Nutrition & Physical Activity
Dear Curious at Columbia,
If you're trying to find your "ideal" weight, you may not want to bet your bottom dollar on a height-weight chart, or any one indicator of fitness for that matter. Body size is actually a pretty hefty topic that deserves a closer look. However, no matter where the scale points, maintaining a healthy diet and regular exercise are two signs that you're on the right track to fitness and overall good health.
One popular way to compare height and weight is the body mass index or BMI. For a full description, read About BMI for Adults on the Centers for Disease Control and Prevention (CDC) website. Basically, the BMI uses a math equation to create a ratio of your weight to height, similar to the older height-weight charts. Lower scores indicate you're on the lean side, while higher scores mean you may be too heavy for your stature. If you're looking for a clear-cut boundary between a "healthy" and "unhealthy" weight, your BMI can provide a helpful guide. However, BMI calculations can hide important differences in body composition. For example, BMI scores don't account for the fact a given volume of muscle weighs more than the same volume of fat. Likewise, the BMI says nothing about the distribution of fat throughout your body.
For another useful way to assess body size, break out a measuring tape. No matter what you weigh, waist size is another indicator of health. As it turns out, all fat is not created equal. Packing extra pounds around the belly carries more health risks than flabby arms. According to experts at the National Institutes of Health (NIH), the chances of developing heart disease and type 2 diabetes shoot up when your waist exceeds 35 inches for women or 40 inches for men.
Measurements aside, there's also a lot to be said for good eating and exercise habits. Another way to define "healthy" weight is by whatever size your body settles at naturally when you follow a healthy diet and exercise moderately. People come in many shapes and sizes so your ideal weight may not conform to the sleek physique pictured in magazines even if you're eating well and getting plenty of physical activity.
Since you're at Columbia, you might want to take advantage of nutrition counseling at Medical Services (Morningside) or the Student Health Services (CUMC). A registered dietitian can assess your eating patterns, activity levels, and body size to help you determine a weight that works for you. Here are some other helpful resources:
How to Get to Your Healthy Weight — Research and tips from the Harvard School of Public Health
MyPlate — Personalized eating plans, calorie assessments, and other nutrition tools provided by the US Department of Agriculture
Weight and body size are important health indicators, but banking on numbers alone may not give you a good picture of your overall fitness. Hopefully this information helps to settle the score!
Regardless of the time of day you eat it, ice cream wouldn't make it on any top ten healthy foods list. However, if your body is able to deal with the high doses of sugar and fat first thing in the morning, which many adults cannot, there might not be reason to toss out the ice cream scoop just yet.
The most important thing is to eat something within the first few hours after waking up in order to get your metabolism going and refuel your body after not eating for several hours. The fat in ice cream may help you stay full longer, and it contains a lot of calcium, which your body needs for healthy bones and other important functions.
Sound too good to be true? It might be… if you did it every day. Like many other things in life, too much of a good thing may not always be the best for you. Ice cream is high in calories and saturated fats, which is why it's a supplement to, rather than a basic staple, of a healthy diet.
If you're choosing ice cream first thing in the morning because you love that it's sweet, creamy, and cold, you may want to try some low-fat yogurt instead. It's like ice cream but not as high in fat, calories, or sugar. All the while, it still provides you with ample amounts of calcium. If you don't mind warming up, you could also try oatmeal sweetened with a touch of brown sugar, cinnamon, or honey and stir in some chopped up fruit for more flavor. Making the oatmeal with milk instead of water can help you feel full longer and provide essential vitamins and minerals, including calcium. If it's just your sweet tooth you're looking to satisfy, you could try switching to granola with fruit and yogurt, toast with jam or fruit spreads, or lightly sweetened cereal with milk.
Combining these foods with the occasional bowl of ice cream in the morning will help to ensure that you're eating a healthy and balanced diet overall. Of course, it's also important to eat well throughout the day, which means including plenty of fruits and vegetables, lean meats, and low-fat dairy products in other meals. For more tips on healthy eating, check out the related Q&As below.
What you're describing sounds like the beginnings of a case of shin splints. Walking on pavement increases the stress on your joints and connective tissue. Shin splints are an inflammation of the muscle and/or tendons of the lower leg caused by repetitive walking or running on a hard surface. The symptoms are pain on the inner side of the shinbone (tibia) in the front part of the leg. Sometimes, it comes on very slowly and eventually becomes quite severe. Shin splints rarely result in permanent damage.
The best cure is to rest. Try taking the bus or train to school for a week. Wearing good shoes when you walk, and stretching your legs in an effective flexibility program before your walks, can help prevent the problem from getting worse or recurring. When choosing shoes, don't hesitate to spend a few extra dollars -- you spend more time than you think every day walking back and forth to campus. Because you're walking on pavement, make sure the shoes have adequate cushioning. The shape of the shoe should correspond to the shape of your foot, without areas of pressure or pain, or a feeling of binding. Solicit advice from friends and from a few specialty stores about what brands and styles are best.
Flexibility exercises help to reduce muscle soreness and the chance of injury. Examples of simple exercises are the sitting heel-cord stretch, where you sit on the floor with one leg extended and the opposite leg bent with the foot against the inside of the thigh. Hook a towel around the ball of the foot and pull the toes towards the knee. Keep your knee straight, and repeat ten times for each leg. Or, try the lying knee-pull, where you lie on your back with your legs extended and bring your left knee to your chest, grabbing just under your knee with both hands. Pull until you feel the stretch, and hold for 10 seconds. Repeat for each side.
Before you start the exercises, take some time off from your regular pavement walking, allow your shins to rest, buy some good shoes, and then get into a reasonable exercise routine. Although walking sometimes seems innocuous, it actually is excellent aerobic exercise, and utilizes and strengthens your muscles. Therefore, you also need to treat your walks as you would any other form of exercise, and use proper equipment and stretch before and/or after.
Dear Sis living without wheat,
First off, kudos to you for seeking out more information on your sister’s behalf. She is lucky to have someone like you looking out for her! To shed some light on your food allergy inquiry, a “gluten allergy” is often used as an umbrella term for four different gluten-related conditions: celiac disease, non-celiac gluten sensitivity, dermatitis herpetiformis, or gluten ataxia. While the treatment for all four conditions is generally the same — avoiding gluten — each has different symptoms and different levels of severity. The most serious of these conditions is celiac disease. If a person has celiac disease, eating gluten can lead to inflammation and damage in the small intestine. Such damage makes it difficult for the body to absorb nutrients and can lead to severe malnutrition, diarrhea, and weight loss.
Based on the low bone density you have described, it seems that celiac disease may very likely be the cause of your sister’s condition. There are a few medical tests that can determine if a person has celiac disease. If your sister were to test positive, it would be a good idea for you and your family to get tested, as there is a genetic component to the disease. There is no cure for celiac disease, so early diagnosis is key!
It might also be a good idea for your sister to speak with a registered dietitian to discuss her new diet and where to find gluten-free foods. If your sister is a Columbia student, she can make an appointment at Medical Services (Morningside) or the Student Health Service (CUMC).
In the meantime, there is an abundance of reliable information available online. You and your sister might want to check out these resources:
- The Celiac Disease Center at Columbia University
- The Gluten-Free Restaurant Awareness Program
- Gluten-Free Girl (a blog dedicated to wholesome gluten-free cooking)
Your sister may have a lot on her plate right now, so to speak, as she adjusts to a new diet. You can be supportive by learning about gluten-free eating and cooking, encouraging her to discuss questions with a health care provider or dietitian, and helping family and friends understand her dietary needs. Many people who have gone gluten-free find they enjoy cooking and eating more, knowing that the food they eat is not harming their bodies. Your sister might find that cutting out gluten will actually expand her cooking and eating repertoire!
Wishing you and your sister many enjoyable meals in the future!
Everyone feels under the weather sometimes, but it sounds like your rainy day has turned into a full-blown season. Following your health care provider's nutrition recommendations and finding ways to reduce your stress level are two ways to clear the clouds and improve your health. If you don't feel better soon, head on back to the office for another check-up.
Hypertension is the medical term for high blood pressure, which occurs when blood pushes too hard against the walls of your veins and arteries. Health experts aren't sure what exactly causes hypertension, but there are several ways to control your condition and improve your overall health. (For more background on hypertension, check out What do blood pressure numbers mean? in the Go Ask Alice! General Health archive.)
High blood pressure has been linked to low physical activity, being overweight, and consuming too much salt or alcohol. In addition, stress can impact blood pressure directly and indirectly. When you're experiencing stress, tension may cause your blood pressure to spike, but only temporarily. Over the long run, stress may act more as a mediating factor by fostering unhealthy eating and inactivity, which in turn raises your blood pressure as well.
It's tempting to take a "wait and see" approach and hope that your blood pressure and other life stressors will improve on their own. However, you may see results more quickly if you tackle these problems head on — especially if hypertension and/or chronic stress have been ongoing issues for you. First, it may be helpful to identify the source(s) of your stress and then take steps to help yourself relax. Exercise, adequate rest, deep breathing, and a variety of other relaxation techniques can keep stress at bay and boost your energy. For more student-friendly stress management techniques, see Stress at the start of school in the Go Ask Alice! archives.
In addition to managing stress, here are some specific lifestyle changes that may help lower your blood pressure:
- Exercise regularly. Aim for 150 minutes of physical activity per week, or about 30 minutes a day for five days. You can break this up into segments of as little as 10 minutes at a time and still gain the benefits of exercise.
- Eat well. Stock up on fresh fruits and veggies and low-fat dairy, and cut down on fatty and salty foods. (Consider the DASH diet and check out Managing high blood pressure through diet in the Go Ask Alice! General Health archive.)
- If you have diabetes, keep your blood sugar under control.
- Trim down if you are overweight. Excess weight strains the heart. In some cases, weight loss may be the only treatment needed to reduce your blood pressure.
- Avoid smoking.
If you drink, limit yourself to one or two alcohol servings a day.
Adapted from Hypertension by the National Institutes of Health.
Along with lifestyle changes, there are also medications available that can help pull down your blood pressure. If you would like discuss medication options with a health care provider at Columbia, you can make an appointment by contacting Medical Services (Morningside) or the Student Health Service (CUMC). If those other emotional stressors are getting to you, then you may also want to consider talking with a therapist at Counseling and Psychological Services (Morningside) or the Mental Health Service (CUMC) about how you're feeling.
It may take time to lower your blood pressure and your stress level, but adopting healthier behaviors like regular exercise and a low-salt diet may brighten your outlook, help you feel better, and bring back your energy levels.
Dear Simple Tastes,
Actually, your diet does sound fairly healthy...for one day, once in a while! What it's missing is variety — you need to vary your foods in order to cover all your vitamin and mineral, or micronutrient, requirements (and not get bored with your food!). Also, it turns out you have good, caring friends who are giving you helpful advice!
Back to varying your diet — luckily, variety doesn't always require lots of time or effort. You can get your micronutrients by quickly including vegetables in the foods you're already eating. Start by adding lettuce, tomato, and/or red pepper slices to your whole grain bread and cheese combo. You can buy the veggies pre-washed and sliced at many grocery stores and delis. Snacking on mini-carrots that come pre-washed and peeled or enhancing your meals with frozen vegetables can also help provide necessary nutrients. What about adding a veggie to your soft-boiled eggs at breakfast? Frozen spinach would taste great and is also quick to prepare.
Next, throw in some additional fruits. Varying by color helps to insure a wide variety of nutrients. So, what about apples? You can choose from a variety of types (e.g., Granny Smith, Empire, and Macintosh) and they are fairly inexpensive. Canned foods are great to have around. Pick up some canned pineapple, mandarin oranges, or peaches. Try to purchase canned fruit in their own juice instead of in heavy syrup — this cuts down on the sugar. What about slicing a banana in your canned pineapple? Easy breezy.
Your body also needs minerals to stay healthy. Some of these minerals include calcium, iron, sodium, manganese, copper, iodine, and magnesium. Since dietary guidelines are different from one person to the next, check out ChooseMyPlate.gov for an extensive breakdown based on daily calorie intake and age. Here are a few of the overall messages:
- Great grains: Grain products include bread, pasta, rice, and crackers. Grains can be whole-grain or refined, but whole-grains are best. Aim to make half of the total amount of grains eaten in one day the whole-grain kind.
- Taste the rainbow: Eat a variety of fresh, brightly-colored fruits and vegetables. The vegetables can be dark green as well. These colors indicate that the produce is full of antioxidants and vitamins, giving you the most nutritious bang for every bite.
- Lean and mean: Choose low-fat and lean versions of meats and dairy products. In addition, tofu and other soy products are great sources of protein.
- Finicky about fat: Make sure the majority of fat in your diet comes from fish, nuts, and vegetable oils. These fats are the unsaturated fats — they're liquid at room temperature and will not raise your cholesterol or increase your risk of heart disease. Saturated fats are solid at room temperature, raise cholesterol, and increase your risk of heart disease. These fats should be limited and include butter, stick margarine, lard, and the white streaks of fat in many fatty meats.
Some other ways to spice up your diet, even when you're in a rush, can also include:
- Shakin' it up: Make a fruit shake with bananas, yogurt, soy or dairy milk, wheat germ, and frozen berries.
- Pita packer: Hummus (a chickpea and sesame puree spread and dip) in a pita or whole-grain bread with sliced vegetables and cheese can provide you with protein, fiber, phosphorus, and zinc.
- Nuts about nuts: Nuts are full of healthy fats (the unsaturated ones listed above), protein, and minerals. They're also easy to eat and require little preparation or clean-up, so grab a handful next time you're on the go.
- Putting the deli in delicious: Adding low-salt and low-fat deli meat, such as sliced turkey, sliced chicken, or tuna, to your sandwiches or meals helps boost the protein content of your diet while giving you a healthy shot of selenium, phosphorus, and chromium. If you're vegetarian, tofu is a good substitute that provides many of the same minerals.
- Just juice: Drinking a glass of juice in the morning (or any other time of day) is a quick and easy way to get some of the vitamins you need. Watch out for juices that are naturally high in sugar though (e.g., orange, apple, and grape juice). These juices should be limited to one or two eight-ounce servings per day. Low-sodium tomato juice or V-8 can give you some of the vitamins you need without all the sugar or sodium, and they can be enjoyed more frequently.
Columbia students on the Morningside campus should check out Get Balanced! for specific information related to eating healthy at Columbia. Students can also make an appointment with a registered dietitian by contacting Medical Services (Morningside) or the Student Health Service (CUMC). Remember, in order for all your hard working efforts to be fruitful, it can only help if your diet is fruit-filled and balanced, too!
Dear Feeling Discomfort,
Whether you're experiencing abdominal bloating, excess gas, or the burping blues, there are many possible causes of your discomfort. Water retention, or edema, is an accumulation or extra fluid that is commonly caused by a temporary imbalance in your electrolyte and fluid levels. In most cases, edema is a totally normal reaction to stress on the body and goes away on its own. More on water retention can be found in Water retention in the big city?.
Abdominal bloating occurs when the abdomen feels full and tight, due to the build-up of gas in the stomach and/or intestines that is not released through flatulence or burping. Bloating is often accompanied by abdominal pain, ranging from mild or dull to sharp and intense. This is a commonly encountered health issue — in fact, eleven percent of the general population reports frequent bloating, and seven percent complains of excessive belching. Passing gas ten times a day is average, and up to twenty times a day is normal. To expand on this (no pun intended), here's a run down on possible causes of your bloated belly:
- Swallowing a surplus of air. This can happen when a person is nervous, chewing gum, drinking carbonated beverages, or drinking through a straw.
- Consumption of certain foods, including Brussels sprouts, turnips, cabbage, beans, lentils, and carbonated drinks with high levels of fructose or sorbitol.
- Consuming excess sodium, particularly in processed foods.
- Lactose intolerance leads to gas buildup from undigested lactose in the large intestine.
- High fiber foods can aid in digestion, but can also produce a lot of gas.
- Fatty foods, which can prevent the stomach from emptying efficiently.
Whether you're a gourmet chef or a microwave meal maven, you can see that diet has a lot to do with abdominal bloating. Certain foods (such as the ones listed above) take longer to digest. This allows more time for bacterial fermentation in your colon and contributes to excess gas production. Foods that are partially broken down play a role in this phenomenon as well.
While daily abdominal bloating may cause you some discomfort, the good news is that it is usually not worrisome. Still, it is recommended to speak with your health care provider if you are experiencing severe abdominal pain that interferes with your daily routine, blood in your stool, diarrhea, vomiting, weight loss, or severe heartburn. These may be signs of more serious conditions, such as celiac disease or irritable bowel syndrome.
Speaking with your health care provider may answer any further questions and help you come up with a solution that best fits your lifestyle. Columbia students can make an appointment by contacting Medical Services (Morningside) or the Student Health Service (CUMC). Hope these tips leave you feeling full of relief, not gas!
Dear Achilles heel,
Running is a great cardiovascular workout and it can be one of the cheapest ways to stay fit. Perhaps the main draw back is the jolting, jarring impact it can put on ones body. The repeated pounding and the accompanying stress are transmitted through joints and ligaments — up to three or four times your body weight with each footfall! Some of the most common runner's injuries include runner's knee, heel spurs, tibial stress syndrome (shin splints), plantar fasciitis, and Achilles tendonitis. Fortunately, there are ways to decrease the risk of injury and strain.
One possible reason for the pain may be related to improper running equipment (i.e. shoes). Proper running shoes provide more support and cushioning than other types of sneakers and they are lighter and still allow feet to "breathe." Stores specializing in athletic shoes often have staff that will assist you in finding not only the right fit, but the right type of shoe based on your individual arch and your gait. Running shoes typically need to be replaced sooner than other types of shoes, even though the surface of the shoe may not look that worn. The padding inside the shoe usually gets pounded down after a certain number of miles so waiting too long to change shoes can increase injury risk or soreness. A general rule of thumb is to replace your kicks after 300 to 500 miles or 6 months of use. (Side note for those who have caught wind of the shoeless running trend: Running barefoot or with unstructured shoes may work for some, but if you're interested in trying it out for yourself, it's important to start with very short runs, adding barefoot distance slowly, to give your feet, legs, and muscles time to adapt to a very different form of running. Consulting with a trainer or health care provider wouldn't hurt, either. And please, watch out for sharp objects!)
Have you noticed any difference in your soreness depending on where you run? Two miles on a hard running surface can certainly be tough on the body. Sidewalk pavement is the hardest on your joints and tendons. Asphalt is slightly better for the knees, joints, and tendons. Dirt or gravel paths are even better. Also, well-maintained grass provides lots of padding and a slightly better work out for the leg and ankle muscles, just be sure to do a little extra ankle stretching before and after the run. Running on a sandy beach not only makes for good fodder for personal ads, it also provides a softer surface. The drier the sand, the better the workout. Even beach runs, however, should not be undertaken without good, supportive, running shoes. Save the barefoot experience for the cool down walk that follows.
Proper warm up, stretching, and cool down are also key injury preventers. The mild pain you are experiencing could be indicative of Achilles tendonitis, micro-tears that result from stress. If so, seeing a health care provider and decreasing your level activity until the pain subsides may help you prevent a serious injury. In addition to warming up and stretching, giving your muscles enough rest is essential to building strength and running capacity. If you're running every day, could you consider cutting back the number of days per week you run? Some people choose another aerobic activity on non-running days, such as biking or swimming. Cross-training can help build muscles that running doesn't target and give your joints and tendons a chance to heal from the stress caused by pounding the pavement.
You also asked about running and weight loss. It is true that supplementing your running workouts with some weight training could provide some extra benefits. Increasing muscle mass can help boost your metabolism (check out the related question below regarding calorie intake for more info). Because of your soreness, however, it would be most beneficial to talk to a health care provider before intensifying your running or strength training workouts to prevent further injury or strain. If you are a student at Columbia, you can make an appointment at Medical Services (Morningside) or the Student Health Service (CUMC).
Here's to your health!
Dear Want to help,
It can be difficult to hear someone you care about constantly putting her or himself down. Your best friend's constant remarks about weight indicate that she feels uneasy about herself. She may be looking for validation to feel better about her body, at least temporarily. Unfortunately, you may not be able to change the way your best friend sees herself, regardless of how many times you tell her she's not fat. You can, however, provide support in several different ways. This may help your friend on her path to seeing herself in a better light. Here are some suggestions:
- Express yourself. Let your friend know how her constant worrying impacts you. Does it make you sad or stress you out? Are you concerned that her preoccupation with her weight may be impacting other parts of her life? Letting her know these things may motivate her to look at how her behavior is affecting those around her and, most importantly, her own well-being.
- Model positive behavior. Make an effort to stop talking about diets and "imperfect" body parts. Challenge media images that unrealistically portray women — to yourself and out loud with your family and friends.
- Be positive and encourage your friend to do the same. Ask her what she likes about herself. Too often people focus on the negative aspects of their bodies and personalities. Rarely do people tell themselves how much they love their bodies or focus on all the amazing things their bodies can do.
- Encourage her to seek support. Speaking with a counselor or meeting with a support group may help her deal with her issues in a healthy manner. Columbia students can make an appointment with Counseling and Psychological Services (Morningside) or the Mental Health Service (CUMC).
Remember, your friend's issues likely go much deeper than the surface. The way a person views her or his body affects self-esteem. A person with high self-esteem has high self-worth and a positive self-image. People with low self-esteem are very critical about themselves. Low self-esteem can have a whole host of negative consequences, including being more at risk of developing eating disorders. Those with severe body image issues may benefit from using antidepressants or cognitive behavior therapy.
Overall, your willingness to help and active seeking out of information is a great start. While your friend's constant questioning may seem pesky, she may be dealing with much greater issues. So equip yourself with knowledge and a positive attitude — she may follow in your footsteps!
What a better way to show your support than to become educated! Celiac disease leads to malabsorption of nutrients and abnormal immune reactions to gluten (a protein in wheat, rye, and barley). Celiac disease works by damaging or destroying villi when gluten is consumed or used in a product. Celiac disease is genetic, meaning it runs in families. Therefore, people who have Celiac disease in their family may want to get tested. The disease affects approximately 1 out of every 133 people.
The only treatment for celiac disease is a gluten-free diet. In other words, a person with celiac disease should not eat most grains, pasta, cereal, and many processed foods. Gluten is also used in some medications, vitamins, and even lip balm. Therefore, it is important that people with Celiac speak with a pharmacist to see if prescribed medications contain wheat. Even if a person doesn’t have symptoms, s/he should still completely avoid gluten in order to prevent damage to the intestines and long-term problems.
It is highly important to diagnose this disease because without treatment, people with Celiac can develop complications such as osteoporosis, anemia, and cancer. Although Celiac disease may affect people in different ways, common symptoms of Celiac disease in adults include:
- Unexplained iron-deficiency anemia
- Bone or joint pain
- Bone loss or osteoporosis
- Depression or anxiety
- Tingling numbness in the hands and feet
- In women, missed menstrual periods, infertility, or recurrent miscarriage
- Canker sores inside the mouth
- An itchy skin rash called dermatitis herpetiformis
So what’s for dinner? A gluten-free diet could include potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. There are also gluten-free breads, pastas, and other products that are labeled "gluten-free." Corn tortillas, rice cake, popcorn, crackers made of rice or corn, rice, pasta made from rice, flax, quinoa, buckwheat are also fine. While oats may not be harmful for most Celiacs, it is best to avoid oat products as they are frequently contaminated with wheat. Also, most gluten-free grain products aren't supplemented with vitamins, so it is important for Celiacs to take a vitamin supplement. Speaking with a registered dietitian can help you and your lady friend come up with delicious and suitable meals. There are also a variety of cookbooks and blogs that cater to a gluten-free lifestyle.
Creating a supportive environment can definitely make life easier for a person with Celiac disease. Here are some tips for you to help your girlfriend manage her health:
- Provide emotional support.Being diagnosed as a Celiac may be a difficult, life-changing experience. Eating, grocery shopping, going to restaurants, and traveling may become much more challenging — even overwhelming. Therefore, it is extremely important to be gentle, patient, and understanding.
- Do your research.Asking Go Ask Alice! was a great first step! Continue to stay up-to-date with the ins and outs of Celiac disease. You can also educate yourself on how to make delicious, gluten-free dinners.
- Remember, wheat-free doesn’t mean gluten-free.There are a whole bunch of products available that are wheat-free but not gluten-free. While someone with a wheat allergy could potentially eat these products, those with Celiac cannot.
- Be aware of hidden gluten. You may want to call or email food companies for clarification on a product’s ingredients.
- Understand that even cross-contamination can be dangerous.For a person with Celiac disease, even the tiniest crumb can cause symptoms. Ideally, a person with Celiac will live in a gluten-free household. This eliminates any chance of accidental contamination. If this isn’t possible, the next best option is to keep foods containing gluten in a separate area of the kitchen, and using different pots, pans, cutting boards and utensils to prepare.
For more information, you may want to check out Celiac Disease Foundation and the related questions below. Here’s to health and happiness — for both of you!