Getting the Test. The Celiac Test.....

I'm finally taking the plunge and getting tested for Celiac Disease. I've been teaching clients for the past year or so that it's important to get tested if you have family members who have been diagnosed with Celiac, yet I haven't practiced what I preach. I have a cousin who was recently diagnosed with Celiac disease, and an aunt who is "gluten intolerant", and as you all know I have had GI issues my entire life, plus I was iron deficient at one time in my life (and haven't really been tested since then) both of which are signs of Celiac. Many people believe that GI upset or weight loss are the two main symptoms of Celiac Disease, but in reality weight gain, iron-deficiency, depression, dermatitis, and osteoporosis or osteopenia are more common symptoms.

The New York Times wrote a fantastic article about the testing that is done for Celiac Disease. The following passage, taken from the article, describes two of the proteins that are looked for when tested;

One protein is an enzyme called tissue transglutaminase, or TTG, that is found in many cells of our body. TTG is released from the damaged intestine during active celiac disease, and antibodies to TTG are found to be elevated in the blood of most patients with untreated celiac disease.

The other protein to which the body’s immune system responds to abnormally in someone with active celiac disease (and occasionally in some other disorders) is a group of proteins found in gluten called gliadins.

I've been following the low FODMAPs diet for over two years now, and since wheat contains FODMAPs, I try to stay away from it. The other two grains that contain gluten are rye and barley, which I really don't consume. So I know my intake of gluten has been pretty low, but I've certainly not been "gluten free". I drink beer, eat gluten-containing samples at work, sometimes eat desserts at parties, plus I take bites of Nick's pastas and breads on occasion, but I want this test to be as accurate as can be, so after reading the following passage from the New York Times article I decided to increase my gluten intake before getting tested.

Going on a gluten-free diet for many months, and particularly for a year or more, can lead to the most commonly used diagnostic tests for celiac disease to no longer being helpful. Even intestinal biopsies can go back to a normal or near-normal appearance if you have been gluten-free for a long time. Without an intestinal biopsy that shows the abnormalities of celiac disease, you cannot be diagnosed with celiac disease. The only way to make a diagnosis of celiac disease after starting a gluten-free diet is to go back on gluten. This is referred to as a “gluten challenge” and is the subject of another discussion.

Here is what I've been eating/drinking:

BEER; Barley contains gluten

Wheat cakes; made from wheat and other gluten-containing ingredients

Panko Bread Crumbs (made from wheat bread)

Tuna: Yes, this does contain wheat, check out the ingredients!

Toasted Oats: While oats aren't a natural source of gluten, many are contaminated. Also, this particular cereal has wheat clearly listed in the ingredient list.

And, of course, Thanksgiving leftovers (turkey sandwich on whole wheat bread).

QUESTION: Do you have any tips for me before I get tested for Celiac? The big day is Wednesday!

If you know someone who has been diagnosed with Celiac Disease within the past 12 months (or if you have been diagnosed yourself), I encourage you to check out what the University of Chicago is doing this season to help those who have been diagnosed. Check out how you can help, or receive a generous gift of your own, here.

Braising With Wine, and Being a Food Detective

Can you believe I had never braised meat prior to about three weeks ago? I was looking through my Clean Eating Magazine and saw a picture of my Le Creuset cast iron braiser (or dutch oven) and realized that I have had it for almost a year now and have never used it for its main purpose....braising! Literally that same day I drove to the store and picked up some braising meat, with a mission of creating the best darn braised meat a girl could make, without onion and garlic (that's quite a mission, I must say).

Wine-Braised Beef With Carrots, Mushrooms, and Broccoli


Ingredients

16 ounces braising meat

2 tsp. sea salt

1/2 tsp. fresh ground black pepper

1 T olive oil

2 cups red wine (I used Malbec )

1.5 cups water

1.5 cups fresh carrots (or parsnips)

1.5 cups fresh broccoli

1.5 cups fresh mushrooms

**If you want to use onion, you can, but I did not **

Parsley for garnish


Directions

1. Season beef with salt and pepper. Place the beef in your braiser (or dutch oven) and heat on medium-high. Brown the beef well on both sides for about 8 minutes. Once heated, take out the meat and place it on a separate plate for the time being.


2. Reduce heat to low, add onion (if you are using onion) and cook for about 15-20 minutes until caramelized. Stir in 1/2 cup of wine and increase heat to bring to boil, scraping the brown bits from the braiser with a spoon.

3. Stir in carrots, broccoli, and mushrooms, along with the remaining 1.5 cups of wine and the 1.5 cups of water. Return to a boil, reduce heat

( This photo is very steamy, and perhaps not so pretty, but it's as pretty as I could make it! I tell you, this meal was delicious, despite the looks of it.)

The house started smelling pretty darn good about an hour into the cooking process. Nick made his way upstairs from his downstairs "man cave" and said he could smell the amazing dinner I was preparing (or...waiting around for).

Nutrition Facts
(Serving Size: 1/4th of recipe, or about 4 ounces meat, with veggies)

As most of you know, I'm not one to take a lot of time making dinner. This recipe may sound like a lot of work, but the Le Creuset braiser did all the work really. I just waited around for a couple hours and worked on other stuff. In other words, this was super easy! I didn't even have to chop anything because I used baby carrots (already small enough to go in the braiser), sliced mushrooms, and fresh broccoli that I just ripped off the stem and threw into the pan. Easy. And the end product was delicious. The only problem was......

An hour after eating this meal, I was in PAIN!

Source: iStock Photo

Sometimes I have to play food detective to find out what I may have eaten that caused me pain. In this case, it was the wine in which my meal bathed for two hours. Wine is something I need to limit on my low FODMAPs diet (about 1 4-ounce glass max, at a time). I know I'm not supposed to drink a lot of wine, but I wasn't thinking about that when I was using wine for braising! Oh man, what a mistake.  I'm pretty sure the braising just concentrated the sugars more and caused me some major malabsorption issues (maybe??).  Oops!  Although, to be honest, the mushrooms and broccoli probably didn't help either!  They both contain FODMAPs as well.

Two weeks earlier I had done something similar. I drank a popular natural diet pop/soda (I can't indicate the name brand, but I bet you could guess it) and about an hour later I was more bloated and uncomfortable than I had been in a long time. I soon realized the diet pop had erythritol, a "natural sugar alcohol" that causes me (and many people) GI issues. A couple days prior to that I realized I had consumed the drink below, which also contains erythritol PLUS fructose (toxic combination for me!).

I think (and hope) I've learned my lesson. No more diet sodas with erythritol or excess fructose added, and no more braising in wine. The next time I braise I'm using low sodium chicken stock (without garlic or onion).

QUESTION: What's your favorite food to braise? What do you use as your braising liquid? On another note, does erythritol cause you stomach pain, like me??

Who Should Take a B-12 Supplement?

I recently started taking B12 (500mcg). The first day I took it I couldn't sleep. To me that meant I was definitely deficient in B12.

The Office of Dietary Supplements says this about B12:

Evidence from the Framingham Offspring Study suggests that the prevalence of vitamin B12 deficiency in young adults might be greater than previously assumed [15]. This study found that the percentage of participants in three age groups (26–49 years, 50–64 years, and 65 years and older) with deficient blood levels of vitamin B12 was similar. The study also found that individuals who took a supplement containing vitamin B12 or consumed fortified cereal more than four times per week were much less likely to have a vitamin B12 deficiency.



They also say:

Individuals with gastrointestinal disorders should probably take a B12 supplement. Individuals with stomach and small intestine disorders, such as celiac disease and Crohn's disease, may be unable to absorb enough vitamin B12 from food to maintain healthy body stores [12,23]. Subtly reduced cognitive function resulting from early vitamin B12 deficiency might be the only initial symptom of these intestinal disorders, followed by megaloblastic anemia and dementia.



I started taking B12 because I'm pretty sure I have some type of malabsorption disorder. When I consume FODMAPs I believe my body has a hard time absorbing other nutrients, such as B12 and magnesium.


Many people think that B12 will give them energy, but in fact that's not the case, unless of course you are deficient (which explains why I was so energized by B12!)



The Office of Dietary Supplements says this about B12, in regards to energy;

Due to its role in energy metabolism, vitamin B12 is frequently promoted as an energy enhancer and an athletic performance and endurance booster. These claims are based on the fact that correcting the megaloblastic anemia caused by vitamin B12 deficiency should improve the associated symptoms of fatigue and weakness. However, vitamin B12 supplementation appears to have no beneficial effect on performance in the absence of a nutritional deficit [81].


B12 is one of the few vitamins that does not seem to pose any danger when high amounts are ingested. It is for that reason than I decided it was worth trying B12, to see if I noticed a difference and to assure myself that I was indeed deficient (sadly). I'm glad I did. I've read some research about how chronic B12 deficiencies may lead to dementia or even Alzheimers. No thanks. Other groups, aside from those with malabsorption/gastrointestinal disorders, who might need a B12 supplement include elderly individuals and vegetarians (especially vegans!).

Sources of B12

Meat

Fish

Poultry

Dairy

Fortified foods (vegan)

Nutritional yeast (vegan)

I'm not even a vegan and I eat nutritional yeast everyday! It's a great replacement for parmesan cheese.

QUESTION: Have you ever talked to someone who told you they take B12 for energy? Now you can tell them it's all in their head! I felt more energy the first couple of days I took the B12, but after that I didn't feel any more energized than normal. Why? Because I believe my levels are finally normal, phew!

Polenta Stuffing; A Gluten-Free Thanksgiving Treat!

I hope everyone had a great Thanksgiving!! Mine was nice and relaxing. I ate lots of delicious food and got to spend some quality time with family and friends.

My aunt and cousin are both on gluten-free diets so they are always coming up with great recipes to share with me over the holidays and throughout the year. Obviously most stuffing (if not all) contains gluten, so this year my aunt created polenta stuffing! She actually came up with this on her own, but I found a similar recipe online, which you can view here.


It did contain onion, which I typically do not eat because they contain FODMAPs, but I still ate this and tried to eat around the onion. It was delicious! It honestly tasted like stuffing, but better.


I highly suggest this recipe if you are on a gluten-free or wheat-free diet. I think if I ever make this myself I will omit the onion and add squash or pepper instead.

QUESTION: What was your favorite dish this Thanksgiving? For me, other than the stuffing, I really enjoyed my aunt's pecan pie. I just love pecan pie!

Elimination Diet; End of Day Four

Only three more days! And guess what? My cravings have pretty much disappeared. Sometimes it just takes a few days of getting it "out of your system" for cravings to diminish. Does this mean I will never eat chocolate or peanut butter or dairy again? Heck no, because I never had a problem with eating too much of it in the first place. However, if I really felt I ate too much and didn't have control over these foods, I might end up giving them up for good.

By the way, thanks for your suggestions on a dairy and soy free yogurt. The only issue I have is that the most popular suggestion I received, coconut yogurt, doesn't come in a plain flavor! Thankfully the cultured coconut milk does come in plan. The flavored ones all contain ingredients I can't have either on the elimination diet, or FODMAPs. My life is over. hehe, jk.


A few more new things I've discovered since my last post;

- I love organic chicken. Seriously, it tastes like a whole new product! I always buy natural chicken (without added hormones) but the extra benefits of the organic chicken really show up in the taste. Maybe it's just the particular brand I bought? Who knows, but it's delicious.

- I am not really feeling any better, overall, but then again, I never felt bad. I think my real elimination diet was my FODMAPs diet. I've felt great since taking all of those foods out of my diet. Actually I'm finding out that I really shouldn't be drinking the cultured coconut milk. It's giving me bad gas. I'm not supposed to have coconut according to FODMAPs, but someone told me that some people can handle the milk. Apparently, I can't.

I was hoping giving up dairy would help my allergies (I've heard some people swear by that concept...) but I'm still getting random allergy flare ups in the middle of the day. Maybe I should be more patient?

- I'm able to survive on only about 200-250 mg caffeine per day, still! Sure, you may be thinking that's still a lot, but considering just last week I was doing 300-350 mg/day, I'm pretty proud of myself. We even have coffee available to us all day long, for FREE, at Market District, but I haven't touched it.

Here are some things I've been eating:

Lunch is still a spinach salad with veggies, quinoa, and balsamic vinegar. Tomorrow I'm going to add organic chicken to my salad.

I've also been packing this delicious acorn and butternut squash soup, for which I will post directions and the recipe soon. It turns more soupy once it's heated (the picture below was taken when it was cold).

I'm also packing my granola, veggies chips, and a banana.

I've also started eating these curry flavored twigs. They are fabulous!



Dinners have been steamed kale, topped with tomatoes and nutritional yeast. This combination is actually very satisfying. I have some type of fish every night for my protein. Last night it was salmon, tonight I did tilapia.

We gave out Halloween candy tonight.

This was staring me in the whole time (and still is...).

Now that the Trick-Or-Treating is over, I will make my new favorite "elimination diet dessert"!


I mix about 1/2 cup frozen blueberries with about 3/4 cup almond milk and some Stevia in the Magic Bullet. I then put it in the freezer for about twenty minutes. It's incredibly satisfying and I plan on making this even when I'm no longer on this diet. Who needs ice cream when you have this?!?! Ok, maybe I still want ice cream, but this is a great substitute every once in a while.


I'll post again on Sunday, my last day! I may end the diet Sunday evening, since I started on last Sunday evening so technically that would be a full week.... We'll see how I feel!

Elimination Diet; Day One

Today is Day One of my 1-2 week long elimination diet! I plan on posting updates a few times throughout the week because really want you to know what I'm going through and how I'm feeling, just in case you decide to do an elimination diet yourself one day.

Early Morning

7:00am: The first thing I typically do is eat a bit of granola and drink my coffee (pre-workout snack). Well, I couldn't enjoy my granola because of some of the ingredients (mainly peanuts), so instead I created a new (peanut and gluten free) granola, which I really enjoyed.

Granola: gluten free oats, almond butter, molasses, almonds and walnuts



I'll just go ahead and admit that caffeinated coffee is not supposed to be included in this elimination diet. However, I'm just not able to go from drinking it, to not drinking it, overnight! It's almost like telling a nicotine addict that they have to stop smoking cigarettes, tomorrow. I can give up every other delicious aspect of my diet, but the coffee is here to stay. So you might think I am cheating, and that's fine, I won't deny that. I typically ingest about 300-350 mg caffeine a day (300 mg is the max for health purposes, I'm working on cutting back), but this morning I only made about 220 mg worth of coffee. So I am clearly trying to cut back for the purpose of this diet (who knows, maybe I'll stick to it)!



As I went to take my Flintstone multivitamin, I noticed it has aspartame, which is not a part of this diet. I still took the vitamin because I'm not about to go buy a special vitamin for this diet. I've already spent $100 more on groceries this month!

Mid-Morning Breakfast

9:30 am: After my workout I ate my gluten free oats, using almond milk instead of water. I also mixed in pumpkin puree and almond butter. I typically sprinkle some Truvia on top of my oats, but since Truvia contains sugar alcohols, I bought Stevia to use instead. I really don't like it as much as Truvia :(

Mid-Afternoon Lunch

1:30 pm: I didn't have to work today so I had the ability to put together a fairly substantial lunch.

I made a salad with organic spinach, organic chicken breast (marinated in rice and balsamic vinegar prior to cooking), butternut squash, and Daiya "cheese".

Have you seen or tried this stuff before? It's awesome!! I hear it melts really well too. It definitely tasted like cheddar cheese, in my opinion (I'm not sure Nick would agree though).


Here is my only problem with this "cheese":

No calcium!! Ok, so it's not supposed to be a replacement for cheese, but still, is it really that hard to fortify with a bit of calcium?! For once I'm begging for fortification.

I also had some of these veggie chips, which I purchased at Market District. These things are so addicting. They are made with a bunch of dehydrated squashes and green beans.

Late Afternoon

I'm getting most of my calcium from almond milk and cultured coconut milk. I chose the cultured coconut milk so I could get some probiotics and prebiotics each day (I typically rely on kefir and/or yogurt for these). Did you know that this cultured coconut milk has 30% DV of magnesium (great for diabetics!) and 35% DV of B12 (great for vegans!!!!)?! And, it tastes pretty delicious. Buy the original flavor if you don't want a bunch of added sugars.


I also snacked on more granola, more veggie chips, a bit of quinoa, and some almond butter throughout the afternoon.

Evening Meal

7:00pm: I'm allowed to have fish on this diet, so I stocked up on salmon, cod, and tilapia. Tonight I had some tilapia. I simply baked it in the oven with a bit of EVOO on top, and some simple seasoning (garlic free).

I ate my carrots and broccoli with some balsamic vinaigrette. Typically I use blue cheese dressing, but there are ingredients in the blue cheese dressing that I have to eliminate.

Some Things I've Learned Thus Far

- I have two addictions; chocolate and caffeine. I will say, however, I am very proud of myself for surviving my first day with about 100 mg LESS caffeine than normal! And I'm feeling pretty good. As for the chocolate, I typically eat a piece right after dinner. I literally have nothing sweet to eat right now. It's rough (especially since we have 5 bags of Halloween candy in the closet....).

- I miss condiments! Three times today I wanted to use a condiment, but couldn't (Red Hot, blue cheese dressing, and soy sauce). I need to find something I can use instead of these.

- It's really hard to get enough calcium without being able to eat dairy and soy! The almond milk is fine, but the coconut kefir is something I need to watch because I'm not supposed to have coconut on my low FODMAPs diet. I think the coconut flesh is worse, but coconut milk may still cause problems. So far, however, I'm fine.


Stay tuned for another update as the week progresses. I hope you are all having a wonderful week, so far!

Do You Have IBS? FODMAPs May Be the Culprit

If you've been following my blog for a while, you know I'm on a diet. It's not a weight loss diet, and it's not some stupid cleanse diet or whatever, it's a diet for my IBS (irritable bowel syndrome), and it's been a lifesaver. I posted my IBS story here (this was before I had learned about the low FODMAPs diet for IBS), and I posted a bit about the low FODMAPs IBS diet here. As it turns out this diet is becoming more and more popular throughout the world, and recently my favorite magazine; Today's Dietitian, wrote an article all about it.

Ever since I've been on this diet I have felt about 1000 times better, and my quality of life has increased tremendously, so I'm not surprised that other people are slowly starting to find this out as well. Imagine going your entire life with constant bloating and gas. It's not fun (not for me or anyone around me.....). Now I can finally say my gas is under control, and all I did was change my diet! Food really is the best medicine, but I guess it can also be your worst nightmare. Here are some important points from the article in Today's Dietitian;

What are FODMAPs?

They are short-chain carbohydrates that tend to be malabsorbed in those with IBS. The acronym stands for:

Fermentable

Oligosaccharides

Disaccharides

Monosaccharides

And

Polyols

Why are these foods considered "trouble foods" for those with IBS?

The short-chain carbohydrates tend to be malabsorbed in those with IBS (and even those without it, but the side-effects aren't as bad for most people). The malabsorbed carbohydrates typically end up undigested in the colon, where gut bacteria happily ferment it and thus produce gas and bloating. Not fun.

What are some foods that contain FODMAPs and which those with IBS should avoid?

You will likely find hundreds of different food lists of "foods to avoid" on the internet, which could quite possibly lead to confusion (some people have told me this). The article in Today's Dietitian, as well as the booklet you can order (see the right side of my blog) seem to be very consistent. I have stuck with these lists.

FODMAPs exist in some very commonly consumed foods, which is why many people with IBS have trouble figuring out the exact cause of their discomfort (I've heard this before, "everything I eat causes a problem!!") . Here are some examples of problem foods;

Fruits: Apples, pears, peaches, mangoes, dried fruits

Vegetables: artichoke, asparagus, brussels sprouts, broccoli, onion, beetroot, chicory root (Inulin), beans and soy products (don't want to give up your beans and soy? BEANO can help with these!)

Grains: Wheat, rye

Sweeteners: Sorbitol, mannitol, xylitol, malitol, HFCS, agave, honey

Spices: Garlic (garlic is found in many, many foods, and unfortunately it tends to cause the most severe issues in those with IBS).

** Visit this link for a more complete list (scroll down all the way once you get to the site), or order one of the helpful booklets on the right side of my blog (Or check out my latest blog post for more helpful resources) **




What are some foods that those with IBS can enjoy instead of some of their favorite fruits, veggies, grains, and dairy products?

Fruits: Berries, cantaloupe, honeydew, oranges, ripe bananas

Vegetables (**Most of these can only be eaten in limited quantities): Squash, spinach, kale, sweet potatoes, tomatoes, eggplant (although eggplant does give me, personally, some problems...)

Grains/Starch: Quinoa, rice, oats, popcorn 

Sweeteners:  Stevia, sugar, brown sugar, molasses


Spices: Cinnamon, pepper, salt, cumin

Please feel free to ask me any questions about my own journey adapting to the low FODMAPs approach to IBS management, or any other questions you might have! I'll tell you upfront that it was very difficult at first, and still is (especially when I'm out to dinner or at a dinner party) but the difference it has made in my life makes it all worthwhile. The most difficult part about this diet (for me) has not been giving up wheat, but giving up onion and garlic. I just love onion and garlic! I now have to read all ingredient labels very carefully, as garlic and onion seem to appear in many sauces, specifically ALL spaghetti sauces!

Question: Have you had to make a major change in your life, which was difficult but well worth the effort?!

**** FOR AN UPDATED LIST OF RESOURCES CHECK OUT MY MOST RECENT low FODMAPS POST!

Pizza From Scratch, and Being Active at Work

I hope you are all having fantastic weekends. Mine has been productive, and relaxing. Today I'm planning on doing some cooking for the week, and working on some blog posts for our workplace wellness company. For today's post, I'm finally celebrating "from scratch weekends"! Melinda, this one is for you.

Quick, Cheap, and Healthy Recipe #14

Oat Bran Pizza Crust

Ingredients
3 cups oat bran flour
1 (.25 ounce) package active dry yeast
2 T extra virgin olive oil
1 t oil (for your fingers when spreading the dough)
1 t salt
1.5 T sugar
1 cup warm water

Possible Modifications

• Use whole wheat flour, or all purpose flour (less nutritious if you use the latter)
• Use canola oil or just regular olive oil

Directions

1) Preheat oven to 375 degrees

2) Combine and mix the flour, salt, sugar, and the yeast in a medium sized bowl. Next, add the EVOO and water.

(It sort of stuck to the side of the bowl. I just scrapped it off and put it back into the ball.)

3) Coat your hands with some oil, or non-stick spray. Use your hands to spread the dough evenly on a pizza pan, the larger the better.

4) Add topping as desired. Cook for 20-30 minutes (depending on your oven and how crispy you like your pizza!)

I put pizza sauce on Nick's half, and EVOO on my half. Pizza sauce has spices in it that I cannot eat, as they are part of FODMAPS.

I ended up putting sauce on 3/4 of the pizza, because that's how much Nick typically eats. One-fourth (or two large pieces) of the pizza is always sufficient for me, especially because I usually have pizza with a nice beer. On this particular night, it was a Great Lakes Burning River (pale ale).

Toppings

• Sauce or EVOO

• Mozzarella cheese (Organic, I usually buy organic dairy) (~3/4 cup)

• Chunks of grilled chicken (Trader Joe's) (~3 ounces)

• Green pepper (~1/2 cup, only on Nick's side)

• Spinach (~1/2 cup, only on my side)

• Tomato (~1/4 cup, only on my side)

Basil (~1 T)
Garlic (~2 t)
Cayenne (~1/2 t)


Nick's Rating: 10 out of 10


My Rating: 9 out of 10
** While this pizza was AMAZING I will use a larger pizza pan the next time I make it. The pieces were really thick and that made it difficult to get the middle crust completely cooked. It was so thick I could barely eat my two pieces, and in fact, Nick only had two pieces himself!! I have never seen him eat only two pieces, EVER. **


Nutrition Facts for the CRUST Only
(Serving Size: 1/8 of the pizza)
** This crust received a C+ rating, but once you add some healthy toppings, like lots of veggies and calcium-packed cheese, it will be a healthier meal!! Also, it is better than a crust made with white flour, as this one provided almost 5 grams of fiber per slice! **

Being Active During the Day

Many people responded to the comment I made on my post a couple days ago, regarding the fact that working out once a day isn't necessarily the end all be all when it comes to weight management and overall health. Some people think they can workout for an hour, then sit on their butt all day, but this just doesn't cut it! I'm not saying you need to be walking and moving all day, but if you workout for 60 minutes, then go to your job and sit all day, that's a problem. What can you do to get a little more activity into your day?

• Park far away whenever you go anywhere. This will force you to walk more.

• Get up and walk to the furthest bathroom whenever you have to go.

• Get up and walk to the furthest drinking fountain, whenever you need a drink.

• Instead of paging someone, get up and personally tell them the message.

• Walk to your car and back during your lunch break.

• Do a set of push-ups (10 slow) every 30 minutes

• Ask about getting a Wii for the office!
  

• Ask your boss about sitting on a stability ball during work. Sitting on a stability ball, rather than a chair, will require the use of different muscles, rather than sitting in a nice relaxing chair, which requires use of very few muscles.

Question: Are there any other ideas you would like to add to this list?

Have a great day everyone! As always, thanks for reading :)