Nutrition & Physical Activity
You've encountered an issue with the body mass index (BMI) that many others have encountered, too! A tremendous amount of press has been given to the BMI charts and the "strict" standards many people feel the U.S. government has imposed upon the population. The truth is most of these articles and news reports don't tell the entire story. To set the record straight, keep reading.
BMI is a ratio of weight to height. BMI is frequently used as a measure of overweight and obesity because it's a quick, easy, and inexpensive measure that correlates pretty accurately with body fat percentage for most people. The key word here is "most." As you've discovered, it doesn't work for everyone. The major shortcoming and the primary point of contention among health care providers is that it cannot decipher between fat and muscle weight. It's a rather simplistic measure that does not take into account other factors such as age, build, and body composition.
The rationale behind these numbers is that, across large population groups, there is an increased prevalence of certain diseases in people with a BMI over 25, and a much greater risk of disease and death in those with a BMI over 30. BMI is calculated as follows:
BMI=weight (kg) / [height (m)] 2
BMI=weight (lb) / [height (in)] 2 x 703.
The standard weight calculations for overweight and obese adults are as follows: a person with a BMI of 25.0 to 29.9 is classified as overweight; those with a BMI greater than 30 are classified as obese.
When BMI measurements are taken into account with other factors such as family history, gender, race, age, and dietary and exercise habits, it may help health care providers determine a person's risk for developing the following conditions:
- Hypertension (high blood pressure)
- Coronary heart disease
- Type 2 diabetes (adult diabetes)
- Gallbladder disease
- Sleep apnea and other respiratory problems
- Endometrial, breast, and colon cancers
List adapted from the Centers for Disease Control and Prevention.
An important point here is the relationship between being overweight or, better yet, "overfat", and disease development. BMI often doesn't tell the entire story. A better tool is a person's waist-to-hip measurement ratio (measuring around the widest part of the hips then dividing this number by the measurement around the widest part of the abdomen). The recommended threshold ratio for these two measurements is equal to or less than 1.0 for men and 0.8 for women. Increased risk for the diseases listed above is associated with lower ratios and thus excess abdominal fat — the apple body shape (vs. pear where body fat is primarily carried on the hips and buttocks). When using either this ratio or BMI measurements, other risk factors for developing disease are important to assess. Considering these factors together, health care providers must use their clinical judgment to determine whether or not a person really does need to lose weight.
Many web sites, books, and articles that publish BMI charts tend to simplify this message. A trained athlete or physically fit individual is NOT the target of this message. These BMI charts are a tool to be used as one part of an overall health assessment. Over large population groups, many people with BMIs in the upper range, and high waist measurements or waist-to-hip ratios, are the folks with whom health care providers need to discuss various aspects of health. A fit, well-nourished person with developed muscles may have a higher BMI, but it's likely due to increased muscle mass.
Hopefully, this answer has clarified some of the misunderstanding about BMI. Overall, it is a very limited and highly criticized measure of overweight and obesity; therefore, focus on your overall health, fitness level, dietary variety, and self-satisfaction. Your well-being is certainly much more than just an absolute number.
You and your husband are probably not the only ones having this debate. Various health professionals have also been in disagreement regarding the long-term outcomes of liposuction. The problem is that much of our evidence about the long-term outcomes of liposuction is based on anecdotes, which indicate that some people maintain the weight/fat loss, others re-gain the weight, and some people even gain more weight/fat than their pre-liposuction amounts. This debate will likely continue for some time.
Truth be told, multiple factors including gender, age, lifestyle, and genetic factors all impact weight. A one-time removal of 4-6 pounds of fat (even in very obese individuals no more than 20 pounds of fat is typically removed in one surgical procedure) must be accompanied by dietary changes and physical activity to maintain the weight loss. In the absence of these lifestyle changes, the individual can regain weight (and fat) that was lost during the liposuction procedure. While liposuction does remove entire fat cells, the fat cells remaining in the body can increase in size and can signal that more fat cells be created if there is an excess of fat in the body that must be stored. In other words, if the individual eats more calories than the body can store with its current supply of fat cells, the body will create more storage space to accommodate the excess fat.
Regarding your husband's argument, people are not born with all of the fat cells they will ever develop. Instead, cell number continues to increase throughout adolescence. After this point fat cell number may become fixed unless the individual gains a significant amount of weight. In this case, existing fat cells will be filled to their limit of about 1.0 microgram of fat per cell (normal is approximately 0.5 - 0.6 of a microgram), and more fat cells may be produced if needed. Pregnancy also seems to permit formation of new fat cells.
Cosmetic motivations aside, some people may opt for surgeries like liposuction to reverse medical complications from extreme obesity. However, research suggests that losing weight by achieving a negative energy balance (by reducing food intake and increasing energy expended through exercise) is important for achieving the metabolic benefits that go along with weight loss (like decreased risk for chronic diseases, increased endurance, and so on) (1). Also, liposuction procedures tend to target the abdominal area and sometimes the back of the upper arms and legs, but fat can be deposited in muscle, on organs, and in several other places throughout the body. These other locations where fat may be stored would be reduced in size when the person loses weight the traditional way. Although some good research has been done, more research with large sample sizes studying the long-term effects of liposuction is needed.
If you are what you eat, being healthy and time efficient sound like great qualities to have! Whether your motivations include saving time or money, improving your nutrition, maintaining or losing weight, or fostering your culinary skills, preparing your own lunch is a grand idea! Doing so can be a way to cater to your individual needs, nutritionally and conveniently, and to energize you through your busy days at school and beyond. With everything else that’s on your plate, preparing nutritious foods may seem like a challenge. However, with a few easy and balanced tips, you’ll be savoring a tasty lunch in no time.
First, a little review of the food groups may serve up some hot and cool lunch options. Main food groups include:
- Fruits, naturally sweet and juicy, are great as salad ingredients, sides, or snacks. Grab a fruit that comes with its own wrapper (e.g. apples, oranges, bananas) or a small container of grapes or cut melon. Dried and canned fruits may also make for portable options.
- Grains come as whole and refined grains. Whole grains use the entire kernel of the grain (e.g., whole wheat flour items, brown rice, oatmeal, popcorn). Refined grains have been milled to remove their bran and germ (e.g., white flour, white rice, white bread, pasta, noodles). They're great for sandwiches, wraps, noodle or rice dishes, and snacks.
- Vegetables (raw, cooked, fresh, frozen, or canned) are easy to transport and are nutritious! Convenient versions include bite-sized vegetables (think baby carrots or cut celery sticks), salads, wrap fillers, soups, and potato dishes.
- Meat and beans make great sandwiches or wraps with turkey, lean ham or roast beef, nut butter, fish (e.g., tuna, salmon), or hummus (chick pea spread/dip). They're hearty and complement most grains and vegetables.
- Dairy products like milk, yogurt, and cheese (e.g., string cheese, cottage cheese) make for portable lunch items high in calcium. Try incorporating low-fat versions with less or no added sugar. Calcium-fortified non-dairy products may also be an option.
- Oils and fats are part of a healthy diet, but use oils, fats, and their products (e.g., mayonnaise, butter, margarine, lard, animal fat, shortening) sparingly. Avoid trans-fat and limit the amount of food items high in oils and fats, such as some baked items (e.g., cookies, cakes), deep fried foods, and some packaged foods.
Suggestions for compiling easy and healthy lunches include:
- Make it a combo meal! Try incorporating three or more food groups into a meal. Focus on fruit, vary your vegetables, consume calcium-rich foods, and make half of your grains whole ones. A sample menu may be a whole wheat pita stuffed with chicken breast, hummus, and spinach with a side of a low-fat yogurt cup and an apple.
- Keep it simple. Whole, unprocessed ingredients make for easy preparation and high nutrition. Try having a sizeable stock of fruits, vegetables, nuts, beans, grains, and lean meats as basics for your lunch combinations.
- Limit sweets and fats. Try to limit food items high in added sugar and fats, such as soda, cookies, candy, some snack bars, and deep fried items.
- Make it up ahead of time. If you’re a top chef, make bigger batches of your famous dishes so that you can portion out meals for several days or freeze some for later use. Not a cook? No problem! Give wraps and salads a try.
- Rotate your menu. Doing this will ensure that you won't get bored of eating the same thing each day, and this may help you incorporate a full range of food groups.
- Remember: Safety first! Wash your hands while preparing and eating. Properly prepare your foods to appropriate temperatures before eating them. If you have access, store your lunch in appropriate temperatures to avoid having your food spoil. An insulated, reusable lunch bag with a reusable cold pack may help you keep your lunch safe and stay green!
For more information about creating a healthy lunch, check out ChooseMyPlate.gov for more tips and a personalized eating plan. You might also get your friends involved in the planning process. Ask them about their favorite quick and healthy lunches and trade ideas. These make for nutritious conversations and fruitful times with others. Bon appétit!
It's a great idea to plan consciously when switching over to a vegetarian diet. Not eating meat can offer many health benefits, as well as addressing environmental and ethical concerns you may have regarding eating animals. However, before making the switch to a meat-free lifestyle, it is important to get a sense of the pros and cons.
Here’s the best news of all: with a well-planned diet, vegetarians can live a totally healthy lifestyle and help contribute to a better planet. The following list describes various benefits of vegetarianism:
- Plant foods are abundant in nutrients, including vitamins, minerals, and protein. They also contain phytochemicals — plant chemicals that are not essential to life, but may help protect against disease — such as beta-carotene. Eating a variety of colors of fruits and vegetables can help ensure that the benefits nature provides are reaped.
- Reduce your risk of type 2 diabetes. Vegetarians benefit from eating less saturated fat and cholesterol, and higher amounts of complex carbohydrates, dietary fiber, certain minerals, and phytochemicals. Cholesterol is only found in animal foods, so vegan diets are completely cholesterol-free.
- Contribute to the vegetarian cause! Whether you have aim to respect animals, lessen your carbon footprint on the environment, or just want to make a lifestyle change, as a vegetarian you are making your own positive impact on the world. You can be proud that you are living according to the beliefs that you stand for.
Whenever you cut a food group out of your diet, it is important to understand how to replace the vital nutrients that go along with it. While the positives are all fine and dandy, it is important to be aware of the challenges of being a vegetarian:
- It can be harder to get the protein you need. Protein is important formaintaining and repairing muscle tissue, and manufacturing blood cells, antibodies, hormones, and enzymes. Fortunately, there are plenty of non-meat proteins to supplement your diet.
- Possible vitamin and mineral deficiencies can develop without a balanced eating plan. Cutting out dairy, meat, fish, and poultry reduces your intake of vitamin B12 (important for nerve transmission and necessary for life), calcium (for strong bones, among other functions), iron (for blood), and zinc (for immunity and healing), just to name a few.
- Depending on where you live, it may be challenging to adhere to a meat-free lifestyle. For example, living in a big city may provide you with endless veggie options, while a small-town lifestyle may make it more difficult to find healthy substitutions for meat.
- You may have difficulty explaining your eating habits to family and friends.While it may seem that being a vegetarian is relatively mainstream, certain cultures leave little room for herbivores. You may encounter some sticky situations where people have prepared for you a meaty meal, or perhaps, your friends and family may challenge your decision to remain meat-free.
Remember, what is included in your diet (rather than what is excluded) is what counts. It is extremely important to incorporate a balanced eating plan full of nutrient-rich foods. For help in selecting a healthy eating plan appropriate for your state of health, age, size, activity level, preferences, and moral and ethical values, consult with a registered dietitian. Columbia students can make an appointment with a registered dietician at Medical Services through Open Communicator or by calling (212) 854-7426. Informed choices are the best choices!
February 23, 2012507783
Dear Union of Uranus,
From the way you signed your letter, your question is most likely related to the discharge of food from the colon and "your anus." In order to cover the ins and outs of the process (no puns intended) it’s best to start from the very beginning:
- The eater spots a delicious-looking bite to eat (amount of time depends how picky of an eater we’re dealing with).
- Food is chewed, lubricated, and partially digested by saliva in the mouth, and then the tongue moves it to the back of the throat. This process takes about one minute to complete.
- Chewed and partially digested food is travels through the pharynx and into the esophagus, where it takes about ten seconds to be propeled into the stomach.
- The stomach is a hollow, elastic sac where food is churned and mixed thoroughly with digestive juices secreted by the stomach lining. This process takes about two to four hours to complete, depending on the type of food and the amount of food eaten.
- Processed food is then released gradually into the small intestine. In the small intestine, digestive juices produced in the liver and pancreas convert carbohydrates, proteins, and fats into chemical mixtures used by the body. The broken down mixtures then pass through the wall of the small intestine into the bloodstream or lymph system if it is fat. This process takes around three to ten hours to complete.
- Water and undigested food are then passed into the large intestine, where the water can be absorbed. It takes between seven to sixteen hours for this process to be completed.
- The solid waste from the large intestine is then stored in the rectum for a variable period of time (between twelve and fourteen hours). The muscles then push the solid waste out of the anus as feces.
So, as you can see, there is a range of time, usually between 24 and 44 hours. Exactly how long it takes is up to the individual’s digestive system, not to mention what s/he eats. For example, eating fiber-rich foods helps speed up digestion, while eating animal proteins, like meat, poultry and seafood can slow it down.
Dear Worried friend,
Your question brings up a couple of different, complicated issues. Let's start with your inquiry, about the dangers of mixing Dexatrim and Prozac. Prozac is not, as you stated, in the antidepressant class of MAOI inhibitors. Rather, it is an SSRI, a selective serotonin reuptake inhibitor. These two different groups of drugs are both prescribed to address biological causes of depression, as well as some other psychological conditions. Their use is only one part of such treatment, which should also include counseling in the form of individual, group, or family therapy with a trained social worker, psychologist, or psychiatrist.
The main ingredient in Dexatrim is phenylpropanolamine (PPA), which decreases appetite and has been, until recently, a common ingredient in decongestants, as it also relaxes the bronchial tubes. A study by the Yale University School of Medicine revealed that PPA is associated with an increased risk of stroke. Therefore, in November 2000, the U.S. Food and Drug Administration (FDA) released a statement asking that manufacturers of products containing PPA replace it with alternative active ingredients. For further important information about this, read the response to Too much Dexatrim?.
If your friend is indeed taking Prozac while also taking Dexatrim, the best bet would be for her to discuss this with her health care providers. Although using these two drugs together is not specifically contraindicated from a medical standpoint, it's possible that there could be adverse reactions, such as an increased or decreased effect of one or both of the drugs, unhealthy changes in heart and blood pressure, or intensified side effects. For example, both Dexatrim and Prozac can cause nausea, headache, trouble sleeping, and nervousness.
There are some other things for your friend to think about, too. One is that PPA is an amphetamine-like drug and can cause people to feel unusually good about themselves and the world while they're taking it. If your friend is taking Prozac to treat symptoms of depression at the same time, it will be difficult to tell which of the drugs is having an effect on her emotions. Discussing this with the health care provider who has prescribed the Prozac will help in figuring out if the anti-depressant is helpful, and, if so, an appropriate dose.
Another complicated aspect of your question has to do with the treatment of eating disorders. One concern is the simple fact that your friend is taking Dexatrim. You state that your friend has anorexia. The hallmarks of anorexia are severely restricted eating and a significant drop in body weight. In fact, Prozac is contraindicated for the treatment of this disorder, as it may actually cause a loss of weight and disinterest in food. It's possible that your friend has been prescribed Prozac because she's depressed (common in eating disorders), yet hasn't revealed the fact that she's struggling with issues around food. On the other hand, Prozac has been found to be helpful in the treatment of bulimia, an eating disorder involving cyclical periods of intense eating or binges, followed by purging of the food by vomiting or other compensatory behaviors. It is very important that your friend be honest with her health care providers and counselors about her patterns of eating and the feelings that prompt her behavior. Only then can she be appropriately diagnosed and helped to find healthier ways of managing food and the emotional stresses in her life.
If you would like to speak to a counselor about your friend, Columbia students can meet with a counselor at Counseling and Psychology Services (CPS) (Morningside) or Mental Health Services (Medical Center). If your friend is a Columbia student (Morningside), she can make an appointment with a healthcare provider by logging on to Open Communicator. If she is a student at the Medical Center campus, she can contact Student Health.
Great question! Diet is one of the most important ingredients for treating kidney, or renal, insufficiency. When a person has renal insufficiency, it means that some of the nephron function in the kidneys has been lost, and the fluid, protein, and electrolytes are not filtered as efficiently through the kidneys. In order to delay renal insufficiency and prevent it from worsening, it is important to limit the amount of electrolytes (i.e., sodium, potassium, phosphorus, and calcium), fluids, and protein that one ingests.
Diabetes is the main cause of kidney insufficiency, which can eventually result in kidney failure. The reason for this is that increased blood sugar damages the capillaries and nerves that support kidney function. In addition to your low protein diabetic diet, you should also be sure that you are testing your blood sugar daily, exercising, and following your health care provider’s instructions.
Depending on the degree of your renal insufficiency, various protein restrictions would be necessary. At this point, you could plan a diet that balances your intake of phosphorus, potassium, and calcium. If you have fluid retention, decreased urinary output, and/or hypertension, it could be necessary for you to have a sodium and fluid restriction as well. In this case, you should speak with to your health care provider about how to restrict these nutrients.
When you eat large amounts of protein, extra stress is placed upon the kidneys. This is because they excrete waste products derived from protein. Since someone in your situation needs to eat a reduced amount of protein, the protein you eat should come from sources that are easily assimilated into body tissue. This type of protein is termed High Biological Value (HBV for short). The highest HBV protein is from an egg — other sources with slightly lower HBV protein include fish, beef, and poultry. In renal insufficiency, about 70 to 80% of your protein should come from these sources.
Various health care providers, such as a registered dietitian, can formulate an eating plan designed to meet your specific needs. If you are a Columbia student, this service is free for you at the Health Service. You can make an appointment with Medical Services through Open Communicator, or by calling x4-2284. You can also check out the American Dietetic Association to locate a Registered Dietitian in your area.
For more information on diabetes, you can try the following resources:
Dear What D'Ya Thinko About Ginkgo,
Gingko (Latin name, Ginkgo biloba) has been part of Chinese traditional medicine for thousands of years. It is extracted from the leaves of the hardy ginkgo biloba tree and is available in a variety of forms, including teas and tablets. Proponents of ginkgo believe that consuming the leaves increases cerebral blood flow and prevents the lumping of platelets in brain tissue. They also believe that ginkgo has other health benefits, such as slowing memory loss, improving cognitive ability, and curing conditions such as asthma, PMS, multiple sclerosis, and sexual dysfunction. For one herb, that's quite a resume!
While some claims on the Ginkgo plant may have some merit, not all are backed by research. Some studies have found that ginkgo biloba has positive effects on cognitive ability, though others have found that this may not be true. Ginkgo has been found to have possible antioxidant properties, which means that it may help the body fight free radicals. Free radicals in the brain attack healthy cells, stealing the cells' electrons. As an antioxidant, ingested ginkgo provides a target for these hungry cells, allowing them to steal ginkgo's electrons rather than from the healthy cells. Ginkgo has been found to be helpful in some patients with claudication (painful legs due to clogged arteries) and dementia. Despite these findings, more research is needed to establish ginkgo as the panacea that it's believed to be.
So, let's say you decide to ginkgo. You may be wondering about the recommended dose. For adults 18 and older, common dosage is typically around 80 to 240 mg, and may be taken two to three times a day (depending on the reason for use). It’s recommended that if you’re just starting to take ginkgo, it’s best to not take any more than 120 mg per day to avoid some gastrointestinal upset. Ginkgo might be safe for children, but it's probably a good idea not to give it to them unless it's under the strict supervision of a health care provider.
Ginkgo, though it is natural, may cause side effects, such as bleeding, headache, nausea, dizziness, diarrhea, and allergic reactions (some of which may be severe). Moreover, the U.S. Food and Drug Administration does not regulate ginkgo or other supplements. As such, it's recommended you ask your health care provider, if you are considering taking ginkgo, especially if you have a bleeding disorder or if you are taking any other medications/supplements. For more information about ginkgo, you may want to check out the section on supplements and ergonenic aids in the Go Ask Alice! Nutrition & Physical Activity archives.
Doing your homework on complementary and alternative medicine is a wise step to take — be proud of yourself for learning more info before you gink-go or gink-no.
RDAs (Recommended Dietary Allowances), prepared by the Food and Nutrition Board of the National Academy of Sciences, have been around for over 50 years, with periodic updates. The RDA is the average daily dietary intake level that would adequately meet the nutritional needs of nearly all (98 percent) healthy persons. RDAs include nutrients for which there is sufficient scientific evidence that they are required for good health. Their intention has always been to establish "standards to serve as a goal for good nutrition." RDAs provide the basis for evaluating the adequacy of diets of population groups. They are set at a level that includes a safety factor appropriate to each nutrient; so, this level actually exceeds the requirement for most individuals.
The Food and Nutrition Board has established Dietary Reference Intakes (DRIs). In addition to RDAs, DRIs include recommendations for food components for which RDAs cannot be established. Some of these include fat, carbohydrate, fiber, and plant estrogens, among others. DRIs also include maximum intake levels. Three dietary intake reference values for DRIs are:
- Adequate Intake — the dietary intake level that would adequately sustain health when an RDA cannot be determined because of insufficient scientific evidence.
- Estimated Average Requirement — the estimated dietary intake level that would maintain the health of half of a specified age and sex group.
- Tolerable Upper Intake Level — the maximum level of daily nutrient intake that's apparently safe and unlikely to cause negative health effects in most healthy individuals.
DRIs and RDAs are not developed for specific individuals, but are for the making of policies for feeding programs, food labeling, and food fortification. The numbers signify levels of each compound that are appropriate for most healthy people in each category. To access information on RDAs and DRIs, check out the United States Department of Agriculture's (USDA) Food and Nutrition Information Center website.
Vitamin supplements may contain an amount equivalent to the RDA for DRI, but you'll probably not find a supplement with every imaginable nutrient, vitamin, and mineral. There are innumerable substances that keep us healthy, many of which cannot be packaged in a pill. In addition, many nutrients are difficult for the body to absorb when they come in pill form. Obtaining nutrients directly from a balanced diet of fruits, vegetables, whole grains, and lean proteins is still the recommended manner of giving your body all it needs to be healthy.
To assess whether your current diet is filled with nutrients, check out ChooseMyPlate.gov. You can also speak with your health care provider about whether you need a multivitamin or if the food you eat is sufficient. Students at Columbia can also make an appointment to speak with a registered dietician or a health care provider either through Medical Services (Morningside) or the Student Health Service (CUMC). Take care,
The Achilles tendon attaches to the calf muscle and to the heel bone. The calf muscles and the muscles along the shin are needed to protect against shock in high-impact exercises. This muscle group is very strong and is used constantly. Because of this, your Achilles tendon is put under a lot of pressure. The Achilles tendon handles forces that range from two to three times the body weight in walking, to four to six times the body weight in running and jumping. When it is overused, or if you continue to use it when it is injured, inflammation of the Achilles tendon could lead to local degeneration and recurrent injury, which may result in a partial, or even a complete, rupture. It was very wise of you to take a break before gradually resuming exercise.
As you get back into an exercise routine, make sure that you follow up with your health care provider and/or a physical therapist to be certain that you are not doing any more damage to your Achilles tendon. If you are a Columbia Student on the Morningside campus, you can call 212-854-2284 or log into Open Communicator to schedule an appointment. For students on the Medical Center campus, contact the Student Health Service by calling 212-305-3400.
Stretching and strengthening exercises can certainly play a role in taking care of your body. Remember that all stretching should be slow and static and that you should listen to your body — feel your muscles stretching, but stop if you feel pain. Specific to the Achilles tendon and surrounding muscles, consider the following:
Stretch #1 — Calf Stretch
- Stand about a foot from a wall, extend one leg behind you, keeping both feet flat on the floor, toes pointed straight ahead, and your rear knee straight and your front knee bent.
- Move your hips forward, keeping your lower back flat.
- Lean into the wall until you feel tension in the calf muscle of the extended leg.
- Hold for 10 seconds, then stretch the other leg.
- Repeat at least two more times.
Stretch #2 — Calf Stretch
- Stand arm's-length distance from a wall (or tree, or lamppost — whatever is handy and gives you support).
- Put your hands on the wall, keep your back and your legs straight, and make sure your heels are flat on the floor.
- Bend your arms and lean forward, trying to touch your chest to the wall.
- Feel the stretch in your calf muscles.
- Hold it for a few seconds.
- Relax and repeat at least two more times.
Stretch #3 — Achilles Tendon Stretch
- Stand with one leg in front of you, slightly bent, and the other leg extended back.
- Lower your hips downward as you slightly bend the knee of the extended leg.
- Keep both heels flat on the floor and toes straight ahead.
- Hold the stretch for 10 seconds, and then stretch the other leg.
Repeat at least two more times.
Note: This Achilles tendon stretch requires only a slight feeling of tension at the back of your ankle. Also, be sure that you do not bounce, and that you stretch gently and completely.
Besides jogging and running, the Achilles tendon can be injured from any activity that has an impact component. To help prevent injury to the Achilles tendon, consider exercises that put less stress on the Achilles tendon, such as bike riding and swimming. Also, abnormal pronation and muscle imbalances can be a problem for a recurring inflammation of the Achilles tendon. If you decide to get back into running, you need to have a physical therapist check out your running shoes to make sure they are not causing extra stress on your Achilles tendon and calf muscles. Be sure that you always wear running shoes that are not worn out, and try to avoid uneven or hard running surfaces. You may want to run on soft surfaces, such as running tracks, or soft trails without holes or ditches.
A reference to mythology seems unavoidable — stretch and allow your body to heal so your tendon doesn't become your Achilles heel.