Tuesday, November 6, 2018

What to do to keep your gums healthy

Practicing good oral hygiene is the most important action that a person can take to prevent and treat gum disease. Most people tend to overlook their gums when it comes to oral health and focus on getting a bright, white smile instead. However, healthy teeth require healthy gums.
Gum disease can lead to tooth loss. Fortunately, a person can take many steps to prevent and even reverse gum disease. These include:
·        brushing the teeth properly
·        choosing the right toothpaste
·        flossing daily
·        taking care when rinsing out the mouth
·        using mouthwash
·        having regular dental checkups
·        stopping smoking
This article examines how these steps can help keep the gums healthy.
7 ways to keep the gums healthy
Adopting the following habits will help a person care for their teeth and gums properly, which, in turn, will help prevent gum disease.
1. Brush the teeth properly

Brushing the teeth twice a day with fluoride toothpaste can help keep gums healthy.
Brushing the teeth properly is key to having a healthy mouth and gums. The American Dental Association (ADA) recommend that people follow the guidelines below:
·        Brush at least twice a day using a soft-bristle toothbrush and fluoride toothpaste.
·        Replace the toothbrush every 3 to 4 months, or sooner if the bristles begin to fray.
·        Brush the teeth at a 45-degree angle to the gums.
·        Move the toothbrush in short strokes.
·        Press gently.
·        Clean the insides of the front teeth by turning the brush vertically and making several short strokes along each tooth.
2. Choose the right toothpaste
The toothpaste aisle in most stores will contain many varieties of toothpaste, from whitening products to formulas containing baking soda.
When choosing toothpaste, a person should ensure that it contains fluoride and has the ADA seal of approval on the packaging.
3. Floss daily
Many people neglect daily flossing, but the ADA recognize this habit as an important part of oral care.
Flossing removes food and plaque from between the teeth and gums. If the food and plaque remain in these areas, this can lead to tartar, which is a hard buildup of bacteria that only a dentist can remove. Tartar can lead to gum disease.

4. Rinse your mouth out with care
Many people rinse their mouth out after brushing their teeth. However, oral hygiene practices should complement the effectiveness of fluoride products, such as toothpaste.
When a person washes their mouth out with water after brushing their teeth with fluoride toothpaste, they wash away the fluoride.
Conversely, when a person rinses their mouth out after eating, they may rinse away food and bacteria that can lead to plaque and tartar.
5. Use mouthwash
According to the ADA, there are two types of mouthwash: therapeutic and cosmetic. Both are available over the counter.
A therapeutic mouthwash can help:
·        prevent gum disease
·        reduce the speed at which tartar builds up
·        reduce the amount of plaque on the teeth
·        remove food particles from the mouth
However, people should not use mouthwash as a replacement for brushing and flossing.
A person should look for the ADA seal. This seal indicates that the manufacturer has demonstrated enough evidence to support the product's safety and effectiveness.
The ADA state that children under the age of 6 years should not use mouthwash.
6. Get regular dental checkups
Dental checkups typically include a professional cleaning of the mouth. Professional cleaning is the only way to remove tartar from the teeth. Professional cleaning can also help eliminate the plaque that a person may have missed when brushing their teeth.
With regular visits, a dentist can help identify the early signs of gum disease and gingivitis, a condition in which the gums become inflamed. Early detection can help prevent more severe problems from occurring.
7. Stop smoking
According to the Centers for Disease Control and Prevention (CDC), smoking makes a person more susceptible to gum disease because it weakens the immune system.
The CDC recommend quitting smoking immediately to help reduce the risk of developing gum disease. The use of other tobacco products can also increase a person's risk.

Tuesday, October 23, 2018

Science says fluoride in water is good for kids. So why are these towns banning it?

In the past five years, 74 cities have voted to remove fluoride from their drinking water, despite thousands of studies showing it prevents cavities.

It has been hailed by the Centers for Disease Control and Prevention as one of the top public health achievements of the 20th century. Numerous studies have proven its safety and efficacy. But fluoride — the naturally occurring compound that prevents cavities and tooth decay — is still sparking heated debates, seven decades after it was first added to America’s water supply.
“Anti-fluoridationists” — a small but vocal minority — are disputing long-established science to say that fluoride added to tap water lowers IQ and causes everything from acne to anemia to Alzheimer’s.
These anti-fluoride believers are active online but also at the polls: In the past five years, 74 cities have voted to remove fluoride from their drinking water, according to the American Dental Association. This year, there have been 13 votes around the country on fluoridation, and at least three more cities have fluoride referendums on the ballot in November: proposed bans in Brooksville, Florida, and Houston, Missouri, and a vote on bringing fluoridated water back in Springfield, Ohio.
The frets over fluoride are reminiscent of the unfounded fear that vaccines cause autism: disproved by science, yet steadfast nonetheless. The persistence of fluoride conspiracy theories — which emerged in the 1950s with claims that fluoridation was a communist plot to dumb down Americans — is alarming public health officials, including the American Dental Association and the American Academy of Pediatrics, who say fluoride is a safe, inexpensive way to boost children’s oral health.
Dr. Johnny Johnson, a retired pediatric dentist who is president of the nonprofit American Fluoridation Society, calls the anti-fluoride efforts “cult-like.”
“You cannot tailor public health to the whims of a small group of people,” he said. “If you are doing that, you are harming a large group of people.”
The anti-fluoridationists, though, say that it’s the fluoride supporters who are harming the public’s health. Some argue that the government uses fluoride as a form of mind control; others believe it's designed to boost the sugar lobby by enabling people to eat more sweets without getting cavities; and still others believe that health officials are afraid to reverse course on fluoride after promoting it for decades.
They spread the word on Facebook groups, like that of the New York State Coalition Opposed to Fluoridation, which blames fluoride for problems including thyroid damage and was slammed in 2012 for falsely claiming that the federal government “recommends avoiding fluoridated water when making infant formula.” (The CDC says it’s fine to use fluoridated tap water for formula, though the agency notes it may cause mild spotting on babies’ teeth, so parents can use low-fluoride bottled water some of the time instead.) Reddit users claim fluoride kills gut bacteria. And on Twitter, fluoride is regularly called a cancer-causing neurotoxin.
The anti-fluoride movement has also made headway offline. In June, the Texas Republican Party opposed water fluoridation in its 2018 platform. In New Jersey, where more than 80 percent of residents do not have fluoridated water, the town of East Brunswick stopped fluoridating three years ago after Mayor David Stahl called it "mass medication of the public," a familiar refrain on anti-fluoridation forums. In Brooksville, Florida, a city of 8,000 about an hour north of Tampa, Mayor Betty Erhard has said for years that fluoride is a toxin and a waste of taxpayer money. Next month, at her urging, Brooksville will vote on removing it.
“I believe that people should consent to what’s in their water,” Erhard said. Some townspeople agree.
“Fluoride is a dangerous cancer-causing agent. I don't even like taking a shower in it,” one wrote on Erhard’s Facebook page.
The first place in America to receive fluoridated water was Grand Rapids, Michigan, in 1945, when residents there became guinea pigs for the theory that boosting existing natural fluoride levels in water would decrease tooth decay, particularly in children. The experiment, by the United States Public Health Service, was done without residents’ consent — still a point of contention among anti-fluoridationists.
The experiment was so successful that 11 years into what was supposed to be a 15-year study, researchers announced the rate of cavities among Grand Rapids’ 30,000 schoolchildren had dropped by 60 percent. But not everyone was pleased.
"I was called a murderer and a communist," Dr. Winston Prothro, director of public health in Grand Rapids during the early days of fluoridation, told The Washington Post in 1988. "I must have had letters from every city in America, and plenty from other countries, too. It fell on me to defend the physical and moral health of our entire city."
Since then, the conspiracy theories have evolved from fears of a communist plot to other worries about purported dangers of fluoride — an abundant element that occurs naturally in water, even when it’s not added by the government.
“Now, you have this weird backlash where people think that anything that is a chemical is bad, even though everything is a chemical,” said University of Miami associate professor Joseph Uscinski, co-author of the book “American Conspiracy Theories.” “There are groups of people who think that if something isn’t natural, it is somehow impure or bad, and it grosses them out.”
To experts, objecting to fluoride is nonsensical. The compound, consumed in water or applied topically through toothpaste or mouthwash, prevents cavities by replacing weakened structures in the teeth, said Dr. Kerry Maguire, associate clinical investigator of Forsyth, an independent research institute specializing in oral health.
It’s true that too much fluoride can be dangerous — one complication is skeletal fluorosis, which causes stiffening and pain of the joints and bones or abdominal pain, nausea and vomiting — but those effects only occur with prolonged exposure to a far higher level of fluoride than is found in public water systems in the U.S., experts say. In this country, the only common side effect of fluoridation is fluorosis of the teeth — minor staining that is often only visible to a dentist.
Today, nearly 75 percent of the U.S. receives fluoridated water from community water systems.
That’s a number that Paul Connett, a chemistry professor emeritus at St. Lawrence University in Canton, New York, hopes to get down to zero.
“There’s umpteen ways that fluoride can cause damage,” said Connett, executive director of the nonprofit Fluoride Action Network, which aims to end fluoridation worldwide.
Connett was initially skeptical of concerns about fluoride when his wife asked him two decades ago about its health effects.
“The prevailing attitude is that people who are opposed to fluoride are crazy, so I didn’t want to be stigmatized in that way,” Connett said.
But the more he looked into it, the more convinced Connett became that fluoride was indeed toxic.
He now cites what he bills as a “dynamite” 2017 study that concluded that higher prenatal fluoride exposure was associated with lower cognitive outcomes in children in Mexico.
The findings, he says, are consistent with more than 50 other studies that concluded that fluoride lowers IQ.
But many dental experts dismiss such studies as bogus, particularly because many of them were done in other countries, where natural fluoride levels are far higher than in the U.S. and there may be other factors, like polluted water.
“It’s as though you have something you want to prove, so you look at other countries that have naturally high levels of fluoride at multiples of what we have in the United States, and they see changes and then they backwards extrapolate it to water fluoridation,” said Johnson of the American Fluoridation Society. “You can’t do that in science.”
Some anti-fluoridationists oppose all fluoride, including in toothpaste. (Sales of fluoride-free toothpastes are relatively small but projected to grow; an article in the dental journal Gerodontology in August found that such toothpastes have “no impact” on preventing cavities.) Fluoride opponents seize on the warning label on toothpaste cautioning that a poison control center should be called if a child accidentally ingests too much, saying that proves fluoride is a toxin.
The American Dental Association, which has supported water fluoridation since 1950, disputes that, pointing out that the amount of fluoride in an entire tube of toothpaste wouldn’t be fatal, but other additives would likely cause a child to vomit.
As for fluoride in water, “there have been literally thousands of studies published in peer-reviewed journals that demonstrate the safety of community water fluoridation,” said Dr. Brittany Seymour, the American Dental Association’s consumer spokeswoman, calling it “the single most important public health measure to prevent cavities.”
The Fluoride Action Network disagrees. The group sued the Environmental Protection Agency in federal court in San Francisco last April to stop water fluoridation.
“Which is more important: protecting your children’s brain, or protecting your children’s teeth?” Connett said.
He expects the case to be heard next August. The EPA said it does not comment on pending litigation.
Kentucky is the only state to require fluoridation in every community water system that serves 1,500 or more people, and as a result, 99.99 percent of residents receive fluoridated water. Anti-fluoridationists have tried to reverse the law, but it’s not going anywhere, said Dr. Julie Watts McKee, the state dental director of the Kentucky Oral Health Program, a public initiative that carries out community programs to reduce oral disease. The cost to fluoridate water for a person’s entire lifetime is cheaper than the price of a single filling, McKee said.
“The science — the true science — proves its effectiveness over and over again,” she said. “It helps people of all ages. It helps the kids better because they have growing teeth and are at a cavity-prone age, but it helps us all.”
Elsewhere in the country, the percentage of residents receiving water varies, with Hawaii at the low end at 11.7 percent.

Fluoride by the numbers
The percentage of people in each state who receive fluoridated water
Hover your mouse over states to see the percentage

It’s not always a health fear that keeps states from raising fluoridation levels; sometimes the decision is budgetary. Either way, the low levels are troubling to fluoridation proponents, who argue that it gives everyone a shot at fighting cavities — regardless of access to dental care.
The effects of cavities, particularly untreated ones, can be far-reaching.
“It’s very, very difficult to concentrate when you have a toothache, and if we are trying to help children succeed in school … this is an important component that is often overlooked,” Maguire said. “It is a winnable war.”
In Brooksville, Florida, where the vote on removing fluoride is just a couple weeks away, Mayor Erhard has high hopes that her townspeople will vote it out. The city has spent about $19,000 on fluoridation over the past five years, and she would like to see that money go someplace else — such as repairing the city’s roads.
Erhard said she doesn’t worry about how kids will fare with nonfluoridated water, so long as parents do their part to encourage good oral health.
“If you’re feeding them a lot of sugar, naturally, you’re going to get a lot of cavities,” she said. “I can tell you firsthand from my experience that I’ve always brushed and I love going to the dentist, and my teeth are healthy.”

Wednesday, July 11, 2018

Beyond tooth decay: why good dental hygiene is important

Most of us are aware that poor dental hygiene can lead to tooth decay, gum disease and bad breath - but not brushing your teeth could also have consequences for more serious illnesses.

We peer beneath the plaque to investigate what other - perhaps unexpected - health conditions are affected by poor dental health.
Alzheimer's disease

In 2010, researchers from New York University (NYU) concluded that there is a link between gum inflammation and Alzheimer's disease, after reviewing 20 years of data on the association.
However, the number of participants in the NYU study was fairly small. The researchers analyzed data from 152 subjects enrolled in the Glostrop Aging Study - a study looking at psychological, medical and oral health in Danish men and women. The study spanned a 20-year period and ended in 1984, when the subjects were all over the age of 70.
Comparing cognitive function at ages 50 and 70, the NYU team found that gum disease at the age of 70 was strongly associated with low scores for cognitive function.
Study participants were nine times more likely to have a score in the lower range of the cognitive test - the "digit symbol test" (DST) - if they had inflammation of the gums.
Although this study took into account potentially confounding factors like obesity, cigarette smoking and tooth loss unrelated to gum inflammation, there was still a strong association between low DST score and gum inflammation.
In 2013, UK-based researchers from the University of Central Lancashire (UCLan) built on the findings of this study, by comparing brain samples from 10 living patients with Alzheimer's with 10 brain samples from people who did not have the disease.
Analysis showed that a bacterium - Porphyromonas gingivalis - was present in the Alzheimer's brain samples but not in the samples from the brains of people who did not have Alzheimer's. What was interesting was that P. gingivalis is usually associated with chronic gum disease.
The team followed up this research in 2014 with a new mouse study, the results of which were published in the Journal of Alzheimer's DiseaseMedical News Today spoke to co-author Dr. Sim K. Singhrao regarding the findings.
Dr. Singhrao says that there is sufficient scientific evidence to show that two of the three gum disease-causing bacteria are capable of motion (or "motile") and have been consistently found in brain tissue.
"These motile bacteria can leave the mouth and enter the brain via two main routes," he explains. "They can use their movement capability to directly enter the brain. One of the paths taken is to crawl up the nerves that connect the brain and the roots of teeth. The other path is indirect entry into the brain via the blood circulation system."
In a patient who has bleeding gums, says Dr. Singharo, the gum disease-causing bacteria will enter the blood stream every time they clean their mouth and even when they eat food.
He continues:
"P. gingivalis is particularly interesting as it has found ways to hitch a lift from red blood cells when in the blood stream and instead of getting 'off the red blood cell bus' in the spleen, they choose to get off in the brain at an area where there are no immune checkpoints. From there, they spread to the brain at their will. In addition, in older individuals, the blood vessels tend to enlarge and become leaky."
"The published work confirmed P. gingivalis placed in the mouths of mice finds its way to the brain once gum disease becomes established first," Dr. Singhrao concludes. "Furthermore, our hypothesis is strengthened by the recent results demonstrating that the chemicals released by the brain's immune system in response to P. gingivalis reaching the brain 'inadvertently' damage functional neurons in the area of the brain related to memory."

Pancreatic cancer

A research team from Harvard School of Public Health in Boston, MA, were the first to report strong evidence on a link between gum disease and pancreatic cancer, back in 2007.
The type of gum inflammation associated with pancreatic cancer in the study was periodontitis, which affects the tissue that support the teeth and can cause loss of bone around the base of the teeth.
The other main kind of gum disease - gingivitis; where the tissue around the teeth becomes inflamed - was not linked to increased cancer risk. However, gingivitis can lead to periodontitis if persistent. Gingivitis happens when bacteria in the plaque around the base of the teeth build up due to bad dental hygiene.
Examining data on gum disease from the Health Professionals Follow-Up Study, which involved a cohort of more than 51,000 men and began collecting data in 1986, the Harvard researchers found that men with a history of gum disease had a 64% increased risk of pancreatic cancer compared with men who had never had gum disease.
The greatest risk for pancreatic cancer among this group was in men with recent tooth loss. However, the study was unable to find links between other types of oral health problems - such as tooth decay - and pancreatic cancer.
The researchers suggest that there may be a link between high levels of carcinogenic compounds found in the mouths of people with gum disease and pancreatic cancer risk. They argue that these compounds - called nitrosamines - may react to the digestive chemicals in the gut in a way that creates an environment favorable to the development of pancreatic cancer.
However, a follow-up study from the team in 2012 was unable to prove whether the periodontitis bacteria are a cause or result of pancreatic cancer - the study could only prove that the two were linked.
"This is not an established risk factor," admitted author Dominique Michaud. "But I feel more confident that something is going on. It's something we need to understand better."
Heart disease

Perhaps more well established is the association between dental hygiene and heart disease.
In 2008, MNT reported on research from joint teams at the University of Bristol in the UK and the Royal College of Surgeons in Dublin, Ireland, who found that people with bleeding gums from poor dental hygiene could be increasing their risk of heart disease.
The researchers found that heart disease risk increased because - in people who have bleeding gums - bacteria from the mouth is able to enter the bloodstream and stick to platelets, which can then form blood clots, interrupting the flow of blood to the heart and triggering a heart attack.
"The mouth is probably the dirtiest place in the human body," said Dr. Steve Kerrigan from the Royal College of Surgeons, explaining that there are up to 700 different types of bacteria co-existing in our mouths.
Prof. Howard Jenkinson, from the University of Bristol, added:
"Cardiovascular disease is currently the biggest killer in the western world. Oral bacteria such as Streptococcus gordonii and Streptococcus sanguinis are common infecting agents, and we now recognize that bacterial infections are an independent risk factor for heart diseases."
The Bristol University researchers investigated how the bacteria interact with platelets by mimicking the pressure inside the blood vessels and the heart. Prof. Jenkinson's team found that the bacteria use the platelets as a defense mechanism.
By clumping the platelets together, the bacteria are able to completely surround themselves. This platelet armor shields the bacteria from attack by immune cells and makes them less detectable to antibiotics.
The American Dental Hygienists' Association (ADHA) recommend that we should brush for 2 minutes, at least twice daily. The ADHA guidelines also stress the importance of flossing daily and rinsing with mouthwash.


Tuesday, April 17, 2018

Are You Brushing Your Teeth Too Hard?

If you have sensitive teeth, brushing too hard or using the wrong toothbrush altogether can make symptoms worse. Learn the proper technique for brushing your teeth.

When it comes to brushing your teeth, there is such a thing as proper technique. Brushing too hard — or using the wrong toothbrush — can damage your teeth and gums, leading to problems like enamel wear and receding gums, which can in turn lead to tooth sensitivity. People tend to brush aggressively, thinking it’s the only way they can get their teeth to feel clean and look whiter. That’s counterproductive, because not only does it cause recession of your gums, but you're also wearing away the white, glossy enamel on your teeth, making them look yellow and darker. And when that happens, you’re putting yourself at risk for developing sensitive teeth.

Not sure if you’re brushing too hard? Take a look at your toothbrush. If you’ve been using it for three months or less, it should still appear relatively new. If it looks beat up and flat, that’s a sign you're brushing way too hard.

The Proper Way to Brush Your Teeth

It requires a lot of mindfulness, but you can change your hard-brushing ways. Follow these tips to brush properly to help relieve tooth sensitivity and prevent damage to your teeth and gums:

Use a soft-bristled toothbrush. Choose one with the ADA seal and replace it every three months — or sooner if it frays.

Place your toothbrush at a 45-degree angle to your gums. That way, the bristles can reach and clean underneath your gumline.

Gently move the brush back and forth. Use short, tooth-wide strokes to clean the outer, inner, and chewing surfaces of the teeth, the ADA recommends. If you have a lot of gum recession, your dentist may recommend you try the roll technique instead.  If you’re using an electric toothbrush, let it do all the work and just lightly glide it over your teeth instead of pushing it against them. To make sure you’re using a gentle grip, try holding your toothbrush in your nondominant hand.

Slow down. Dentists recommend that you brush for two full minutes — 30 seconds in each quadrant of your mouth — twice a day. Use the timer on your phone or choose an electric toothbrush that alerts you every 30 seconds.  For people who have never tried it, it can feel like an eternity. You don’t really know what two minutes feels like until you actually brush that long. But when you’re not rushing to finish, it will keep you more mindful about brushing too aggressively.

Sticking with these tips can help you keep your teeth clean and your mouth healthy, while eliminating symptoms of tooth sensitivity.

Thursday, January 4, 2018

Making Any Fitness Resolutions?

15 signs they won’t last 7 days

Treating yourself to a new tracksuit, yoga mat or pair of kicks helps make your workout routine stick by getting you psyched for your sweat session, say sports psychologists.

Plenty of us intend to work off those Christmas cookies with extra cardio in the New Year. But an estimated 1 in 4 people who have made the decision to get in more exercise in 2018 won’t be able to stick to their new fitness habits for more than a week, according to the Association for Psychological Science. Gym traffic spikes in January by as much as 40 percent, only to taper off in a few weeks. No wonder people who gain weight over the holidays typically lose only half of the added pounds 12 months later. Don’t be part of the 25 percent who get tripped up before gaining traction. We’ve collected behavioral experts’ top reasons why the well-intentioned experience fitness fails — and the fixes to keep your workouts working for you all year long. 

1. Fitness fail: You’re not really ready. Picking up a magazine that has “New Year, New You,” on the cover doesn’t count as willpower. 

The fix: Think about your goal. Now ask yourself, on a scale of 1 to 10, how bad do I want this? Next ask yourself on a scale of 1 to 10, how confident am I that I can make it happen? If you don’t rate at least a 6 on both motivation and confidence, experts say, select a simpler goal. Also, run the plan by your doctor. 

2. Fitness fail: You’re starting the New Year with old gear. Old shoes could have you sidelined with an injury. A chlorine-faded swimsuit might show off more than your breaststroke.

The fix: Treating yourself to a new tracksuit, yoga mat or pair of kicks helps make your workout routine stick by getting you psyched for your sweat session, sports psychologists say. 

3. Fitness fail: The countdown clock has stopped. With the incentive to look great in a New Year’s party dress behind you, what culminating event will keep you motivated? 

The fix: Sign up for a 5K race, a bike-a-thon or a hiking trip — and mark your calendar.

4. Fitness fail: Your mind-set is too macro. Those with an all-or-nothing approach often give up too soon. 

The fix: If you’re new to running, don’t start with a mile. Start with a minute, then walk for a minute or two, and repeat. 

5. Fitness fail: You don’t have a backup plan. It’s raining. The pool is closed. Yoga class is full. Oh, well. 

The fix: Arm yourself with workout alternatives before you need them. If I’m too late for Zumba, I’ll get on the cross-trainer. If the treadmills are all taken, I’ll use the rowing machine. If it’s too cold for a walk, I’ll follow a workout video indoors. 

6. Fitness fail: Your routine is so … routine. 

The fix: If you’ve been doing intervals on the elliptical trainer all week, try a cycling program. Vary your walking route. 

7. Fitness fail: You don’t reward yourself.

The fix: Celebrate small wins as often as possible. Losing 10 pounds by next month is great, but logging 10,000 steps will help you get there

8. Fitness fail: You don’t have a digital cheering section.

The fix: Health-related online social networks enable people to monitor their diet and motivate them to make healthy fitness changes, University of Connecticut researchers found.

9. Fitness fail: You’re not having fun. 

The fix: If you don’t like Pilates, try karate. 

10. Fitness fail: You’re tracking “exercise,” not “activity” — which means you’re not getting credit for your full calorie burn. 

The fix: It’s pretty NEAT. Non-exercise activity thermogenesis (NEAT) is the energy expended for everything we do that is not sleeping, eating or sports like exercise. It ranges from the energy expended walking to work and typing to performing yard work and housecleaning. Move more to boost your metabolism. 

11. Fitness fail: Your gym bag isn’t packed — which means you’ve set yourself up for a.m. mayhem.

The fix: Swap out the sweaty shorts and shirt for clean togs and towels the night before. Refill that travel-size shampoo bottle. Stow everything by the door.

12. Fitness fail: Your habit has no “hook.” You meant to take a short walk, but you forgot. 

The fix: Reinforce new habits by attaching them to existing ones. “When I go to the mailbox, I’ll walk around the block before collecting letters and packages.”

13. Fitness fail: You’re going it alone.

The fix: A date with a gym buddy or trainer makes it harder to skip sessions. A series of group texts between your like-minded buddies keeps you accountable, too.

14. Fitness fail: You trip if you skip a workout. The day got away from you after you put a fire out at work. Now all you are exercising is regret, which sours your feelings about fitness. 

The fix: Don’t sweat a setback. Tomorrow is another day. 

15. Fitness fail: You haven’t learned the three R's. These are the thoughts and behaviors you’ve got running in a loop, creating a bad habit — or a good one. Why is it so hard to get up and run in the morning?

The fix: If you need to get to bed earlier, look at the loop that’s making you turn in late. Reminder: What trigger initiates the behavior? I watch the late-night host’s monologue. Routine: Right after, it’s light’s out. Reward: Laughing lets go of the stress of the day so I can sleep. Now you can sub in a similarly relaxing reward that supports getting more shut-eye, say, meditating for five minutes or enjoying herbal tea an hour before the show airs. (You can time-shift and enjoy it while on the treadmill tomorrow).