virginia Beach, Virginia (GEHA Standard Option): I've been having poor circulation in my feet. Is that a health issue?
Kipp Wilhoit, RN:

Sometimes feeling cold is a part of life and nothing serious. But there are times when cold toes, numb feet, and poor circulation may be a sign of an underlying medical condition. Warning signs of poor circulation in the legs and feet include: cramps in your legs and feet, especially when you exercise; open sores on the feet or legs that take a long time to heal; change in color or temperature of your legs or feet; and loss of hair on your feet or legs. If you have any of these symptoms, I would recommend that you contact your doctor and schedule an appointment to be checked out.


Sherwood, Oregon (GEHA High Option, Connection Dental Federal (FEDVIP) High): If my blood sugar is not at goal often and I won't take insulin, what organ are affected and what are the damages?
Katherine Lurk, PharmD, BCPS: Many organ systems are affected by increased blood glucose levels.

Heart and blood vessels: Elevated blood glucose levels increase risk for various cardiovascular problems, including chest pain, heart attack, stroke, narrowing of the arteries, and high blood pressure.

Nerves: Excess sugar can injure the walls of the tiny blood vessels that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

Kidneys: The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Blood glucose elevations can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease.

Eyes: Uncontrolled blood glucose can damage the blood vessels of the eye, potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

Feet: Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.

Medford, Massachusetts (GEHA Standard Option): For losing 10-20 pounds of weight, I would like to hire someone to help me. Is it better to hire a nutritionist or a fitness instructor? I already exercise regularly. Thank you.
Nicole Doyle, MS, CPT: Weight loss can be difficult and frustrating, especially when you are exercising regularly and not seeing the pounds come off. I would suggest focusing in on your nutrition, since you state you are exercising regularly. Nutrition is such a key player when it comes to weight loss! I think it would be a good idea to get some professional assistance to help learn what foods your body needs, and to help you stay accountable on your weight loss journey.

Washington, District of Columbia (GEHA HDHP Option, Connection Dental Federal (FEDVIP) High): In the last week I bought the nutria bullet machine and have been blending every fruit and vegetable I can find. I've used papaya, honeydew melon, raspberries, blueberries, blackberries, baby spinach leaves, chard, red, yellow and orange peppers, kale, chia seeds, bananas, apples, pears and grapes. I've used the cup size --about 12 oz. -- in the morning to substitute breakfast. I also return home and drink another cup before preparing dinner. My goal is to lose 100 lbs. Is that too much vegetable and fruit daily for me?
Liz Bell, MSW, LCSW: Congratulations on taking steps to improve your nutrition! While it is important to incorporate fruit and vegetables in your diet, it is also important to balance your intake of fruits and vegetables with food from other categories. The amount of fruit and vegetables you need to eat depends on age, sex and level of physical activity. It is also important to remember that fruits and vegetables have calories.

It is possible to not lose or even gain weight if you are not eating the correct amount of calories. An appropriate calorie recommendation can be calculated for you based on age, height, weight, and activity level. The correct balance of caloric intake and caloric expenditure from exercise is key in weight loss. A deficit of 3,500 calories at the end of the week is needed for a 1 pound weight loss. Once calories are assessed, the appropriate food plate recommendations for each food group can be followed for weight loss.

Park City, Utah (GEHA Standard Option): Is LDL particle number a better indicator of cardiovascular disease risk than amount of LDL in the standard blood screen? Is LDL particle size a more accurate indicator of cardiovascular disease risk? Recent reports indicate that saturated fat in the diet may not be a significant factor in cardiovascular disease. What is the evidence for and against this statement?
Katherine Lurk, PharmD, BCPS: LDL particle number and particle size are hot topics in cardiovascular research.  In a standard lipid panel, LDL cholesterol is a calculated number based on measured total cholesterol, HDL (good) cholesterol, and triglycerides.

Newer research is showing that an actual measurement of LDL particle number in the blood may be useful in assessing a person’s risk and may be a stronger predictor of cardiovascular events than the calculated value.

In regard to LDL particle size, findings show that people with predominantly small, dense LDL particles are at a three-fold greater risk of coronary heart disease.  This occurs because the dense LDL particles are better able to slip through the cells that line the walls of arteries and form cholesterol-rich plaques.  Additionally, blood levels of the small, dense LDL cholesterol particles increase with elevated triglyceride levels and also tend to run in families.

A diet high in saturated fat may not directly increase LDL cholesterol; however, as previously stated, saturated fat is known to increase triglycerides, which in turn are associated with smaller, more dense, plaque-forming LDL particles.  A diet low in saturated fat continues to be recommended to minimize cardiovascular risk.

Vancouver, Washington (GEHA HDHP Option): Please discuss how low vitamin D-3 (serum) levels affect enamel/teeth/gums etc.
Katherine Lurk, PharmD, BCPS: The primary role of vitamin D is to help improve the absorption and utilization of calcium.  Calcium is an important mineral to maintain the strength of bones and teeth, and deficiency can lead to weakened teeth, which may increase risk for cracking and the need for intensive dental care.  There are many other speculated roles vitamin D may play; however, available evidence is unclear to support them.

Everett, Washington (GEHA High Option, Connection Dental Plus, Connection Dental Federal (FEDVIP) High): I would like to lose 30 lbs; I need help.
Nicole Doyle, MS, CPT: Exercise and nutrition are key players when it comes to losing weight and maintaining health. Managing your weight can be tough, especially when it seems like you are doing everything right. Following a consistent calorie intake with a variety of nutrients will help stabilize blood sugar and keep your metabolism at a stable level. The exercise guidelines recommend performing 30 minutes of moderate cardiovascular activity 5 days a week, and performing a total body strength training session at least 2 days a week. I would suggest implementing these guidelines, along with a consistent nutrition plan, and I bet you will see a few pounds come off!

New York, New York In addition to diet, how can I lower my cholesterol and blood sugar? I have a bad back and am limited as to the physical activities that I may perform. My doctor said that I should not lift anything more than 15 pounds.
Kathy Johnson, RN: There are basically three ways to lower your cholesterol: eat right, take cholesterol-lowering medications, and be physically active.

Being physically active when you have a bad back, or other limitations, is a real challenge. Walking, even at a slow pace and for only a few minutes, is worth it. Also lifting weights, even 1 to 2 pounds, can strengthen muscles over time. That can help with cholesterol and blood sugar control.

Most of all, start small and gradually increase the duration and intensity of what you do.


Ogden, Utah (GEHA Standard Option): My hip clicks when I get up from a chair or roll over in bed. What is going on? Is it a sign of a hip replacement? I do have some pain after being on my feet all day
Kathy Johnson, RN: Occasionally our joints creak and groan, but usually it is not consistent. My recommendation would be to schedule a visit with your physician since you are experiencing pain. Good luck! 

Oklahoma City, Oklahoma (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): I am a naturally thin 34 year old female. I have been lifting weights for the past year 4 days a week. Although I have been gaining strength I have not been able to grow very much muscle; tone my body. What should I be doing to increase muscle or tone my body?
Nicole Doyle, MS, CPT: By increasing lean muscle tissue, toning comes as a byproduct. This can be harder to do for females than males, because we have a different chemical and physiological make-up. I would suggest taking a look at the amount of protein you are getting on a daily basis (grams and sources), and perhaps increasing that amount. The American College of Sports Medicine recommends 0.8 grams of protein per kilogram of body weight for sedentary people, and up to 1.8 grams of protein for intense weight training. I would make sure you are getting enough based on your goals (and barring any physician restrictions).

Also, change up your exercise routine! The body adapts quickly to any type of exercise so making sure to change it up every 12 weeks or so is important. I would suggest a split routine (upper body one day, lower body the next, etc.), and lifting heavier weight for fewer repetitions. Don’t be afraid to lift heavier weight in the gym; you will not get bulky. Good luck!

Arlington, Virginia I can't join the chat today. Will the Q&A be available somewhere later?
Kathy Johnson, RN: Yes. The transcript of today's chat will remain right here on the website for at least several months.

Hadley, Massachusetts (GEHA Standard Option, Connection Dental Plus, Connection Dental Federal (FEDVIP) Standard): I recently heard a nutritionist say that the best way to lower cholesterol, triglycerides in particular, was to cut out sweets. Reduce intake of foods with added sugar, whether from sucrose, high fructose corn syrup, honey etc. doesn't matter. 1) Are there research studies to support this claim? 2) Is the best way to reduce overall cholesterol, without taking medication, to eat less foods high in saturated fat like red meat and full fat dairy? 3) How much can regular exercise contribute to lowering one's cholesterol level compared to suggested dietary changes?
Teresa Westmoreland, MS, RD, LD: The Dietary Guidelines for Americans is the Nation’s go-to source for nutrition advice. Published every 5 years for public health professionals, each edition of the Dietary Guidelines reflects the current body of nutrition science and is supported by accepted research studies. These recommendations help Americans make healthy food and beverage choices and serve as the foundation for vital nutrition policies and programs across the United States.

Exercise is very important in controlling cholesterol levels. Not only does total and LDL cholesterol tend to decrease with activity, but HDL cholesterol increases. In order to get this effect “aerobic” activity is best. Aerobic exercise is any exercise that is continuous, rhythmical and involves large muscle groups. Most aerobic exercise end with the letter “ing” (walking, running, rowing, cycling, swimming, rope skipping, dancing, hiking, and skating). The cholesterol lowering effect of exercise is greatest when individuals exercise at least 3 times per week for 30 minutes or more.

A proper diet can help lower cholesterol for several reasons. Diet modifications are essential for weight loss but can affect cholesterol levels even if weight remains unchanged. Also, a proper diet is essential to provide energy for those engaging in daily aerobic exercise. Fat is often targeted as the main dietary factor which affects blood cholesterol. Fat serves many functions in the body therefore, a fat free diet is not a healthy diet. However, the amount and type of fat in the diet is important in controlling cholesterol.

Saturated fat is the main dietary component associated with raising cholesterol. Saturated fats are found mainly in animal products and the tropical oils. The following foods are high in saturated fat and should be used sparingly in the diet:
  • Beef fat, lamb, pork fat
  • (Lard), butter, cream, whole milk dairy products (whole milk and cheeses)
  • Coconut oil, palm oil, palm kernel oil, and cocoa butter
Replacing saturated fats in the diet with monounsaturated and polyunsaturated fats can help decrease total cholesterol. The two fats highest in monounsaturated fats are canola and olive oil. Examples of fats high in polyunsaturated include: corn, cottonseed, sunflower, safflower and soybean oil.

Hydrogenated fats. Hydrogenation increases the saturation and therefore makes it more harmful to the body. Therefore limiting the use of hydrogenated oils is recommended. Hydrogenated oils are commonly found in fast foods, margarine, peanut butter, and snack crackers. It is evident that not all fats are created equal and do not affect your body the same way. However, all fats have about the same amount of calories regardless of their degree of saturation. Fats have over twice as many calories as protein or carbohydrate of a given weight.

Other Dietary Suggestions
  • Eat a variety of foods from all food groups choosing low-fat products from each group. Fiber binds cholesterol and can help in cholesterol reduction. Choosing whole grain products (bran cereal, whole wheat bread)as well as fresh fruits and vegetables will increase fiber intake.
  • Read food labels. Food labels are required to list ingredients as well as the amount of fat, saturated fat and cholesterol in the food. Reading food labels will allow you to choose heart healthy foods.
  • Select protein sources from: *fish which contains omega 3 fatty acids and can be helpful in reducing the risk of heart disease lean cuts of meat (trim visible fats and look for little marbling), skinless poultry, cooked dry beans and legumes, eggs (limit 3-4 per week).
It doesn't take long to lower triglycerides by eating the right foods. We can often see changes in triglycerides in just a few days.
  • Decrease or eliminate sweets: The sugar in sweets will quickly raise triglycerides in many people. Examples: soda, candy, cookies, pies, pastries, sweet desserts, and concentrated fruit juices.
  • Decrease or eliminate alcohol: Drinking alcohol is a strong contributor to high triglyceride levels. For people who are sensitive, even a small amount of alcohol can trigger elevated triglycerides. And the type of alcohol doesn’t seem to matter, beer, wine, or mixed drinks all have the same effect.
  • Decrease refined carbohydrate-containing foods: White rice and bread and pasta made from white flour or semolina can have an impact on triglycerides in sensitive individuals. However, diets which greatly restrict or eliminate high carbohydrate foods such as breads, pasta, cereal, and grains are very unhealthy and can actually contribute to heart disease. Instead, choose moderate amounts of whole grains such as 7-grain breads, whole-wheat pasta, brown rice and other grains such as quinoa, barley, oats, and millet.
  • Choose foods rich in omega 3 fatty acids, the "good" fats! Include foods high in omega-3 fatty acids. To accomplish this, The American Heart Association recommends eating 2 servings of fatty fish (salmon, mackerel, sardines, tuna, trout) weekly. Other sources of omega-3 fats include: ground flax seed, flaxseed oil, soy products, legumes, walnuts, and dark leafy green vegetables. Include these foods daily!

Port Richey, Florida (GEHA Standard Option): Is there a supplement to augment my testosterone?
Katherine Lurk, PharmD, BCPS: There are a couple vitamins/minerals that may help boost your testosterone levels. Zinc is an important mineral for testosterone production and can be obtained through dietary sources, such as meat, fish, cheese, beans, and yogurt. It can also be obtained through supplementation at recommended doses of 40 mg or less per day. Vitamin D can also help increase testosterone levels and is naturally produced in the body when exposed to sunlight. It can also be obtained through supplementation of vitamin D3 at doses of 1,000-2,000 units daily, unless otherwise advised by your doctor.

Additionally, testosterone levels can be improved through the following lifestyle changes:
  • Weight loss
  • Strength training
  • Stress reduction
  • Eliminating sugar from diet
  • Eating healthy fats, such as olives, raw nuts, and avocados

Jonesboro, Arkansas I understand GEHA has a program for gym membership discounts. Can you tell me more about this program?
Kipp Wilhoit, RN:

All GEHA health plan options include our Connection Fitness® program by GlobalFit at no additional cost to our members or their covered dependents.

Through the GEHA Connection Fitness partnership with GlobalFit, you'll have access to:

  • Discounts on gym memberships at thousands of fitness clubs nationwide, including 24-Hour Fitness, Anytime Fitness, Curves and Gold's Gym – all with GlobalFit's guaranteed lowest rates. You can shop for your new gym with a free Guest Pass to try participating clubs before joining.
  • Special pricing and food discounts at 400 participating Jenny Craig Centers.
  • Virtual fitness training with Exercise on Demand.
  • Discounts on at-home workout equipment and videos that include Zumba Fitness; get in shape with the Latin-inspired dance-fitness phenomenon for a special low price on the 5-DVD box set.
  • Health Coaching discounts on 12-week programs with personalized access by phone or online to a professional health coach who will help you quit smoking, lose weight, reduce stress, start walking or meet other health goals.
  • Monthly newsletter, ebooks and podcasts that provide education and tools to help you stay motivated and up to date on the latest fitness and wellness news and training tips.
  • Quarterly "Fit Kit" that includes discount coupons for up to $1,000 in discounts at major retailers across the United States.
To register for GEHA's Connection Fitness program by GlobalFit, or to find more information, go to www.globalfit.com/geha or call (800) 294-1500.

Westerville, Ohio (GEHA Standard Option): Hi, what can I do to repair and stop my fingernails from splitting vertically? I have asked my doctor and nail technician; both say it is age and there is nothing I can do. I don't think this is normal for a healthy 52 year old woman. It is getting painful as they are splitting into the pink area. Thank you for any help you can give.
Kipp Wilhoit, RN:

I am glad to hear that you already addressed your concerns with your doctor. I would first want to see that you were thoroughly examined and that basic screening tests were done. Here are some suggestions:

  • Limit how long you expose your nails to water. According to experts at the Mayo Clinic, prolonged contact with water is the most common cause of split fingernails. Skip taking long soaks in the tub, and bathe in lukewarm water to avoid stripping the nails of moisture.
  • Wear gloves while cleaning or exposing your hands to any harsh chemicals. Choose cotton lined gloves to protect the nails.
  • Reduce how much you use nail polish remover on your nails. The harsh chemicals in nail polish removers can thin and weaken the nails, which makes breakage more likely to occur. Use nail polish remover no more than bi-monthly. When you do use the nail polish remover, choose an acetone-free version.
  • Keep your nails well-moisturized by applying a hand cream. Lock in moisture and strengthen the nails by using a hand cream after washing the hands. The hand cream you choose should contain alpha hydroxy acids or lanolin.
  • Take a vitamin supplement. Nutritional deficiencies can cause fingernails to break and split. According to the American Osteopathic College of Dermatology website, take 2 mg daily of biotin to stop brittle and splitting nails. It is not recommended to use this supplement if you are pregnant. I would recommend you discuss taking any supplements with you doctor.

I do hope these help.


Brownsville, Texas (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): I'm 40yrs old, 4ft 11in and have always maintained my weight between 104-107. This past year, I've had to watch what I eat more to avoid not only gaining weight, but also to with that bloated feeling. It's gotten so bad that I just feel that constant bloat feeling that is so uncomfortable plus I feel more tired. I've had to buy pills to help my digestive system. I've tried added food items that supposedly assist with this, but they haven't helped. I'm not a vegetable person, but I do love salads. Should I be getting a hormone level checked? Or what could I do? I've tried exercising daily, but I just maintain my weight and continue to experience that horrible bloat feeling. I drink at least 8-10 glasses of water per day.
Teresa Westmoreland, MS, RD, LD: Bouts of excess bloating and gas often resolve on their own. The most common ways to reduce the discomfort of gas are changing diet, taking nonprescription or prescription medicines, and reducing the amount of air swallowed. If your symptoms don't improve with changes in eating habits. These symptoms could signal an underlying digestive condition.

When gas doesn't pass through belching or flatulence, it can build up in the stomach and intestines and lead to bloating. With bloating, you may also have abdominal pain that can vary from mild and dull to sharp and intense. Passing gas or having a bowel movement may relieve the pain.

Bloating may be related to:
  • Eating fatty foods, which can delay stomach emptying and make you feel uncomfortably full
  • Drinking carbonated beverages or eating gassy foods
  • Eating too quickly, drinking through a straw, chewing gum or sucking on candies, resulting in swallowing air
  • Stress or anxiety
  • Smoking
  • A gastrointestinal infection, blockage or disease
  • Irritable bowel syndrome, a condition characterized by abdominal pain or cramping and changes in bowel function
  • Conditions such as celiac disease or lactose intolerance in which the intestines aren't able to digest and absorb certain components of food
To reduce bloating, it may help to avoid or reduce the amount of gas-producing foods you eat. Many carbohydrates cause gas, and the following items may be a cause:
  • Beans (you may try presoaking the beans to help reduce the gas-producing potential of beans. Be sure to discard the soaking water and cook using fresh water)
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Carbonated drinks
  • Cauliflower
  • Chewing gum
  • Fruits, such as apples, peaches and pears, raisins, prunes
  • Hard candy
  • Lettuce
  • Milk and milk products
  • Onions
  • Sugar alcohols found in sugar-free foods (sorbitol, mannitol and xylitol)
  • Whole-grains and bran
  • Milk and milk products, such as cheese and ice cream
Foods less likely to cause gas include:
  • Meat, poultry, fish
  • Eggs
  • Vegetables such as lettuce, tomatoes, zucchini, okra,
  • Fruits such as cantaloupe, grapes, berries, cherries, avocado, olives
  • Carbohydrates such as gluten-free bread, rice bread, rice
How we respond to dietary components varies from person to person. Try keeping a journal to log potential “trigger foods.” Then for one week try eliminating those foods or beverages in your diet that you suspect most likely are causing you gas. Then gradually reintroduce them one at a time to help identify the true offenders.

Consult your doctor if your symptoms don't improve with changes in eating habits. Health coaching is available as a free service of GEHA to help you assess your caloric intake and calorie expenditure to help you find a balance for weight maintenance or weight loss if needed. If you are not seeing results with special attention to diet and exercise, it is always a good idea to consult your physician.

New Orleans, Louisiana (GEHA High Option): How many times a year is teeth cleaning necessary? My dentist is trying to get me to come in every 6 months. Is this necessary?
Kathy Johnson, RN: Good oral health is important including brushing your teeth 2 times/day and flossing regularly. Your dentist is the best person for advice on frequency of cleanings; but it is important to have regularly scheduled cleanings.  Happy brushing! 

Morrow, Georgia (GEHA Standard Option, Connection Dental Plus, Connection Dental Federal (FEDVIP) Standard): What does an A1c reading of 6.4 mean?
Teresa Westmoreland, MS, RD, LD: Hemoglobin A1C is a test that measures the amount of sugar that “sticks” to your red blood cells. It is usually reported as a percentage and can be used to give your doctor an idea of what your glucose level has been over the last 2-3 months. Related to hemoglobin A1c is another measure called estimated average glucose or eAG. This measure converts your hemoglobin A1c number into a corresponding blood glucose level. A hemoglobin A1c is equal to an eAG of 137 mg/dl.

Diabetes is typically diagnosed at an A1C of greater than or equal to 6.5%.
Result A1C
Normal less than 5.7%
Prediabetes 5.7% to 6.4%
Diabetes 6.5% or higher

For more information from the American Diabetes Association, click Diagnosing Diabetes and Learning About Prediabetes or A1C and eAG


Mount Pleasant, Wisconsin (Connection Dental Federal (FEDVIP) Standard): How many days should a person age 65+ rest between weight lifting or strength training sessions?
Nicole Doyle, MS, CPT: Great question!  This really depends on the person and their current fitness level, medical history, and current nutritional intake.  It is recommended to place at least 48 hours between strength training sessions of similar muscle groups; meaning, you wouldn’t want to do biceps curls every day.  However, for example, you can perform upper body exercises one day and then do lower body exercises the next day, and then go back to upper body exercises the following day, etc.  My main suggestion is to listen to your body and rest as you need to!  If you have been exercising for several days in a row, and you feel fatigued and/or see your form while strength training start to diminish, it would be best to give yourself a rest day or two.  Good luck!

Brielle, New Jersey (GEHA Standard Option): I'm 68 and it seems that I'm having trouble losing weight and gain it easily. I feel that my metabolism has slowed down. I take vitamins and blood pressure, and cholesterol medicine. I eat salads and protein but it seems that the last 2 years I've had to struggle to keep my weight down. I sometimes walk 2 to 4 miles several times a week, but I don't lose a pound. What can it be? Laura
Nicole Doyle, MS, CPT: Great question! Managing your weight can be tough, especially when it seems like you are doing everything right.  Following a consistent calorie intake with a variety of nutrients will help stabilize blood sugar and keep your metabolism at a stable level.  The exercise guidelines recommend performing 30 minutes of moderate cardiovascular activity 5 days a week, and performing a total body strength training session at least 2 days a week.  I would suggest implementing these guidelines, along with a consistent nutrition plan, and I bet you will see a few pounds come off!

St. Louis, Missouri (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): Over four years ago, I stopped smoking to benefit my health. However, doing so caused me to gain over 40 pounds, which increased my cholesterol, blood sugar, stamina, and joint problems. I have been unable to lose the weight, regardless of what I have tried (diet, exercise, etc.). I feel that the benefits of quitting smoking have been negated by the weight gain and other health issues I now face. Can you recommend another way to shed the weight and regain the health benefits I expected to gain by quitting cigarettes?
Nicole Doyle, MS, CPT: First of all, congratulations on quitting smoking, that is not an easy task! Weight gain is a common occurrence after someone quits smoking; this is due to a few factors. Studies have shown that smoking burns up to 200 calories a day in a heavy smoker; therefore, when one quits smoking, it is important to develop a routine involving good nutrition and exercise, to mitigate these effects. Also, smoking is a known cause of altering one’s taste buds, so shortly after a quitting tobacco the taste buds start to change. This can lead to one eating more foods because they taste better than they probably have in years!

Again, weight gain can be minimized by focusing on nutrition and exercise. I suggest following a daily nutrition plan and developing a consistent exercise routine, to see the pounds start to come off.

Mesquite, Texas (GEHA High Option, Connection Dental Federal (FEDVIP) High): I had back surgery on 9/24/2014, I have not been to therapy. Would it be too late to go to therapy now?
Kathy Johnson, RN: It sounds like you are experiencing some soreness or pain. My recommendation would be to check with your back surgeon; he may want to see you before starting therapy.

Santa Barbara, California (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): My question or concern would be EXERCISE! I go to my gym 4 days a weeks sometimes 5. I have a thyroid problem in which I take medication every day for this. My problem is my weight, I'm not overweight, but it seems to me that around my stomach area is the problem. Which foods should I be staying away from and which do I use? Thank you.
Nicole Doyle, MS, CPT: First of all, great job on the 4-5 days a week in the gym! If the mid-section seems to be the problem area, or if you just aren’t seeing the changes you want, I would suggest logging your foods to track your calorie intake and make sure you are getting in a good variety of nutrition and the right amounts. My next suggestion would be to change up your exercise routine. Take a class a couple times a week, lift heavier weights for few repetitions, and add in some fun cardiovascular exercise such as cycling or swimming. The body adapts quickly to any kind of exercise routine, so changing it up will probably get you the results you are wanting. Nutrition and exercise go hand in hand!

Durango, Colorado I take vitamins and minerals daily. Currently, I take 1200 milligrams of calcium in addition to a multi-vitamin, E, and fish oil. Is there a preferred time to take the calcium -- with the multiple vitamin or separately? I’ve heard that the calcium would not be absorbed if 1200 milligrams is taken at one time -- true or not?
Kathy Johnson, RN: Taking a large dose of calcium, like the 1200 mg you are taking, would be better absorbed by your body if you can break it into two doses of 600 mg or three doses of 400 mg.

Remember too: Calcium supplements can interact with many different prescription medications, including antibiotics, bisphosphonates and high blood pressure medications. You may need to take calcium supplements several hours before or after taking your medications.


Belton, Texas I have been walking 4 miles per day, 6 days per week. What do you recommend for a 68 yr., old male nutrition wise. I am not losing weight like I would like to. Thanks.
Liz Bell, MSW, LCSW: Great question.  It sounds like you are doing a great job of getting in your exercise consistently. The other key to weight loss is nutrition. It is possible to not lose or even gain weight if you are not eating the correct amount of calories. An appropriate calorie recommendation can be calculated for you based on age, height, weight, and activity level. The correct balance of caloric intake and caloric expenditure from exercise is key in weight loss. A deficit of 3,500 calories at the end of the week is needed for a 1 pound weight loss. Once calories are assessed, the appropriate food plate recommendations for each food group can be followed for weight loss.

Sioux City, Iowa I took the Health Risk Assessment last year and received a $75 dollar gift card, can I take it again this year and get another $75 dollar gift card?
Kipp Wilhoit, RN: You can participate in the Health Rewards program annually. GEHA health members and one other member of their household (age 18 or older) can earn gift cards and merchandise up to $250 in value when you participate. For more information, click Health Rewards program.

Bismarck, North Dakota (GEHA Standard Option, Connection Dental Plus): What is a good exercise regime for an 81-year-old male in good health? What can I do to improve my balance? I feel it getting a little shaky!
Nicole Doyle, MS, CPT: Exercise, at any age, is a great way to maintain strength, flexibility, and balance. I would suggest following the guidelines of performing 30 minutes of moderate cardiovascular activity, five days a week. This can be walking, biking, swimming, and anything you find enjoyable that is aerobic in nature. Also, performing 2 strength training sessions a week that utilize the major muscle groups of the body is key in maintaining strength. Specifically, balance, can be improved by adding in balance training 2-3 times a week. There are many exercises you can do to help improve balance, consisting of leg lifts, while standing near a chair (in case you have to hold onto for assistance, and to reassure you that you won’t fall). Walking toe to heel near a wall, standing up from a seated position and trying to not use your hands, standing on two feet and lifting one leg or the other and holding for 15-30 seconds, and many others. Find a balance routine that works for you!

New Braunfels, Texas (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): What kind of exercises and exercise limits should one do if you have osteoarthritis in wrists. I had been doing chest presses, rear row deltoids, pull downs, and curls. I didn't want to exacerbate my wrist problem so have cut down on the weight, but I would like to maintain maximum strength. I'm a 77 year old male.
Nicole Doyle, MS, CPT: I am glad to hear that you have kept your exercise routine going. With osteoarthritis, it is important to keep exercising to maintain the strength you have. I recommend to keep exercising as you are and just modify the exercises as you need. Lowering your weight is a good way to keep your muscles actively engaged, while lessening the pressure placed on your wrists. Be sure to perform total body strengthening exercises and cardiovascular exercise on a regular basis to help you maintain your fitness level!

Central Point, Oregon (GEHA Standard Option, Connection Dental Plus): I have seen several advertisements for "diets" that are supposed to end my diabetes condition and enable me to stop taking meds for it. Do these diets really work and if so due you offer such a diet? If not, do you recommend any particular one? Thank you.
Teresa Westmoreland, MS, RD, LD: I would always be cautious of advertisements making claims that they can cure your diabetes. Lifestyle changes with nutrition and exercise are key to diabetes management, however being able to get off diabetes management meds depends on the type/your genes, how long you’ve had the disease, and how severe it is.

A registered dietitian can help you with making healthier food choices and meal planning. S/he will make an individualized assessment of calorie needs to aid in weight loss, carbohydrate counting for better glycemic control, and selecting foods low in saturated fat and higher in fiber.

Hagatna, Guam (GEHA Standard Option): What to do for pre-diabetic patient? What are the foods to avoid?
Teresa Westmoreland, MS, RD, LD: For the pre-diabetic to try to prevent or delay type 2 diabetes, the following is recommended:
  • Cut back on calories and saturated fat -- Start with making small changes by cutting back on sweets such as candies and cakes that offer little nutritional value. Try switching from regular soda and juice to water with a squeeze of fresh fruit. Try starting each dinner with a salad of leafy greens. The salad provides nutrients and fills you up. Then you might eat less of any high-calorie foods that come later.
  • Lose weight -- Losing 7% of your total weight can help you a lot. For example, if you weigh 200 pounds, your goal would be to lose 15 pounds. You don’t have to make big changes. Small steps can add up to big results.
  • Increase your daily physical activity -- Goal is to get up to 30 minutes a day, 5 days a week.

Online resources from the American Diabetes Association:

Miami, Florida (GEHA High Option): Good morning. I'm thinking about having back surgery. Should I be doing some kind of exercises to make my back stronger?
Nicole Doyle, MS, CPT: Great question!  First of all I would check in with your physician and make sure it is okay for you to start an exercise program and make sure you don’t have any restrictions on what you can/can’t do.  Many people suffer from back pain from time to time. It sounds like your core could be weak, which is also very common.  I suggest building some core strengthening exercises into your routine to help strengthen your abdominals and back.  Traditional exercises such as sit-ups and crunches mainly target the abdominals, and aren’t the best to strengthen the entire core area.  I suggest doing a variety of exercises such as:  planks, leg lifts/raises, opposite arm/leg raise (on all 4’s), etc.  Targeting the entire core is going to best to help mitigate the back pain and gain strength.

Kennan, Wisconsin (Connection Dental Federal (FEDVIP) High): Within the last few months I have been experiencing joint stiffness. My hands are painful and my other joints hurt from time to time. The only medication I take is for thyroid. What changes in my diet can I make to ease my discomfort?
Teresa Westmoreland, MS, RD, LD: Due to joint stiffness and pain, it is recommended to see a physician if there is potential for arthritis. The following recommendations come from the Arthritis Foundation:

The answer, fortunately, is that many foods can help. Following a diet low in processed foods and saturated fat and rich in fruits (such as citrus fruits, strawberries, raspberries, blueberries and blackberries), vegetables, fish (salmon, tuna, sardines, herring, anchovies, scallops, cold water fish), nuts, olive oil, and beans is great for your body. Studies confirm eating these foods can do the following:
  • Lower blood pressure
  • Protect against chronic conditions ranging from cancer to stroke
  • Help arthritis by curbing inflammation
  • Benefit your joints as well as your heart
  • Lead to weight loss, which makes a huge difference in managing joint pain.
More recently, researchers have shown that taking fish oil supplements may help to reduce joint swelling and pain, duration of morning stiffness and disease activity among people who have rheumatoid arthritis. Consult your physician before starting fish oil.

Colorful fruits and veggies – the darker or more brilliant the color, the more antioxidants it has. Good ones include blueberries, cherries, spinach, kale and broccoli.

Should you avoid ightshades?
Nightshade vegetables, including eggplant, tomatoes, red bell peppers and potatoes, are disease-fighting power­houses that boast maximum nutrition for minimal calories. They also contain solanine, a chemical that has been branded the culprit in arthritis pain. There’s no scientific evidence to suggest that nightshades trigger arthritis flares. In fact, some experts believe these vegetables contain a potent nutrient mix that helps inhibit arthritis pain. However, many people do report significant symptom relief when they avoid nightshade vegetables. So doctors say, if you notice that your arthritis pain flares after eating them, do a test and try eliminating all nightshade vegetables from your diet for a few weeks to see if it makes a difference.

Orlando, Florida I have MS and I’m in a wheelchair. It is hard for me to get enough exercise to drop the pounds.
Kipp Wilhoit, RN: You have some unique challenges. I would recommend that you take advantage of GEHA’s free program for members with multiple sclerosis. This program offers a nurse who can help make sure your disease is well-managed and offers education on such topics as chair exercises. Also, GEHA provides a benefit for you to work with a dietitian to tailor a diet plan for your disease and level of activity. Please send your name, member ID number and contact information to caremanagementinbox@geha.com and a nurse will work with you to get you involved in the appropriate program.

Pennville, Indiana (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): My husband has a severe heat rash that we have been battling for a couple of weeks. We have tried diaper rash ointments and now are trying Lotrimin Spray, but it doesn't seem to be getting better. Is there a better product that may help? He works in a furnace room.
Kipp Wilhoit, RN:


I understand your concern about your husband's rash since it is not responding to the ointments that he is using. In most cases, heat rash will clear up on its own in a few days if the affected area is kept cool and dry. It sounds like the challenge may be that his skin is exposed almost daily to higher temperatures when he is at work.

It is usually recommended not to use any oil-based products that might block his sweat glands. Drinking fluids to cool the body and to keep hydrated is also helpful. Since the rash is not improving, I recommend that your husband call his doctor. The doctor can examine the rash and determine the appropriate treatment for him.  


Philadelphia, Pennsylvania What is the best way to get off the couch? Any suggestions on little things to do to get motivated?
Kathy Johnson, RN: Ha! You know, there’s an old saying, "The best exercise is the one you’ll do." You have to assess your motivation to change. Obviously you’ve thought about exercise because you’re asking about it. That’s a great first step. Now put some action to it!

Get your walking shoes out. Walk to your mailbox, around the block or around your house. Best bet: take your dog, or find a friend to go with you. Having someone (or something) to hold you accountable will double your efforts.


San Antonio, Texas (GEHA Standard Option): I am a billiard player, and I notice my lower back stinging when I play a long time. What exercises do you recommend?
Nicole Doyle, MS, CPT: Great question! Many people suffer from low back pain from time to time, especially when doing an activity for a prolonged period of time. It sounds like your core could be weak, which is also very common. I suggest building some core strengthening exercises into your routine to help strengthen your abdominals and back. Traditional exercises such as sit-ups and crunches mainly target the abdominals, and aren’t the best to strengthen the entire core area. I suggest doing a variety of exercises such as planks, leg lifts/raises, opposite arm/leg raise, etc. Targeting the entire core is going to best help mitigate back pain and gain strength.

Aurora, Colorado (GEHA Standard Option, Connection Dental Plus): Since they are not regulated, what is the best daily vitamin supplement for someone age 60?
Katherine Lurk, PharmD, BCPS: As we age, our dietary requirements change.  It is important to focus mostly on finding a vitamin supplement to meet your specific needs and ensure you are meeting the recommended daily intake.  At your age, important nutrients to focus on are calcium to help improve and maintain bone strength, vitamin D to help absorb and utilize calcium, vitamin B12 for memory and cognitive function, folate to help reduce risk of cardiovascular disease and dementia, and vitamin A for vision.  There is not one vitamin supplement known to be the best.  I recommend to review labels and look for “Consumer Lab” approval.  These products have been independently tested and contents are verified.

Grain Valley, Missouri (GEHA Standard Option): What exercises do you recommend to build muscle for females? Thank you.
Nicole Doyle, MS, CPT: Great question! Always check with a physician before starting a new exercise regimen. That being said, developing a routine consisting of total body exercises is key in building overall muscle. First, make sure you have a good nutritional intake in place, next, make sure you are getting in the recommended 30 minutes of moderate cardiovascular exercise 5 days a week (totaling 150 minutes, or 75 minutes of vigorous exercise).

There are many different ways to build muscle and strength. Finding a weight training program that works for you and one that you enjoy is crucial to consistency and sticking with it. If you are just starting out I would recommend doing a total body exercise routine, 2 days a week, to start building strength. Exercises such as squats, chest press, overhead press, bicep curls, leg press, and many more, can be done using dumbbells and or machines. You can also get a great strength training session with no equipment, by using your own body weight. Get creative, have fun, and build some muscle!

Homosassa, Florida (GEHA High Option, Connection Dental Federal (FEDVIP) High): I have been having numbness or neuropathy in my middle toes. I have also been recently diagnosed with type 2 diabetes and take metformin HCL 250mg daily. I also take hydrochlorothiazide 12.5 MG daily and losartan potassium 25 MG daily.
Katherine Lurk, PharmD, BCPS: Symptoms of numbness and neuropathy in your toes can be caused by a number of things, and the most likely cause in your case is your recent diagnosis of diabetes.  Over time, high blood glucose levels from diabetes can damage nerves throughout the body, so controlling blood glucose levels throughout life is very important to reduce the effects and slow the progression of neuropathy symptoms.  Additionally, since you are experiencing numbness in your feet, it is important to examine your feet at least once daily to check for any open sores or wounds.  If not identified early, these minor injuries can quickly turn into serious infections.

Boise, Idaho I would like to get my cholesterol checked and have heard about the biometric screening that GEHA offers. Can you tell me more about this program?
Kathy Johnson, RN:

It is important to know your lab values -- especially cholesterol. GEHA offers a free biometric screening program that I encourage you to take advantage of.

You can schedule your biometric screening to be completed by a health examiner in the comfort of your home, at work, or at a Quest Diagnostic Patient Service Center. You pick the time and location that is most convenient for you. Your screening will include readings for blood pressure, height, weight, hemoglobin A1C (a screening for diabetes), cholesterol, and blood creatinine (a screening for kidney disease). Call ExamOne at (888) 234-1314 to schedule your screening.


Snellvie, Georgia What are some good breathing exercises?
Liz Bell, MSW, LCSW: Hi. Thank you for the question.  Proper breathing is an underestimated, but critical building block of good health. Slow, deep breathing gets rid of carbon dioxide waste and takes plenty of clean, fresh oxygen to your brain and muscles. More blood cells get the new, oxygen-rich air instead of the same old stale stuff. Experts estimate that proper breathing helps your body eliminate toxins 15 times faster than poor, shallow breathing. You'll not only be healthier, but you'll be able to perform better (mentally and physically) and, of course, be less stressed and more relaxed. Here are some breathing exercises that will help you get the full benefits of good breathing:

Diaphragmatic Breathing: Put one hand on your upper chest and the other on your abdomen just above your waist. Breathe in slowly through your nose - you should be able to feel the hand on your abdomen moving out (the hand on your chest shouldn't move). Breathe out slowly - you should be able to feel the hand on your abdomen moving in as you exhale.

Mini relaxation exercises are focused breathing techniques which help reduce anxiety and tension immediately. You can perform these mini exercises anywhere:

Mini Version 1: Count very slowly to yourself from ten down to zero, one number for each breath. With the first diaphragmatic breath, you say "ten" to yourself, with the next breath, you say "nine", etc. If you start feeling light-headed or dizzy, slow down the counting. When you get to "zero", see how you are feeling. If you are feeling better, great! If not, try doing it again.

Mini Version 2: As you inhale, count very slowly up to four; as you exhale, count slowly back down to one. Thus, as you inhale, you say to yourself "one, two, three, four," as you exhale, you say to yourself "four, three, two, one." Do this several times.

Mini Version 3: After each inhalation, pause for a few seconds, after your exhale, pause again for a few seconds. Do this for several breaths.

Another Exercise: Progressive muscular relaxation (PMR) helps release muscle tension. Your muscles tighten as one of the first signs of stress and can become a real pain in the neck (or lower back). But this pain doesn't have to be a way of life. PRM is simple yet effective at reducing pain and enhancing relaxation. Sit comfortably and close your eyes. Start by tightening a group of muscles, such as your fists, as much as possible. Hold this tension for a few seconds and then relax the muscles. Once your muscles are relaxed, consciously soften them even further in order to be as relaxed as possible.

Kansas City, Missouri (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): I have been reading and hearing a lot about consumption of wheat, corn, barley, rye, rice products contribute to "wheat belly." I was under the assumption as long as the product was in its whole form such as whole wheat, it was probably OK. What are your thoughts on the term "wheat belly"?  Thanks.
Teresa Westmoreland, MS, RD, LD: Excellent question! There is a lot of confusion around gluten. In my opinion a “wheat belly” would apply to someone with celiac disease or a gluten sensitivity. In this case it is advised to follow a gluten free diet.

If you are experiencing symptoms such as diarrhea, bloating, stomach upset, and abdominal pain in response to eating gluten, it is recommended that you see a doctor to get tested for celiac disease. The consumption of gluten in an individual with celiac disease will cause damage and inflammation to the lining of the small intestine. This makes it harder for the body to absorb nutrients. If you do not have a diagnosis of celiac and still experience GI symptoms and possibly fatigue and headaches, it may be a gluten sensitivity. There is no medical test to diagnose the sensitivity currently. Gluten sensitivity does not damage the intestines.

Individuals may see a big weight loss while following a gluten-free diet. It may also be likely that it was more from making healthier food choices and substitutions than just from eliminating gluten in the person that does not have celiac or gluten sensitivity. Losing weight will come with eating a healthy, balanced diet that has fewer calories and with the addition of activity.

In the person without celiac disease or gluten sensitivity, whole grains such as whole wheat bread is included in a healthy, well balanced diet. Whole grains are packed with nutrients and have been shown to reduce risk of obesity, heart disease, Type 2 Diabetes, and some forms of cancer. Ideally the first ingredient on the food label will have the word “whole” preceding the grain to show that the product is whole grain.


Pierre, South Dakota (GEHA Standard Option, Connection Dental Plus): I currently suffer from both Type II Diabetes and Chronic Kidney Disease. The diets for each are mutually contradictory. To complicate matters I, also, have mild arthritis for which I've been prescribed Meloxicam , an NSAID prohibited from CKD treatment. You're best solution would be welcome.
Katherine Lurk, PharmD, BCPS: NSAIDs can be used to treat pain in people with CKD under the supervision of a physician.  The reason this type of medication is generally not recommended or used with caution in people with known kidney disease is because they have potential to cause further kidney damage by reducing blood flow through the kidneys and inducing other inflammatory conditions in the kidney.  Your doctor is monitoring your kidneys through routine labs, so be sure to complete those requests to ensure your Meloxicam therapy continues to be safe.

Atlanta, Georgia I have decided to have a life style change and eat right according to the food plate - less meat, more vegetables, fruit and grains such as flax seed, quinoa, etc. Why am I not losing weight? Will this just help you maintain a healthy weight?
Teresa Westmoreland, MS, RD, LD: Great question! It sounds like you have been making healthy food choices. Even though you are making great food choices, it is possible to not lose or even gain weight if you are not eating the correct amount of calories. An appropriate calorie recommendation can be calculated for you based on age, height, weight, and activity level. The correct balance of caloric intake and caloric expenditure from exercise is key in weight loss. A deficit of 3,500 calories at the end of the week is needed for a 1 pound weight loss. Once calories are assessed, the appropriate food plate recommendations for each food group can be followed for weight loss.

Berlin, Maryland (GEHA High Option, Connection Dental Plus, Connection Dental Federal (FEDVIP) High): I am a recovered victim of Guillian-Barre and I was wondering if I could now get the flu shot. I had GBS in 2005 and am now 79 years old.
Kathy Johnson, RN: The CDC lists a history of Guillian-Barre as a precautionary condition.  My recommendation would be for you to check with your primary care physician just to make sure. GEHA covers the cost of the flu vaccination at 100%.

Grove City, Ohio (GEHA High Option, Connection Dental Federal (FEDVIP) High): I am considering switching to a pump for insulin therapy but I know very little about the details about how they work. Can you explain the use of an insulin pump for delivery of my insulin? Thanks.
Katherine Lurk, PharmD, BCPS:

Insulin pumps deliver short- or rapid-acting insulin 24 hours a day through a catheter placed under the skin.  The insulin doses are separated into:

  • Basal rate, which is a small, continuous dose throughout the day

  • Bolus doses to cover carbohydrates in meals

  • Correction or supplemental doses

Basal insulin keeps your blood glucose levels in range between meals and through the night.  Often times, you program different amounts of insulin at different times of the day and night.

 

When you eat, you use buttons on the insulin pump to give additional insulin, called a bolus.  You take a bolus to cover the carbohydrates in each meal and snack.  You also takes a bolus to treat high glucose levels.  If you have a high glucose level before you eat, you can give a correction or supplemental dose of insulin to bring it back into target range.

Albuquerque, New Mexico How much water should we drink every day? Does this include the water found in juices and other things we consume each day?
Kathy Johnson, RN: The Institute of Medicine advises men to consume about 3 liters (approximately 13 cups) and women to consume 2.2 liters (about 9 cups) of water per day. The foods you eat provide about 20 percent of your total fluid needs. While all fluids do contribute to your daily total, water is the best choice because it is calorie free, cheap and easily accessible. When you consider that a 12-ounce can of cola contains 250 calories, a 12-ounce glass of fresh, unsweetened orange juice contains 156 calories, and a McDonald’s medium-size sweet tea contains 151 calories, it is easy to see how quickly those calories can add up. So it’s a great idea to keep water readily available.

Salt Lake City, Utah (GEHA High Option): I am a breastfeeding mother. My question is: how do you know how many calories are enough while trying to lose weight? What would be an ideal number of calories a day to intake?
Teresa Westmoreland, MS, RD, LD: Calorie recommendations are based on your age, activity level, and weight loss goals. The U.S. Department of Agriculture’s site, choosemyplate.gov, can help you design a personalized eating plan with a section for a breastfeeding mom.

To start try not to go under 1,800 calories a day. You may find that the weight will start to come off naturally just by choosing healthy, well-balanced options and avoiding empty calories, meanwhile eating off of hunger cures. Keep healthy, quick snacks around such as apple slices, carrot sticks, celery and peanut butter.

Portland, Oregon I have arthritis, and find if I do an exercise -- even swimming -- at a pace that actually makes me sweat that I’m in pain for several days after. I’m trying to find something that is a real workout but doesn’t leave me wiped out. I feel OK when I’m doing the routine -- it’s the recovery time.
Kathy Johnson, RN: Making sure to include a longer warm up and cool down is essential for people who have arthritis when exercising. It is also important to keep your exercise intensity below the discomfort threshold. It sounds as though you may be pushing yourself too hard, which is leaving you "wiped out." If you are still experiencing pain for 24 to 48 hours, it is advised you discontinue that exercise. However, I suggest reducing the intensity and re-evaluating how you feel during your recovery.

San Antonio, Texas (GEHA High Option): I have been diagnosed with a rotator cuff injury in my right arm and shoulder. I have seen a sports specialist doctor, and X-rays revealed no tears. I have followed the rehab routine of exercises faithfully, and regained some strength and mobility. However, I still lack a normal range of mobility, such as being able to place my arm up behind my back. I have read about scar tissue in the shoulder as a possible factor, which may be reduced by massage therapy to improve blood flow in the area. Is this option covered by GEHA, or can you recommend additional treatment options to regain full strength and mobility?
Nicole Doyle, MS, CPT: It sounds like you have tried many methods in order to regain full ability in your right arm and shoulder area. A rotator cuff injury can be a tough one to fully rehab from, depending on the severity of the injury. The GEHA benefits line can be accessed by calling (800) 821-6136 to determine what is covered by your insurance. That being said, doing everything you can do, such as consistent cardiovascular exercise and regular strength training, over time, is going to help you regain full strength, mobility, and range of motion. Keep doing your physical therapy exercises too, and you should be well on your way to a full recovery.

Joplin, Missouri (GEHA HDHP Option): My son, who is getting ready to turn nine, is very athletic and is playing tackle football this year. He is very dedicated all on his own, and he wants to work out and "beef up" for football. I am thrilled that he is so into health and exercise, but should I be setting limits for him? He jogs and lifts light weights, which doesn't concern me so much, but recently he's been asking me to buy Muscle Milk for him. He is exercising a lot more than an average boy his age, but I feel like we eat pretty healthy and I see no need for supplements. I would really appreciate advice!
Nicole Doyle, MS, CPT: First of all, how great to hear he is so into sports and exercise! The jogging and light weights are fine for him. Keep in mind that prepubescent children have immature skeletons, and vigorous strength training is not advised. It sounds like your nutrition as a family is fairly well-balanced, and I agree with you as far as the supplements go. I wouldn’t suggest supplements because he can get all the nutrients he needs from a well-balanced diet.

Long Island, New York (GEHA Standard Option): What is GEHA doing to help improve health care costs across the board to both improve cost and to improve health outcomes? Please provide some examples?
Kipp Wilhoit, RN: This is a great question! GEHA is committed to helping control health care costs while promoting the best possible health outcomes. Every day, we work to find new ways to connect members with the quality care they deserve to help them stay healthy. GEHA invests in programs that improve the health of our members. One of those programs is the biometric screening. The free biometric screenings help members to know their numbers including blood pressure, height, weight, hemoglobin A1c (a screening for diabetes), cholesterol, and blood creatinine (a screening for kidney disease). These screenings can be scheduled in the home, at work, or at a participating Quest lab center. Health plan members can schedule a free biometric screening today by calling (888) 234-1314.

Another great resource for our members is the GEHA Health Advice Line. It provides members with the chance to speak with a registered nurse 24 hours a day/7 days a week. The nurse can help evaluate symptoms and determine the appropriate care. The phone number to the Health Advice Line is (888) 257-4342. For members with weight-loss goals, GEHA provides VLM (Virtual Lifestyle Management). This is our free online program that features interactive lessons and personal coaching. GEHA health plan members may qualify if they have 30 or more pounds to lose, or if they have a health condition caused or worsened by their weight. GEHA offers a Health Rewards program to our members to encourage healthy lifestyles. Our rewards program incentives are all wellness-based, and provide an opportunity to earn merchandise by participating in health-related activities.

You will find information on all of these programs and more by clicking on the Health & Wellness tab at geha.com. I also encourage you to sign up for our monthly newsletter, Health e-Report. Thank you!

Summerton, South Carolina (GEHA Standard Option): My doctor has told me that I am pre-diabetic. She said to start a low glycemic diet. I am eating natural foods (for example: teff, quinoa, chia seeds, oak groats, buckwheat flour, cocoa nibs, pumpkin seeds, hemp seeds, etc.) I also eat beans, green vegetables and fruits. I use protein powder and yogurt. While eating these types of foods as a life-time change, is there any danger of having my pre-diabetes affected?
Teresa Westmoreland, MS, RD, LD: Great question! By making changes in your diet with reducing high glycemic foods and saturated fat, such as you have, you can help prevent or delay diabetes. You will not develop type 2 diabetes automatically if you have prediabetes. For some people with prediabetes, early treatment can actually return blood glucose levels to the normal range. Research shows that you can lower your risk for type 2 diabetes by 58% by:
  • Losing 7% of your body weight (or 15 pounds if you weigh 200 pounds)
  • Exercising moderately (such as brisk walking) 30 minutes a day, five days a week
Don't worry if you can't get to your ideal body weight. Losing even 10 to 15 pounds can make a huge difference. See more at Diagnosing Diabetes and Learning About Prediabetes.

To assist in weight loss, it is always helpful to meet with a dietitian and/or health coach one on one to help assess an individualized calorie recommendation.

St. Paul, Minnesota At what age do you suggest children start taking vitamins? What type of vitamins are important for them to have?
Kathy Johnson, RN: There is no consensus about the need for vitamins for children. This is even true for children who are considered "picky eaters."

Most common foods -- including cereals and milk -- have extra vitamins and minerals in them, so your child most likely is getting enough. However, there is little harm in giving an age appropriate vitamin ... other than the cost.

Don’t think of multivitamins as a replacement for proper nutrition. Also a child can get too many vitamins -- so be careful with them like you would with any medicine.

There are some times when a vitamin might be recommended, such as when a child has an eating disorder, isn’t growing well (called failure to thrive), doesn’t eat regular or well-balanced meals, has a restrictive diet (such as a strict vegan diet), or has certain chronic diseases or food allergies. When in doubt, always check with your health care provider.


Andover, Kansas (GEHA High Option, Connection Dental Plus): Hi. Since I have 38 years in a 12-step program, is there anything I can do to stop the sugar and salt cravings. They are much more pronounced when I am under stress. My weight is also creeping up, and I haven't been successful in the past with the MOVE program. I am open to any and all suggestions. Thanks in advance.
Liz Bell, MSW, LCSW: Hi. I love that you are dedicated to your health and weight loss. This is a great question and a very common question surrounding stress and food. It sounds like your cravings are related to the amount of stress in your environment. It will first help to address the stress and how you are coping with your stress. As health coaches we use a “food and mood” journal that assists individuals to become aware of how their mood is directly related to their cravings. When you are having a craving you can check how you are feeling, what you are doing at the time and choose an alternative to eating a sugary or salty snack. You may look at taking a walk, deep breathing, choosing a healthy snack option, drinking water or even talking to a friend can help.  Eating a well-balanced diet, including adequate amounts of protein, fruits and vegetables can help during times of stress.

Baltimore, Maryland I have diabetes and take two different medications and I just can’t lose weight. Any suggestions?
Kathy Johnson, RN: Great question. First things, first—is your diabetes in good control? Did you know GEHA pays for members with diabetes to work with a dietitian on a nutrition plan? Also, you have access to a nurse to educate you about your diabetes and a health coach to work with you on an individualized plan. If you are interested, contact Customer Service at (800) 821-6136 and ask to speak with a Care Management Personal Health Nurse Consultant.

Kamiah, Idaho (Connection Dental Federal (FEDVIP) High): Do natural no calorie sweeteners (such as Stevia) have the same health risks associated with artificial sweeteners, such as increased risk of Type 2 diabetes?
Teresa Westmoreland, MS, RD, LD: Stevia is also referred to as Rebaudioside A, Reb-A or rebiana. Technically, Reb-A is a highly purified product that comes from the stevia plant and is several hundred times sweeter than sugar. According to the U.S. Food and Drug Administration (FDA), Reb-A is generally recognized as safe (GRAS) as a food additive and table top sweetener. When something is generally recognized as safe by the FDA, it means that experts have agreed that it is safe for use by the public in appropriate amounts.

The FDA approved only the purified form of stevia, called stevioside, as safe to use. If you see whole stevia leaves or crude stevia extracts at your local natural foods store, don’t buy them.

Stevia, when used in moderation, can be incorporated into a healthy, well balanced diet.

For more information, visit the Food and Drug Administration website and read Low-Calorie Sweeteners from the American Diabetes Association.

Meeker, Colorado Thank you for offering the live chat today! I was wondering if you could give an idea of the recommended amount of time/days per week a beginning/average person should lift weights per week, and to balance that what would be the ideal amount of protein a person should regularly eat to support that?
Kipp Wilhoit, RN: Good for you for starting a strength training program! The American College of Sports Medicine (ACSM) recommends a strength program 2 or 3 days per week. This definition of strength includes muscular strength and endurance, resistance exercise, calisthenics, balance and agility exercise.

Given that most Americans eat plenty of protein already, you probably don’t need to add any extra protein to your current diet. You can track your protein, and carbs and fat online. One good site is the "My Food & Exercise Diary" tool that is part of the Onlife Health website. Just log in to onlifehealth.com.

Lake City, Florida Can exercise reverse osteoporosis? If so, what exercises are best to build bones?
Kipp Wilhoit, RN: According to experts, exercise cannot reverse osteoporosis, but it is important in achieving and maintaining good bone health.

Get at least 1,200 milligrams per day of calcium and 800-1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium. Your doctor may recommend a supplement to give you the calcium and vitamin D you need.

Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include:
  • Weight-bearing exercises -- walking, jogging, playing tennis, dancing;
  • Resistance exercises -- free weights, weight machines, stretch bands;
  • Balance exercises -- tai chi, yoga;
  • Riding a stationary bicycle;
  • Using rowing machines; and
  • Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures.

Washington, DC How much sleep a night should adults get to remain alert and healthy? If you get substantially less sleep for a couple of days, how can your body catch up?
Kipp Wilhoit, RN: Sleep is important for your physical and emotional health. Sleep may help you stay healthy by keeping your immune system strong. Getting enough sleep can help your mood and make you feel less stressed. Most people need between 7-8 hours of sleep each night to feel refreshed and function at their best.

If you don’t get the amount of sleep your body needs, you start to accumulate a “sleep debt.” Consequences of sleep debt include memory problems, depression, a weakening in your immune system and even an increase in perception of pain.

You can "pay off" a sleep debt of a few hours by getting extra sleep over the next week or so, which is why you may have such a strong urge to sleep in on Saturday mornings. However, if the debt remains unresolved and continues to mount, you could be at increased risk for accidents, injury or illness. The best way to catch up on lost sleep is to get back into a regular sleep schedule.

Washington, DC Is the protein from meat the same as the protein from plants and nuts? How do I get good protein without the saturated fat, hormones, transfat, etc., that is in meat?
Kipp Wilhoit, RN: The protein from meats is classified as complete protein because animal proteins contain all the amino acids that our bodies need. The proteins in plants and nuts are classified as incomplete because they do not contain all the essential amino acids. By eating a wide variety of plants, grains and nuts supplemented with fish and organic free-range chicken and low-fat dairy products, it is possible to get all the protein your body needs.

In fact, it is possible to get all the protein you need by eating a wide variety of grains, nuts and vegetables. Just be sure to include good calcium sources like dark green leafy vegetables, calcium-fortified orange juice and soy products. Also, include fortified whole grain breads and cereals to ensure your intake of zinc, iron and B12 is sufficient.

Panhandle, Texas (GEHA Standard Option): My last blood test showed high triglycerides (304). Is there something I can take besides doubling up on the statin? All other tests were normal (cholesterol and Ldl). Are statins safe to take for long periods?
Katherine Lurk, PharmD, BCPS: There are other medications that can be taken with statins to specifically focus on lowering triglycerides. The two most common medications available for this purpose are Gemfibrozil and Fenofibrate, and they should be coupled with a diet low in saturated fats and sugar for optimal results.

There is no known time frame for duration of statin therapy. Generally, statins are continued for the time they are needed to manage cholesterol and reduce cardiovascular risk as long as they are tolerated by the person taking them. There have recently been some claims that statins may contribute to an increase in blood glucose and memory loss; however, risk of potential side effects must outweigh the cholesterol-lowering and cardiovascular protective benefits of statin therapy to warrant any changes.

Lavernia, Texas (GEHA Standard Option): I vaguely recall see something about obtaining a $75 gift card if I completed a think a survey, can you provide any clarity?
Kathy Johnson, RN: GEHA offers a Health Rewards program that once a Health Risk Assessment is completed you receive a $75 gift card! The program has been very popular this year.  The following link gives additional details regarding the program.   https://www.geha.com/health-and-wellness/health-rewards-program

Monterey, California (Connection Dental Federal (FEDVIP) Standard): My doctor just told me I'm right on the edge of being diabetic and wants me to start cutting down on sugar and carbs. Now it seems like everything has sugar or carbs! I'm having a hard time giving up ice cream and frappuccinos! Is "no sugar added" ice cream okay? How about sugar-free frappuccinos? Or are the sugar replacements just as bad?
Teresa Westmoreland, MS, RD, LD: Cutting down on sugar and carbs is a good place to start with trying to prevent diabetes. For example, switch from regular soda and juice to water with a squeeze of fresh fruit. These foods are mainly empty calories, having little nutritional value. Cutting back on these foods will help cut calories, which may in turn help with weight loss, which is a problem for many who are on the edge of diabetes. Being overweight is a big contributing factor to the development of diabetes.

Sometimes low-calorie sweeteners (also called artificial sweeteners, sugar substitutes or non-nutritive sweeteners) can be used to sweeten food and drinks for less calories and carbohydrate when they replace sugar.

- See more at: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/artificial-sweeteners

Still, many foods containing low-calorie sweeteners will provide some calories and carbohydrate from other ingredients. That means foods that carry claims like "sugar-free," "reduced sugar" or "no sugar added" are not necessarily carbohydrate-free or lower in carbohydrate than the original version of the food. Always check the nutrition facts panel, even for foods that carry these claims.

There are six artificial sweeteners that have been tested and approved by the U.S. Food and Drug Administration (FDA): acesulfame potassium (also called acesulfame K) aspartame, saccharin, sucralose, neotame, advantame. These foods still contain calories and may still contain carbohydrates, so use them in moderation along with an appropriate calorie intake coming from a healthy, well-balanced diet.

Try and prevent or delay type 2 diabetes, the following is recommended:
  • cut back on calories and saturated fat
  • lose weight
  • increase your daily physical activity
A dietitian can help you with individualized meal planning and can help you make a plan for ways to get more active to aid in weight loss.

Davenport, Florida (GEHA Standard Option): I have been trying to lose weight for the past 8 months, and can't. I know I am doing all the right things (eating whole foods, watching added sugar content, I stopped eating meat a couple of months ago, and I exercise 6 days a week (3 days weight training slow movement for 20 mins/with 25 mins HIIT training, and 3 days 30 mins on a treadmill normal speed). I'm 72 and have type 2 diabetes and hypertension. I'm taking meds, and can't get rid of belly fat. Do you think I may have a hormone problem? I have an appointment to see an endocrinologist, hoping he can help. This is really starting to stress me out.
Nicole Doyle, MS, CPT: First of all, great job on the exercise regimen. That is impressive for anyone, and especially for a 72 year old!  It sounds like your nutritional intake is well-balanced, and your exercise is certainly in a good place too. I am glad to hear you are following up with an endocrinologist to make sure everything is okay with your hormones. 

There could be many factors as to why you are not seeming to lose weight. I would suggest logging your food intake for several days to see how many calories you are eating and the types/sources of nutrients you are getting. Storing fat in the mid-section is very common, and over time can decrease by following a consistent nutrition and exercise plan. I would also suggest changing up your exercise routine if it has been similar for 8 months. The body adapts to exercise quickly, and it is a good idea to change up your routine every 12 weeks or so.

Pleasanton, California (GEHA HDHP Option): I have tried quitting smoking numerous times and in many years. Tried all the OTC nicotine cessation aids. What other options, tips, recommendations do I have to help with quitting successfully?
Liz Bell, MSW, LCSW: This is a great question and a common one for individuals who are working on quitting smoking.  There are many options and tips to assist with quitting smoking and it is very important to find the options that best suit your lifestyle and specific needs, and then make a plan to quit smoking for good.  As telephonic health coaches we work using behavior change techniques to assist with tobacco cessation and work with members to help generate a quit plan that matches their specific needs. Here are just a few tips and recommendations to help with quitting smoking.

Write down why you want to quit (the benefits of quitting): live longer, feel better, for your family, save money, smell better, find a mate more easily, etc. You know what's bad about smoking and you know what you'll get by quitting. Put it on paper and read it daily.

Set a quit date. Decide what day you will extinguish your cigarettes forever. Write it down. Plan for it. Prepare your mind for the "first day of the rest of your life". You might even hold a small ceremony when you smoke you last cigarette, or on the morning of the quit date.

Begin an exercise program. Exercise is simply incompatible with smoking. Exercise relieves stress and helps your body recover from years of damage from cigarettes. If necessary, start slow, with a short walk once or twice per day. Build up to 30 to 40 minutes of rigorous activity, 3 or 4 times per week. Consult your physician before beginning any exercise program.

Cut back on cigarettes gradually (if you cut back gradually, be sure to set a quit date on which you WILL quit). Ways to cut back gradually include: plan how many cigarettes you will smoke each day until your quit date, making the number you smoke smaller each day; buy only one pack at a time; change brands so you don't enjoy smoking as much; give your cigarettes to someone else, so that you have to ask for them each time you want to smoke. Count out how many you want just for that day and put them in a Ziploc bag.

Quit smoking "cold turkey". Many smokers find that the only way they can truly quit once and for all is to just quit abruptly without trying to slowly taper off. Find the method that works best for you: gradually quitting or cold turkey. If one way doesn't work do the other.

Learn what triggers your desire for a cigarette, such as stress, the end of a meal, arrival at work, entering a bar, etc. Avoid these triggers or if that's impossible, plan alternative ways to deal with the triggers.

Find something to hold in your hand and mouth, to replace cigarettes. Consider drinking straws or tooth picks, etc.

Keep a picture of your family or someone very important to you with you at all times. On a piece of paper, write the words "I'm quitting for myself and for you (or "them")". Tape your written message to the picture. Whenever you have the urge to smoke, look at the picture and read the message.

Believe in yourself. Believe that you can quit. Think about some of the most difficult things you have done in your life and realize that you have the guts and determination to quit smoking. It's up to you.

After reading this list, sit down and write your own list, customized to your personality and way of doing things. Create your own plan for quitting.

Saint Louis, Missouri (GEHA Standard Option): I went and got the biometric exam. I never got the results.
Kipp Wilhoit, RN:

I am so happy to hear that you participated in the biometric screening program. It does take 2-3 weeks to receive your results in the mail.  I have sent notification to ExamOne to check on the status of your results and verify that they were sent. Please call Customer Service at (800) 821-6136 if you do not receive the results in the next couple of weeks. 

 Thank you!


Reno, Nevada I am diabetic. Are sweet potatoes and rice something I can eat?
Kipp Wilhoit, RN: Great question! Often people think that having diabetes means that you have to completely avoid potatoes and rice, but that’s not accurate.

People who have diabetes need to follow a balanced diet, with the right amount of calories, including carbohydrates, protein and fats.

If you are taking medications and/or insulin to control your blood sugar it’s very important to work your dietitian or certified diabetes educator to understand the total amount of carbohydrate you should be eating daily, and for each meal. There is a bit of a learning curve to understand the amount of carbs per food choice/portion, but after a while it becomes really easy to understand.

Fiber is really important for helping to stabilize blood sugar, so scrub and eat that small sweet potato with the skin (that’s where the good fiber is!); choose whole grains instead of white, refined grains...brown rice has a bit more fiber than white rice--the portion size is really important. Hope this helps!

Mandan, North Dakota (GEHA High Option, Connection Dental Plus): I have joined Anytime Fitness in Mandan, ND. Can I be reimbursed for my fee? I paid a yearly fee.
Kipp Wilhoit, RN:

All GEHA health plan options include our Connection Fitness® program by GlobalFit at no additional cost to our members or their covered dependents.

Through the GEHA Connection Fitness partnership with GlobalFit, you do have access to discounts on gym memberships at thousands of fitness clubs nationwide, including most Anytime Fitness facilities. To verify that Anytime Fitness in Mandan, ND is a participating gym, please go to globalfit.com/geha or call (800) 294-1500.  Since you have already paid the yearly fee and based on whether the gym is participating with Connection Fitness, you may need to work with the gym for reimbursement.

Thank you!


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