Since my first year in college in 1967, and probably even before that, I have consistently managed without elevators (except in rare, exceptional cases). I enjoy using the stairs. At my height of 192 centimeters,) I generally walk up the stairs two-by-two. Since retirement this year, I have actually increased my walking, by walking up to the top of [Jerusalem's] Har Nof [neighborhood], for a total of more than 500 stairs up and 500 stairs down ( I'm counting only stairs – not steps walking on sidewalks, which add up to a few kilometers). I have always walked down the stairs one-by-one. A few people have told me that walking down large numbers of stairs is unhealthful. Presumably the risk would be to the cartilage, especially in the knees. Is that in fact a problem? After decades of walking up and down innumerable stairs, I have never felt any discomfort in the knees. Is there any reason to limit walking down stairs? If it is not safe, I could walk part of the way down the hill on downwards-inclined sidewalks instead if down stairs; would that be preferable? -S.M.A., Jerusalem Prof. Naama Constantini, a veteran sports medicine physician and director of the Sport Medicine Center at Shaare Zedek Medical Center and chairman of the Health Ministry's National Council for Women's Health, replies: Congratulations to you for so many years of not using elevators. I wish everyone adopted this habit. I don't see any reason to change what you have always done, especially if you feel well and don't suffer from any knee problems. It is true that there is more “impact” when you go down stairs compared to ascending them. But if you have no discomfort, why worry? Besides that, one should not “change winning horses,” and it sounds like you function well with your lifestyle. I know of no study that compares the long-term condition of the knees of those who do a lot of downstairs walking compared with those who avoid stairs. It would be quite difficult to conduct such a study. So keep doing what you're doing. Our six-year-old son started first grade about a month ago, and he's already causing us problems with what food I made for him to take to class. I have been making sandwiches with tuna, yellow cheese or white cheese, but he insists I send him with bread topped with chocolate spread. When he was in kindergarten and nursery school, he was given bread with chocolate spread there quite often even though a few of the parents, including me, protested. Is there anything else I can prepare that he would like? Is it too late to get him to adopt healthful eating habits in school? -V.M., Ma'alot Shira Nehushtan, a clinical dietitian at Ziv Medical Center in Safed, replies: Eating properly before first grade and in the early years of school is very important in getting children used to having a balanced diet during adulthood. A lot is being said by the health authorities now about avoiding junk food. Chocolate spread with a lot of fat and sugar is not desirable. First you should make sure that your son eats a nutritious breakfast before he leaves home. Give him a slice of whole-grain bread with a vegetable or whole-grain cereal with milk or yogurt and a minimum of sugar. I hope you have tried to get him used to whole grains in various forms, including bread, as it is much more nutritious than highly processed white flour, which causes a spurt in blood sugar. Sandwiches can include avocado, egg salad and olive oil, hummus, tehina tuna salad, white cheese and low-fat yellow cheese together with cut vegetables at the side. Avoid sending him to school with sandwiches using mayonnaise, as these go bad quickly, especially on a hot day. If he wants something sweet, you can use spreads of halva from whole-grain sesame seeds, carobs, almond spread and a bit of fruit jam, but limit these to only once a week. Children tend to dislike sandwiches that are moist and squashed, so wrap them separately from vegetables and fruits and put them in protective plastic containers. Send him to school with a bottle of tap water and not sweetened juices or sweetened chocolate milk. Fresh fruit, dried fruit with walnuts or almonds and granola treats are also a good idea. Kids tend to “eat with their eyes,” so the more the sandwich and other foods you pack look aesthetic and attractive, the easier it will be for you to get him off chocolate spread. You can cut sandwiches into triangles or add vegetables that look like faces. Wrap them well. Even at the age of six, you can try to explain to him the importance of eating right for growing, concentration and alertness at school. Take him to the supermarket and explain the nutritional differences among foods on the shelves. Read ingredients on the labels of salty and sweet snacks so he'll realize what, including salt and sugar, preservatives and artificial flavors and colors, are in them. Parents are always a model for their kids, so if you eat a nutritious breakfast, take a healthful sandwich to work and exercise regularly, you have a good chance that he will follow your example. Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.
Cartoon man climbing the staircase