Weeding Out Tobacco’s Role in High Cholesterol: Explaining how smoking affects cholesterol levels, Noting the connections between smoking and cholesterol, Identifying the typical smoker and Finding ways to break the habit.

Weeding Out Tobacco’s Role in High Cholesterol

In This Chapter

� Explaining how smoking affects cholesterol levels

� Noting the connections between smoking and cholesterol

� Identifying the typical smoker

� Finding ways to break the habit

Consider this chapter, in fact, this entire book, a nonsmoking area. In fact, close your eyes and visualize little signs up all over the virtual walls

explaining what’s wrong with tolerating tobacco, how tobacco interacts with cholesterol, and showing how to quit, right now. Then think about how this will make your healthful life style even more so.

Enumerating Smoking’s Health Hazards

Puffing on a lit tobacco stick, that is, inhaling smoke from burning, dead leaves produces the following reactions in your body:

� Raises the level of carbon monoxide in your blood, which reduces the amount of life-giving oxygen

� Injures the lining of your blood vessels

� Constricts arteries that may already be narrowed by cholesterol plaque

� Heightens your risk of high blood pressure

� Reduces the amount of blood carrying oxygen to your body tissues

� Makes it more likely that your blood will clot

� Increases your risk of sudden cardiac death, a genuinely catastrophic moment when, without warning, your heart may stop beating forever

Not to mention, smoking increases your risk of these forms of cancer:

� Bladder

� Esophagus (throat)

� Lungs

� Pancreas

And, if that’s not enough to get to you thinking, how about this: Smoking also destroys your good looks by promoting facial wrinkles.

But did you notice that this list of bad stuff smoking can do to your body is incomplete? Look carefully. Something is missing. What can it be? Surely you jest. It’s smoking’s ability to upset your cholesterol — specifically your “bad” cholesterol.

Burning up the cholesterol charts

The relationship between smoking and cholesterol is straightforward. Over time, lighting up and inhaling all those deep, “flavorful” breaths will

� Increase your total cholesterol levels.

� Decrease the level of your high-density lipoproteins (HDLs), the “good” cholesterol described in detail in Chapters 2 and 3 of this book.

� Hasten the buildup of cholesterol plaque on damaged blood-vessel walls.

� Constrict your blood vessels, increasing the risk that a passing clump of cholesterol may block blood flow.

� Increase the level of triglycerides in your blood, another risk factor for heart attacks (check out Chapter 2).

� Double your risk of heart attack, regardless of your cholesterol level.

That last point deserves serious attention, so I’ve asked my editor to print it in boldface type, and doggone if she didn’t do it!

Although many studies demonstrate a relationship between smoking and heart disease, many smokers are convinced that having a low cholesterol level reduces their risk of smoking-related heart disease. They’re wrong. Low cholesterol levels don’t protect smokers from heart disease. I can say this with impunity because I’ve read the results of the Korea Medical Insurance Company Study, the first effort to pin down a relationship between smoking, cholesterol levels, and the risk of heart attack. (Check out the “East Asia’s heart disease” sidebar in this chapter.) Do I do my homework, or what?

East Asia’s heart disease

East Asia is a part of the world that’s best known for gorgeous scenery and scrumptious food. But it’s also known for having a large population of smokers and a rate of heart disease that’s now among the highest in the world. The confusing part of this equation has been that East Asians have a high risk of heart attack even though they generally have low cholesterol levels. A good guess to clear up this confusion may be that their love of smoking is an independent risk factor against which low cholesterol offers no protection. And by golly, that’s exactly what turned up in data from the 10-year, 106,745-man Korea Medical Insurance Corporation Study, named for the volunteers who were all Korean men with insurance policies from the Korea Medical Insurance Corporation.

Based on the number of men who were either hospitalized or died from heart attack or stroke during the study, the researchers found that smoking significantly increased the risk of heart attack and stroke. Even among men with very low cholesterol levels, smokers had a risk of heart attack and stroke that was 330 percent higher than that of nonsmokers.

Conclusion? As reported in the Journal of the American Medical Association, “This study demonstrates that . . . a low cholesterol level confers no protective benefit against smoking- related atherosclerotic cardiovascular disease.” Translation: Low cholesterol levels provide no protection for smokers against heart disease caused by smoking.

Getting a bad deal on secondhand smoke

As if your own smoking weren’t bad enough for your body, somebody else’s smoking can also be hazardous to your health.

Secondhand smoke, also known as environmental tobacco smoke, isn’t some- thing you buy in a secondhand store. It’s the smoke you inhale from other people’s cigarettes, pipes, or cigars and from the air that people breathe out while they’re smoking.

Like all tobacco smoke, this recycled version contains at least 250 toxic chemicals including at least 50 known carcinogens, which is why, in 2006, the Centers for Disease Control and Prevention (CDC) issued yet another warning on secondhand smoke. For the umpteenth time, the CDC repeated that expo- sure to secondhand smoke increases the risk of heart disease by 25 to 30 percent in adult nonsmokers and increases their risk of lung cancer by 20 to 30 percent.

As for the effect on kids, don’t ask. No, do ask.

Kids and secondhand smoke

If you smoke, children in the room smoke, too. No, they don’t actually light up, but they do breathe the same air you do, so if you exhale smoke into the air, they breathe it into their lungs. In fact, the American Heart Association states that 43 percent of all American kids between the ages of 2 months and 11 years are exposed to secondhand smoke at home.

While their lungs are still developing, smoke from other people’s burning tobacco may slow the normal rate of lung development in children and increase a child’s risk of

� Eye, nose, and throat irritations

� Middle ear infections

� Reduced lung functions

� Respiratory irritations (cough, phlegm, and wheezing)

� Respiratory tract infections (pneumonia and bronchitis)

� Worsened asthma (or new cases)

Clearing the air

Is the word getting out? You bet.

No-smoking-in-public-spaces laws to ban smoking in offices, hotels, restaurants, and other indoor spaces are now commonplace in the United States. And by summer 2007, American cities had passed at least 1,124 laws banning smoking outdoors in places such as amusement parks, zoos (including the National Zoo in Washington D.C.), beaches (no more burying your butts in the sand), golf courses, and — get this one — cemeteries.

Across the Atlantic, in 2004, Ireland became the first European country to ban smoking in all workplaces, including the legendary Irish pubs. Sweden and Italy soon followed suit, and then came the big one: France.

In 2007, the French banned smoking in public practically everywhere: airports, railway stations, hospitals, schools, shops, offices, and so on. Today, in Paris, where people practically invented serious, sexy smoking, many restaurants and most cafes still permit your pampered pooch to dine along with you, but may now ban les cigarettes, which is French for small cigars — cigarettes.

Sacre bleu! But no smoke-blue air.

Identifying the Smokers

Despite all the terrible things that are known about smoking, including its effects on cholesterol levels and the consequent risk of heart disease, many people continue to puff away.

You may wonder who these smokers are. Well, wonder no more: The hard- working statisticians at the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) have crunched the numbers and come up with figures to identify U.S. smokers by age, gender, ethnicity, and level of education. It’s a hard job, but somebody had to do it.

Gender and ethnicity

The percentage of American men who smoke is slightly higher than the percentage of American women who smoke, perhaps because some women still cling to the discredited idea that women are at lower risk of tobacco-related lung cancer. Silly girls.

When it comes to ethnicity, there are distinct differences among Americans. Table 9-1 shows who is more likely to light up.

Getting older, getting smarter

When you count smokers, age matters. So do educational levels. According to the CDC, more than 2,000 new smokers younger than the age of 18 light up every day for the first time. That’s the bad news.

The good news is that as Americans get older, they’re less likely to smoke. Higher levels of education also seem to reduce the likelihood that people will smoke. Maybe the message of Table 9-2 is that as Americans get older (and smarter), they really do get wiser. At least when it comes to smoking.

Mapping the smokers

Okay. You’ve made it past gender, ethnicity, age, and education. How else do researchers classify American smokers? Geography!

Poison control

Because smoking delivers relatively small amounts of nicotine to the body, cases of nico- tine poisoning are rare, if not unknown, among smokers. But eating one cigarette, three cigarette butts, one pinch of chewing tobacco, or any tobacco-replacement medication, such as that found in nicotine gums or patches, is hazardous for an infant, small child, or pet.

Nicotine poisoning is a medical emergency that requires immediate medical assistance! Check with your local poison control center before administering any therapy. The possibility of your tobacco use harming another person in this way is just one more reason to seriously consider the information contained in the “Breaking the Habit” section in this chapter.

Where you live in the United States says a lot about whether you’re likely to be a smoker. According to the CDC:

� In 2005, the percentage of adults who smoke ranged from a high of 28.7 percent in Kentucky and 27.3 percent in Indiana all the way down to a low of 11.5 percent in Utah.

� For men, the states with the highest percentages of smokers were Kentucky (30.6 percent), Indiana (29.7 percent), and Alabama (28.5 percent). Lowest? Utah, again, at 13.7 percent.

� More women smoke in Kentucky (26.9 percent), West Virginia (26 per- cent), and Indiana (25.1 percent). Fewer light up in good old Utah (9.3 percent).

What makes the difference? Must be something in the air.

For those of you who prefer pictures, Figure 9-1 shows the CDC smoking map of the United States in 2005 with the states ranked according to the percentage of adults who are smokers (defined here as people who smoke every day).

Breaking the Habit

A smoker’s risk of coronary artery disease (CAD) rises in direct relationship to the number of cigarettes he or she smokes each day:

� Smokers who quit have only half the CAD risk of people who keep smoking.

� People who quit after having coronary artery bypass surgery or a heart attack, fairly good signals that it’s time to quit, lower their risk of early death.

� Quitting decreases the likelihood of illness and the risk of death for people with atherosclerosis (cholesterol buildup) in arteries other than those that supply the heart and brain.

Ending your relationship with tobacco isn’t a Sunday walk in the park. Nicotine is such a rewarding drug that leaving it behind takes time and effort — a lot of time and effort in many cases. People often feel guilty when their first attempt at breaking the habit isn’t totally successful. That’s nonsense!

Not quitting forever the first time you try to stop smoking is neither a crime nor a moral failure. In fact, not making it the first ten or twenty times isn’t the end of the world. Every time you stop smoking, you keep your body free of tobacco smoke for hours, days, or weeks. Consider that an accomplishment to celebrate. In the end, the only important thing is the end of smoking. Eventually, you’ll get there.

But from the moment you stop (for as long as you stop), your body benefits. Table 9-3 shows exactly how.

Choosing How to Quit

When you decide to quit — right now would be a really good time — you have four basic ways to go:

� You can just quit.

� You can quit with the help of medication.

� You can quit with the help of a behavior-modification program.

� You can try one method from column A, one from column B, and one from column C — in other words, you can take the smorgasbord approach.

The good points and bad points of each of these methods are described in the following sections.

Quitting cold turkey

I decided to stop smoking when my habit reached three packs a day and everything — my apartment, my clothes, my hair — smelled like dead cigarettes.

As a highly competitive, Type A person, I couldn’t stand the thought of being beaten by a paper tube filled with crumbled leaves. Naturally, when I decided to quit, I took the cold-turkey route. The first six weeks weren’t pleasant. I really, really wanted a cigarette, and it was really, really hard not to give in to my craving. Worse yet, I was so used to lighting up when I typed that I couldn’t write a coherent sentence for weeks. Luckily, my editors understood and supported my desire to quit. To make the situation bearable, I made some concessions to reality. You may also find them useful.

Concession #1: Stop smoking, but don’t throw out the cigarettes

An about-to-be-ex-smoker’s worst nightmare is waking up at 4 a.m. without a cig in the house. At that point, resolve dissolves during a frantic search through every possible drawer and coat pocket in the house. Without the comforting thought that a cigarette is close at hand, should it be necessary, the willpower-challenged sort of ex-smoker may succumb to panic and rush to the corner gas station to buy — you guessed it — cigarettes!

To keep my own panic in check, I kept a pack of cigarettes in my purse for about two years, and I kept a pack in the back of my desk drawer for what turned out to be seven years. When I found the withered cigarettes by accident, seven years after I had stopped smoking, I was able toss them in the trash without a second’s hesitation.

Concession #2: Don’t promise more than you can deliver

When coworkers stopped at my office door to say, “Hey, I hear you’ve stopped smoking,” I would grin like a Cheshire cat and purr, “Well, at least for this morning,” or “this afternoon,” or whatever.

A lot of people consider this weak-willed. I call it telling the truth. I knew, for example, that I could make it through an hour, and then four hours, and then a morning, and then an afternoon, and then a day. But I really didn’t know what would happen after these increasingly longer periods of smoke-free time. By not saying “Never!” to the possibility of smoking again, I avoided setting myself up for a fall.

Concession #3: Don’t be a nag

Ex-smokers can be very annoying. It’s not their business if someone else wants to muck up his lungs or stink up her clothes. After you decide to stop smoking, let other people come to the same conclusion on their own. And don’t give up your smoking friends. The funny thing is that smokers may smell bad, but they’re often looser and more fun than nonsmokers.

Concession #4: Don’t sweat the small, guilty pleasures

Once in a while, when we’re out walking, my husband and I get a whiff of a pipe or a cigar. Our eyes sparkle. Our step quickens. And we follow that smoker for a couple of blocks, remembering. But we’ve never lit up — so far (see Concession #2).

Letting loose

After I stopped smoking, it was only a matter of time until my husband gave into my nagging. (I didn’t mean you shouldn’t nag your loved ones; just leave strangers alone.) Several years later, we received an assignment to write about a weekend at a honeymoon hotel. In the dining room, the seating plan was tables for eight. On the first night, the only open seats were at a smoking table. We agreed to sit there, and we had such a great time that we kept going back to sit with the smokers. (No, we didn’t smoke.)

The last morning, there were no open seats at our regular table, so we sat with the ex-smokers. What pills! They kept grabbing the butter and wouldn’t let us have it. Frankly, a discreet smoker’s cough would’ve been more welcome.

Applying effective medicines

For some people, the path to a smoke-free nirvana runs through a prescription, either for the antidepressant medication bupropion (formerly known as Wellbutrin; now known as Zyban) or the new nicotine-blocker varenicline (Chantix).

Anti-smoking medicine #1: Buproprion

In several well-controlled studies, buproprion (Zyban) alone, with no counsel- ing or other therapy, helped nearly 50 percent of the people who took it stay smoke free for seven weeks and aided roughly 23 percent of people in avoiding cigarettes for at least a year. These figures may not sound all that impressive, until you hear that only 4 to 7 percent of smokers who try to quit on their own are able to make it for a full year without cigarettes. As a result, in 1997, the Food and Drug Administration (FDA) approved buproprion as a stop-smoking aid.

Buproprion does have some potential adverse effects: upset stomach, head- ache, insomnia, irritability, and seizures in people with a history of seizure disorders. But the medicine also has an interesting benefit in addition to its ability to diminish cravings for a smoke. Smokers who kick the habit often gain weight in the process, but buproprion actually produces a slight weight loss. No smoking, no weight gain, and it’s covered by insurance? Glory, glory!

Anti-smoking medicine #2: Varenicline

When you smoke, the nicotine in your tobacco hooks onto receptors in your brain that tell the brain to release dopamine, a natural mood elevator. The newest anti-smoking med, varenicline (Chantix), approved by the FDA in the spring of 2006, is a chemical that clicks into place on these brain receptors, blocking nicotine so that smoking fails to produce its usual “high.” In double- blind studies (studies in which neither the researchers nor the subjects know what they are getting), varenicline enabled 44 percent of people who had been smokers for as long as 24 years to quit smoking after 12 weeks.

The most common side effects of varenicline are gastric upset (nausea, vomiting, intestinal gas, and constipation) and sleep disturbance (frequent waking and vivid dreams). The drug has not been approved for women who are pregnant, plan to be pregnant, or are nursing. In addition, this medicine may interact with anticoagulants (“blood thinners”), asthma medication, and insulin.

Get your nicotine here!

Smoking is both a chemical addiction and a psychological habit. By stopping smoking, you immediately break the psychological habit of putting a cigarette in your mouth. Nicotine replacement therapy (NRT) products help deal with the chemical addiction by delivering small doses of nicotine to your blood- stream to make up for what you give up when you quit cigarettes. They also help reduce your cig cravings by lessening common withdrawal symptoms such as irritability, headache, sleep disturbances, and fatigue.

Most cigarettes sold in the United States contain 10 milligrams (mg) of nico- tine each, delivering about 1 to 2 mg of nicotine per smoked cigarette — yes, you lose some nicotine because the cigarette burns down between puffs. The best way to use all nicotine replacements is to start at a dose equivalent to the number of cigarettes you smoke a day, and over each subsequent month, reduce the amount you use daily by either going to a lower concentration or fewer ingestions of nicotine. NRTs are often most successful when taken along with buproprion.

To get the best results from a NRT, start using your preferred method as soon as you quit smoking. You shouldn’t use any NRT for longer than three months. Some people find these products incredibly effective when used on their own; others may need the extra help that can come from counseling or participating in a smoking-cessation program with other people. And always check with your doctor before starting to use these products. Like all medicines, they (the NRTs) do have potential side effects and interactions.

Nicotine chewing gums

You don’t need a prescription to buy nicotine-replacement chewing gum, but you do need to be 18 or older. The manufacturers’ directions usually tell you to start with one tablet per hour. If you smoked fewer than 24 cigarettes a day, the 2-mg gum should be fine; people who smoked more may need the

4- mg dose. To get the most bang from your gum, avoid food and beverages for 15 minutes before chewing. (Some foods and beverages reduce the gum’s effect.)

If necessary, you can take an additional piece to tamp down a sudden craving, but you shouldn’t use more than 30 pieces of gum a day. And do remember to follow the directions when chewing the gum. You stick the wad between your lip and gum so that the nicotine makes its way into your system. If you forget to do that, the gum may make you queasy.

Transdermal patches

The nicotine patch is a medical device that delivers a constant amount of nicotine through your skin. Nicotine patches come in two versions: a 16-hour patch that you wear while you’re awake and a 24-hour patch for people who wake up craving a cigarette. The patch, which started life as a prescription drug, is now available over the counter.

But it’s always a good idea to check with your doctor before using it because, as the American Lung Association notes, potential side effects may include

� Headache, dizziness, and blurred vision

� Itchy or burning skin

� Sleep disturbance (vivid dreams)

� Upset stomach and diarrhea

When you remove your nicotine patch, dispose of it carefully and as directed. (The package comes with storage space for used patches.) Remember: Nicotine is a poison. The amount of nicotine in your discarded patches may be lethal for pets and small children.

Inhalers

The nicotine inhaler is a plastic cylinder that looks like a cigarette, but instead of tobacco, it contains a pressurized cartridge filled with nicotine mist. When you puff on the inhaler, the nicotine mist is absorbed through the mucous membrane lining your mouth and throat.

The inhaler is a prescription product, with a maximum dose of six cartridges a day. Ask your doctor about the inhaler’s risks and benefits, and be absolutely sure to read the instructions carefully before using this device.

Nasal sprays

You can take two spritzes from this pump bottle, one in each nostril, up to five times an hour. The spray delivers nicotine straight to the mucous mem- brane lining your nose, which lets the nicotine zip into your bloodstream faster than it does with gums, patches, or inhalers.

Like the inhaler, the spray is a prescription product. And, as with all nicotine- replacement therapies, you should read the patient insert to check out the possible side effects and drug interactions.

Comparing the alternatives

Table 9-4 briefly reviews the different types of nicotine-replacement products. All are available as generics and as brand-name meds. As with most drugs, you can count on the generics being equally effective at a lower price.

Modifying your behavior

When you decide to quit smoking, behavior modification programs can be a valuable tool in teaching you how to avoid or ignore the emotional and physi- cal triggers, such as anxiety or nicotine cravings, that tell you to light up.

Here are some suggestions:

� You can get your behavior-modification advice from a stop-smoking clinic or a stop-smoking book. As with every other step associated with quitting smoking, the best solution is the one that works for you.

For information about behavior-modification programs to help you quit smoking — and even good books on how to toss the tobacco — visit the American Lung Association (ALA) Web site at www.lungusa.org. The ALA has a ton of information to help you declare freedom from smoking.

� Don’t want to go through ALA? No problem. You can also call your local hospital, YMCA, or YWCA. At least one of these organizations is almost guaranteed to have a low-cost or maybe even free smoking-cessation program.

Hypnosis and acupuncture

Think of hypnosis and acupuncture therapies as effortless behavior modification. Someone else does the work — waving a magic hypnosis wand or sticking skinny needles in various parts of your body — and you reap the benefits.

Many hospitals have trained professional hypnotists and acupuncturists on staff, so one path to a reliable practitioner is through your doctor or local hospital.

Although no evidence shows that either hypnosis or acupuncture is any more effective at ending your smoking habit than the other stop-smoking therapies, both approaches do turn some smokers into ex-smokers. If you’re one of those people, hooray! If not, just pack up your bags and move on to another method. Just remember — no quitting on your quitting. Okay?

Future perfect

Today’s stop-smoking techniques aren’t perfect, so smarties around the world are always on the lookout for better ways to break the habit. This section covers two interesting works-in-progress.

Eating your way out of the cigarette pack

Believe it or not, in 2007, scientists at Duke University’s Nicotine Research Program in Durham, North Carolina, the very heart of tobacco-growing coun- try, reported that drinking milk and water or eating fruits and veggies seems to make tobacco taste yucky, while alcohol beverages, coffee, and meat have just the opposite effect.

Is this the way to a stop-smoking diet? Couldn’t hurt, according to program director Jed E. Rose, who recommends diet modification along with any standard stop-smoking stratagem you prefer.

Anticipating the quit-smoking vaccine

Wouldn’t it be nifty if you could just zip off to the doctor for an anti-smoking shot? Take heart: Dr. Dorothy Hatsukami and her colleagues at the University of Minnesota Medical School are working on it.

Their solution, reported in the November 2005 issue of the medical journal Clinical Pharmacology and Therapeutics, is a vaccine that enables your body to produce nicotine antibodies — teensy molecules that hook on to nicotine molecules to prevent them from making their way into your brain.

Volunteers given the experimental vaccine four times in one 26-week period were more likely to be able to stay away from cigarettes for 30 days without nasty withdrawal symptoms than those given a placebo (look-alike) injection. Both those who received the vaccine and those who received the placebo reported a similar incidence of mild or moderate side effects (headache, cough, or upper respiratory tract infection).

Hatsukami’s research is a work in progress. Keep your eyes peeled for more info.

Movie babes and butts

Many smokers lit up their first cigarettes because some movie star looked so darned cool smoking. Unfortunately, some of the great- est stars, such as John Wayne and Bogie, went to their untimely reward courtesy of that cool cig. Nonetheless, smoking is still a prominent silver-screen fixture. In Basic Instinct, Sharon Stone uttered this really great line: “What are they going to do, arrest me for smoking?” These days, in a lot of American cities, the answer is, “We could if we wanted to.”

Take the following quiz and match the star with the movie in which she lit up. And by the way, if you still think that smoking is sexy, imagine the poor hero who had to kiss the glamorous woman with the awful tobacco breath.

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Exercising Options to Control Your Cholesterol: How working out works cholesterol numbers down, Evaluating specific exercises, Counting your heartbeat and Getting with the right program.

Exercising Options to Control Your Cholesterol

In This Chapter

� How working out works cholesterol numbers down

� Evaluating specific exercises

� Counting your heartbeat

� Getting with the right program

Regular exercise is such an important part of a heart-healthy lifestyle that the authors of the Dietary Guidelines for Americans 2005 (U.S. Departments of Agriculture and Health and Human Services) put “Physical Activity” right before the info on every single type of food a healthy diet is likely to include.

According to the American Heart Association, exercise can alter your cholesterol levels, pushing up your HDLs (the “good” cholesterol) and pushing down the LDLs (the “bad” cholesterol). In other words, moving your bod is good for your heart.

This chapter presents tips on how to use exercise to help with controlling your cholesterol. Hey, isn’t that the title of this book? You bet.

Sweating the Definition: Exercise

Do you know what exercise is? That isn’t a trick question — really. When many people hear the word exercise, they think of things such as professional-level sports, a 10-mile run, or a hop-’til-you-drop celebrity work- out. But in reality, exercise is nothing more than simple movement.

If you’re not training for the Olympics, your favorite sport — golf, tennis, or even ping-pong — is good exercise. No, dusting the house is not good exercise, but if you get down on your knees and really scrub the floor or, as the American Heart Association (AHA) suggests, “vacuum vigorously,” that counts. (You can even clean to music to get a good rhythm going.)

Walking is also good exercise. No, let me revise that: Walking is a great exercise that moves virtually every part of your body. (Swing those arms! Shift those eyes from right to left! Turn that head!)

Of course, you may prefer riding a stationary bike in front of the TV, jogging a mile before or after work, dancing, mowing the lawn, or raking leaves — all of which come with the AHA seal of approval (as long as your doctor gives the green light).

You can estimate how effective an exercise is in two ways:

� By counting the calories you use up

� By counting your heartbeats while you’re doing the exercise

Counting calories

The more calories an exercise consumes, the harder you’re working. Table 8-1 classifies very light, light, moderate, and heavy activity by calorie count. Table 8-2 tells you approximately how many calories you burn by engaging in some specific activities for either 15 minutes or one hour.

The numbers in the first chart come from the U.S. Department of Agriculture. I found the numbers in the second chart in Fitness For Dummies, 3rd Edition, by Suzanne Schlosberg and Liz Neporent (Wiley), a terrific book for recover- ing couch potatoes who can’t tell a rowing machine from a washing machine.

Counting heartbeats

Aerobic, as in “aerobic exercise,” means “with air.” An aerobic exercise is an exercise that forces you to use oxygen, challenging your heart to beat faster and your lungs to breathe more deeply.

Exercises that use your big muscles — the ones in your legs, back, and chest — are the ones most likely to be aerobic. Walking, running, swimming, bicycling, and climbing up (not down) stairs are all aerobic exercises. When you do these exercises, your heartbeat begins to speed up. That’s good.

How fast should your heart be beating during exercise? Grab a piece of paper and a pencil and follow these three steps to find your “target range” for how fast your heart should beat while you’re exercising:

1. Subtract your age from 220.

The number you get is your estimated maximum heart rate. For example, Ellen is 27 years old. 220 – 27 = 193 (which means 193 beats per minute).

2. Divide that number by 2.

The number you get is the low point for your “target range.” In Ellen’s case, 193÷2 = 96.5. Oh, call it 97. The low point for Ellen’s target range is 97 beats per minute. If her heart is thumping out 97 beats per minute, she knows she’s not exerting herself to her fullest potential.

3. Multiply the original number by 0.85.

The number you get is the top boundary for your “target rate.” In Ellen’s case, 193 × 0.85 = 165. If her heartbeat hits 165 beats per minute while she’s working out, man, she knows she’s working out! If it goes higher than 165, she needs to slow it down.

To burn fat and receive heart-healthy benefits from exercising, you must reach — and hold — your personal target heartbeat range for at least 30 minutes, at least three times a week. (But only after checking in with your doctor.)

Pairing Exercise and . . .

Everybody knows that exercise makes your heart healthy. But here’s a fact to make it beat a bit faster: Regular exercise — even as little as a brisk 30-minute walk several times a week — also improves your cholesterol profile.

How about that? The same exercise regimen that strengthens your heart will

� Lower your total cholesterol

� Lower your low-density lipoproteins (LDLs) — the “bad” fat-and-protein particles that ferry cholesterol into your arteries

� Raise your high-density lipoproteins (HDLs) — the “good” fat-and-protein particles that carry cholesterol out of your body

How does exercise do all this good stuff? Nobody knows for sure. It may have something to do with exercise enabling your heart to pump extra oxygen- toting blood out into your body. Or it may not.

Either way, why look a gift horse — carrying lower total cholesterol, lower LDLs, and higher HDLs — in the mouth? Especially when he’s packing even more good stuff in his saddlebags (and getting rid of yours), such as the possibility that exercise may change your arteries so that they’re less susceptible to cholesterol damage.

CRP

C- reactive protein (CRP) — discussed in detail in Chapter 3 — is a compound in your blood that medical folks regard as an indicator of otherwise-invisible arterial inflammation.

Inflamed arteries have rough interior surfaces with many little nooks and crannies that may snag cholesterol particles as they float by. If that happens, the snagged cholesterol attracts other particles, eventually building the kind of plaque that blocks the artery and leads to a heart attack.

In 2002, data from a six-year study of 128 males in Finland ages 50 to 60 showed that those who engaged in even mild exercise, such as walking, reduced their CRP levels by 16 percent, suggesting that their arteries were healthier than before they began exercising.

By the way, the change even occurred in men who have a gene that increases their risk of blood clots.

Blood pressure

Blood pressure is the term used to describe the force exerted by your heart when it pushes blood out into your arteries. If your arteries are narrowed in any way, your heart must work harder to get blood out.

Exercise relaxes and dilates your blood vessels, lowering your risk of high blood pressure. Some research has suggested that exercise also widens blood vessels enough to allow a stray piece of cholesterol gunk to float on through rather than block the artery. Only a suggestion, but sure sounds good!

Triglycerides

Triglycerides are the most common fats found in food and the most common fats circulating through your blood. Having high triglyceride levels raises your risk of heart attack. Exercise lowers triglycerides, thus lowering your risk of heart attack. To find out more about triglycerides, check out Chapter 2.

Weight control

If you’re overweight, losing weight makes you look and feel better. It also lowers your total cholesterol and raises your HDLs.

Regular exercise is such an efficient weight loss technique that the American Society of Bariatric Physicians (the group of fine folks who treat weight disorders) considers a regular exercise plan the number one predictor for long- term weight stability.

In other words, you can lose weight by cutting calories, but according to the bariatric docs, you’ll lose pounds faster and keep them off longer if you exercise.

Exercise can also change your body shape — and not just by making your muscles bulge. For example, exercise can transform a person’s “fruit” shape from the round-in-the middle “apple” shape known to carry a higher risk of heart attack to a slimmer, trimmer . . . banana? Carrot? No, wait. That’s a vegetable. Well, you get the idea.

Your body

If you need a refresher course on the whole-body health benefits of exercise, stick around for the next few paragraphs. The short version is

� Exercise builds muscle.

� Your heart is a muscle.

� Exercise strengthens your heart.

When you exercise, your heart pumps out more blood. More blood means more oxygen to every part of your body. More oxygen means healthier body tissues. Keep exercising. Your heart is only one of the organs and systems that benefits from regular exercise.

Exercise also strengthens bones, revs up your brain, keeps your digestive system moving along, sharpens your immune system, and improves your mood.

To save time (yours) and space (the publisher’s), I’ve put all this good stuff into Table 8-3, which lists the various ways in which a regular exercise pro- gram tunes up your body and mind.

Riding the Stationary Bike into the Sunset

Did you wake up this morning and decide it’s time to exercise? Well, don’t just do something. Sit there! Yes, you heard me right. Untie your running shoes. Unzip your warm-up jacket. Brew yourself a cup of tea, coffee, or whatever, and relax in your favorite armchair while you carefully consider how to put together an exercise program that fits your individual needs.

Just keep in mind that you want to choose an exercise (or exercises) that works your muscles. Yoga, for example, is a wonderful relaxation technique, but — sorry about this — it won’t jump-start your heart or raise your HDLs.

The Web is totally jam-packed with special sites that offer balanced advice on exercise and its billions of benefits — well maybe not that many — for your body. To save you hours of surfing time, expand your universe by typing exercise sites into the search box of any search engine. Doing this often brings up one site with links to many other sites. How handy!

Table 8-4 shows several useful exercise and health sites. Wait! Did I mention you should always check with your own doctor before starting an exercise program? I think I did, but now I’m sure. It never hurts to be sure.

Checking with your medical mechanic

You wouldn’t take your car out for a 3,000-mile trip without a tune-up would you? For your body, starting a new exercise program is the equivalent of that multi-mile trip.

The first step on the way to a healthful exercise regimen should be an appointment with your doctor so he can run a basic body check. He may even want to do a stress test.

This caution clearly applies to anyone who’s already had a heart attack. But it’s also recommended for people who’ve never had even the slightest hint of heart trouble. Even if you are (or think you are) a healthy young person, this is one time when it’s definitely better to be safe than sorry.

Exercise is hard work, and you want to be sure your body can handle it with- out folding on you. Call your doctor first. No exceptions!

If you skipped this all-important step and headed straight for a health club or gym, turn right around and walk out of any facility that lets you sign up for an exercise program without first checking your vital signs.

Setting yourself up for success

An exercise program should make you feel good about the program and about yourself. If you choose a regimen that’s too strenuous, you’re apt to quit in the middle. Bummer.

Your exercise goal is to rev up your body and lower your cholesterol, not wear yourself to a frazzle in an unsuccessful attempt to qualify for the Olympic couch-potato-turned-pro-athlete team.

In other words, it’s A-okay to settle for the warm and fuzzy sense of well- being you get by stretching your muscles while walking a mile, riding a stationary bike, or once in a while picking up the pace to jog (if you really want to that is).

Here are a few helpful hints:

� Have realistic expectations. Rome wasn’t built in a day, and that new, fabulously healthy, lower-cholesterol body of yours won’t be either.

• Start small: If you’ve been sedentary for the last 15 years, you shouldn’t expect to sprint 3 miles a day out of the gate. Walk first and work up to a run; start with 1 mile and work your way up to the 3-mile plan.

• Give yourself time: Positive changes in your body won’t pop up overnight. Give yourself at least six months of effort to see notice- able change.

� Exercise some days, not every day. You intend to wake up every morn- ing at 5 a.m. and jog? Who — I mean whom — are you kidding? Set a more realistic goal of a jog every other day, and you’re more likely to stick to the schedule. By the way, the three-times-a-week rule comes from the American Heart Association. For the AHA — and you — three times can be the charm.

� Reward yourself. But not with a huge stack of pancakes drizzled in syrup when you get back from your morning run. Try other rewards like a new article of clothing, a plant, or a CD. If you prefer to indulge in food rewards, do so less often.

Choosing something you like

As the AHA puts it, choose “activities that are fun, not exhausting.” If you hate football, loathe jogging, despise aerobics, and can’t stand to get your hair wet in a pool, you won’t make it past the first week with an exercise regimen that includes these activities.

In other words, your aim is to find some kind of movement you actually enjoy — or at least one that fits into your normal daily routine. No one can tell you exactly what that exercise is — you know what you enjoy. What I can share with you is the assurance that anything that moves your muscles benefits your body.

If everything else fails to pass your “I like that” test, there’s always walking (briskly, that is).

Here are a few ideas to set the wheels in motion:

� Biking (streets, parks, hills, or flats)

� Hiking (meadows or mountains, doesn’t matter)

� Working out along with a TV fitness guru — start slow, work up

Sticking to a schedule

To get the most from your exercise, follow a consistent regimen of moderately intense movement for at least 30 minutes a day five days a week, if possible.

Okay, okay, three days a week. As I said before, the AHA says three days is okay, and even a recovering couch potato can remember Monday, Wednesday, and Friday. Try it: Monday — Wednesday — Friday. See?

Did you know that you don’t have to do all your exercise at once? You can break it up into two or three sessions during the day. For example, suppose you drive to work or take public transportation. Instead of driving all the way to the front door, park your car 15 minutes away from work and walk. Or get off the bus or train at a stop 15 minutes before your final destination and, yes, walk. Doing that twice a day equals (can you believe it?) 30 minutes of moderate-intensity exercise.

Don’t ya just love it when things work out the way they’re supposed to?

No pain, no gain? No way

“No pain, no gain” is an out-of-date, never-was-right slogan that deserves a decent burial once and for all. Pain means injury. Injury is bad for the body. Yes, the pros play with problems — after all, they’re playing for millions (dollars, not fans) — but that’s why so many of them end up hobbling around at a really tender age.

Avoid anything that requires you to twist yourself into a pretzel or perform activities that feel uncomfortable. True, stretching muscles that haven’t moved in heaven knows how long can leave you with some soreness, but if your exercise leaves you hobbling, you’re doing something wrong. This book is Controlling Cholesterol For Dummies, not Fitness For Dummies, so my best advice is that you seek guidance from a professional trainer or check out Fitness For Dummies, 3rd Edition, by Suzanne Schlosberg and Liz Neporent (Wiley), which also lays out rules for finding a trainer. Think of it as a two-fer bargain — and safe, sane, and sensible besides.

Rating an exercise program or gym

How can you tell if a fitness program or plan or video is right for you? That’s easy. The program fits your needs, which means

� It fits into your schedule (rather than forcing you to shift your life around to accommodate it).

� You’re comfortable with the exercise expertise required.

� The price is right.

Here are some examples of what can work for you:

� Group programs, such as an exercise class at the local YMCA/YWCA, are great for people with no talent as self-starters. They’re not so great for people who hate to play follow the leader.

� Individual trainers are great for folks who hate to leave the house (and can afford the trainer). They’re not so great for people who enjoy work- ing out in the company of others.

� Videotapes are a delight! You get to sit and watch someone else work up a sweat on TV. No, wait, that’s not how it’s supposed to work. If that’s what you’re doing, join a group or get a trainer. Of course, using a tape properly gives you the freedom to exercise at your own speed and on your own schedule.

If you go the videotape route, remember that being a TV sitcom star may not be the best training in the world for handling other people’s bodies. Any videotape you choose should have guides to exercise and skill levels printed on the box. A credit for an expert adviser is also good.

As for gyms and health clubs: No matter what type of program you choose, be sure to check out the instructor by taking in the diplomas on the wall. Preferably, your exercise guru should have a four-year college degree in exercise science or a related field.

Certification from a recognized group for fitness professionals such as these is also a really, really good recommendation:

� American Council on Exercise (ACE)

� American College of Sports Medicine (ACSM)

� National Academy of Sports Medicine (NASM)

� National Strength and Conditioning Association (NSCA)

Then, after you have your ducks in a row, start your engines. You may be mixing metaphors, but you’ll also be benefiting your heart — and optimizing your cholesterol. Pretty good, all around.

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Weighing Weight’s Weight on Cholesterol: Examining the risk of excess pounds, Determining who’s fat, Choosing a healthful weight and Listing exceptions to the weight/cholesterol rules.

Weighing Weight’s Weight on Cholesterol

In This Chapter

� Examining the risk of excess pounds

� Determining who’s fat

� Choosing a healthful weight

� Listing exceptions to the weight/cholesterol rules

Some Americans worry about global warming. Others suspect that the real threat to North America isn’t the rising temperature but the rising poundage of several hundred million well-padded citizens. If the trend continues, they say, the whole darned continent may soon sink. Okay, maybe that’s an exaggeration, but according to Health, United States 2006, the 30th edition of an annual Centers for Disease Control and Prevention report on trends in health stats:

� Compared to 1960/1962, the percentage of overweight American adults ages 20 to 74 remained pretty much the same in 2003/2004, but the percentage of obese adults rose from 13 percent to 34 percent.

� The percentage of overweight children ages 6 to 11 more than doubled between 1976/1980 and 2003/2004, rising from 7 percent to 19 percent. Among adolescents ages 12 to 19, the percentage of those who were overweight more than tripled, rising from 5 percent to 17 percent.

In Canada, where the percentage of obese adults nearly doubled between 1978/1979 and 2004, things are pretty much the same. Check out these factoids from Statistics Canada’s 1996/1997 to 2004/2005 National Population Health Survey:

� From 1996/1997 to 2004/2005, Canadian adults, men as well as women, grew steadily heavier. Every two years, younger adults ages 18 to 33 gained more weight than did adults ages 34 to 49. Adults ages 50 to 54 also gained, but they gained less than the younger folks.

� The average weight gain among adult men rose from 10 pounds in 1996/1997 to 11 pounds by 2004/2005. Among women, the average gain rose from 9.9 pounds to 10.5 pounds.

While all this extra weight may not tilt the planet, it may certainly be a predictor of health problems, especially for people who work to control their cholesterol, which, come to think of it, is pretty much the title of the book you hold in your hands.

Presenting the Health Risks Posed by Extra Pounds

Many people want to lose weight to look better. Others want to gain weight for the same reason. But reaching a healthful weight — and staying there — is more than a matter of vanity. It’s also about being healthy. Years and years of scientific studies and surveys have produced irrefutable evidence that excess pounds often equal higher risk of morbidity, doctor-speak for illness, and mortality, doctor-speak for you-know-what — the big D (d-e-a-t-h).

To be precise, the message from your good friends at the American Heart Association (AHA) is that being overweight raises your risk of five of the top-ten leading causes of death in the United States, Canada, and Europe:

� Cancer (some types)

� Diabetes

� High blood pressure

� Stroke

Wait! That list shows only four kinds of big trouble. The missing fifth item is, you guessed it, coronary heart disease, which you may know by its alias, heart attack. Table 7-1 lists several other weight-related problems that, although not in the big five, can certainly make you extremely uncomfortable.

Connecting cholesterol with weight

You don’t have to be enormously overweight to experience a connection between your higher weight and a higher risk of heart disease. Being as little as 20 percent over your suggested healthy weight — which I get to in a minute — raises your total cholesterol and your “bad” LDLs while lowering your “good” HDLs. (To brush up on this coronary alphabet soup, check out LDLs and HDLs in Chapter 2 and Chapter 3.)

But don’t despair. Losing weight reverses the equation. Diet and exercise away those extra pounds, and your not-so-hot LDLs will start to fall while your hot-stuff HDLs begin to rise.

Gaining is the same as losing in this arena

Toting around too many pounds is hard on your heart and blood vessels, but gaining weight is worse because it forces your body to adapt to new, stressful conditions. Think about it. When you gain weight, you make more tissue. The tissue needs oxygen, so you have to make more blood, which carries oxygen. The extra blood stretches the chambers of your heart, which must work harder to push the blood out into your body where the extra volume of blood stresses your blood vessels. Anyone hear a diagnosis of high blood pressure in the near future?

As a result, the AHA, which ¥’s your heart, wants you to know that simply preventing weight gain is the most important factor in preventing your cholesterol level from rising as you grow older. Imagine! As you grow older, not gaining weight keeps your cholesterol level in check more effectively than a low-fat diet, cholesterol-lowering drugs, or exercise. And you don’t have to go on a crash diet to see the benefits. According to the AHA, even a modest weight loss — say 5 to 10 percent of your total weight — lowers total cholesterol. Pretty encouraging stuff, huh?

By the way, several similar studies show that gaining weight also increases levels of triglycerides (check out Chapter 2), another risk factor for heart attacks. Hey, a two-for-one special: Controlling weight controls both your cholesterol and your triglycerides. What a bargain.

Figuring Out Who’s Fat

Up to this point in this chapter, I have used the word overweight seven times, but I haven’t defined it. So let me do that right now.

One way to decide whether someone’s overweight is to see what he or she looks like. Right? Wrong.

Actress Lillian Russell, the femme fatale during the late 19th and early 20th centuries, weighed in at a hefty 230 pounds. One hundred years later, Nicole Richie or Eva Longoria tips the scales at, oh, maybe, 98 pounds. Your great- grandparents would have rushed these skinny merinks (great-granny’s word for v-e-r-y thin) to the doctor for a weight-gain tonic. Today, it may be Russell whom people would want to ship off to the doctor.

Clearly, judging whether an individual is overweight or thin by appearance is subjective. It depends on who’s doing the lookin’ and the cultural standards that person applies. Conclusion: The eyeball test isn’t a reliable method for determining healthful weight. You need something a tad more scientific.

Luckily, modern nutrition offers some reasonably rational options to decide who’s overweight. These options include

� Body shape

� Weight charts

� Body composition

Evaluating body shape

All healthy adults have some body fat. Women generally have proportion- ately more body fat than men who, in turn, have proportionately more muscle tissue than women. Where a person stores the fat tissue he or she accumulates is gender-related. Men are most likely to pile excess fat around the middle (abdomen). The result is a body type called an “apple.” Women usually store excess fat around their hips, buttocks, and upper thighs, a pattern called a “pear.”

A more scientific name for the apple/pear shape descriptions is the waist/hip ratio, a measurement of the relative size of the waist and hips. To find your ratio, follow these steps:

1. Run a tape measure around your waist.

2. Run a tape measure around your hips.

3. Divide the measurement of your waist by the measurement of your hips.

For example: waist (29 inches) ÷ hips (39 inches) = a waist/hip ratio of 0.74

A woman whose waist/hip ratio is higher than 0.8 or a man whose waist/hip ratio is higher than 0.95 — both apple shape numbers — may be at higher risk of weight-related health problems, including heart attacks.

However, it’s only fair to point out that the BMI-plus-waist circumference described below is considered far more reliable than the apple/pear waist- to-hip ratio alone.

Charting a healthful weight

In 1990, the U.S. Department of Agriculture and Department of Health and Human Services included a weight chart in that year’s edition of the Dietary Guidelines for Americans:

� The new chart numbers were weight goals, not ideal weights.

� The weight goals were based on the entire population of the United States.

� The weight charts were unisex with a single set of weight goals for men and women of the same height.

� Best of all, the new weight goals were divided into two age groups — one set for people ages 19 to 34 and the other for people ages 35 and older.

Table 7-2 shows the 1990 Dietary Guidelines for Americans weight charts for adult men and women. People with small, lighter bones and proportionately more fat tissue than muscle tissue (fat weighs less than muscle) are likely to weigh in at the low end. People with large, heavier bones and proportionately more muscle than fat, are likely to weigh in at the high end. As a general (but by no means invariable) rule, women have smaller frames and less muscle than men, so they weigh less than men of the same height and age.

For ten years, weight charts remained fairly friendly and forgiving. Then boom! The Dietary Guidelines for Americans 2000 tossed out the higher weights for older people. As of the new millennium, the healthy weights for everyone, young or old, woman or man, were the weights for people between the ages of 19 and 34 from the 1990 Dietary Guidelines for Americans, which you can still find in Table 7-2. Pretty skinny thinking, if you ask me.

Then boom! — again. The Dietary Guidelines for Americans 2005 tossed out all weight tables in favor of the body mass index chart.

Indexing your mass

In 1990, just as the Dietary Guidelines for Americans published its pleasantly elastic two-tier weight chart, the National Heart, Lung, and Blood Institute introduced the first federal guidelines on how to identify, evaluate, and treat people with excess poundage.

The most interesting section was the introduction of a new weight measurement: body mass index (BMI). BMI is a unisex measure of weight relative to height, a number — such as 24 — that serves as a predictor of your risk for weight-related illnesses, such as diabetes, high blood pressure, heart disease, stroke, gallbladder disease, and arthritic pain. The higher your number, the higher your risk. So, what’s your number? Keep reading.

Calculating your BMI

The original equation used to calculate BMI was set up in kilograms for weight (W) and meters for height (H): BMI = W÷H2. But if you’re partial to pounds and inches, you can calculate BMI in pounds and inches as long as you add one extra step. The equation looks like this:

BMI = W÷H2 × 705

To get your own BMI, plug your numbers into the BMI equation. For example, if you’re 5'3" tall and weigh 138 pounds, the equation for your BMI looks like this:

BMI = W÷H2 × 705

[138÷(63 × 63)] × 705

(138÷3969) × 705

24.5

Hate math? Eyes glazing over? Just run your finger down Table 7-3, which does the math for men and women from 4'11" to 6'4" tall, starting with a weight of 91 pounds. To use the table, find your appropriate height in the column labeled Height. Move across to your weight. The number at the top of the table is the BMI at your height and weight.

Using BMI to predict health

Based on health statistics and death rates provided by the World Health Organization, the Centers for Disease Control and Prevention’s National Center for Health Statistics characterize the various categories of BMI as follows:

� Underweight: BMI lower than 18.5.

� Normal: BMI of 18.5 to 24.9. (A minimal risk of weight-related health problems.)

� Overweight: BMI of 25 to 29.9. (A moderate risk of weight-related health problems. For reference, BMI of 25 is about 10 percent over ideal body weight.)

� Obese: BMI of 30 to 39.9. (High risk of weight-related health problems.)

� Extremely obese: BMI over 40. (The highest risk of weight-related health problems.)

BMI is a valuable health predictor for most men and women between the ages of 19 and 70, but it’s not for everyone. BMI isn’t a reliable guide for the following:

� Women who are pregnant or nursing. Weight gain is temporary and does not reflect a true weight/height relationship.

� People who are very tall or very short.

� Professional athletes or weight trainers. Very muscular people, such as boxer Laila Ali or the great gang of guys at the World Wrestling Federation, can have a high BMI but not be fat.

Making Lifestyle Changes

The rules of the weight-loss road are fairly simple and entirely sensible. After you decide that you really do need to lose a little weight, the following list of do’s and don’ts can make life bearable — and less weighty.

Waist not

The size of your waist may affect the riskiness (or lack thereof) of your BMI. To get the relevant number, measure your waist circumference (the distance around your natural waist just above

the navel). If your BMI is higher than 25, a waist circumference equal to or higher than 35 inches for a woman or 40 inches for a man puts you into a “high risk” — that is, overweight — category.

Counting those dreaded calories

Repeat after me: A healthful weight-loss regimen isn’t a starvation diet. Keep these calorie requirements in mind when you’re working to lose weight:

� Women require a food plan that provides at least 1,200 calories a day.

Top limit for weight loss: 1,500 calories.

� Men require a food plan that provides at least 1,500 calories a day. Top limit for weight loss: 1,800 calories.

You probably noticed that I describe a totally unfair fact of life: Men and women — even when they’re exactly the same weight and height — require different amounts of calories to stay healthy. A man’s body has proportion- ately more muscle tissue than a woman’s body. Muscle tissue is “active” tissue that burns calories. Therefore, men need about 10 percent more calories each day, even when they’re losing weight.

Ingesting your daily vitamins and minerals

Your weight-loss food plan (have you noticed that I’m subtly substituting “food plan” for “diet?”) should provide all the essential nutrients. Exactly what nutrients you need and how much of them are spelled out in excruciat- ing detail in your copy of Nutrition For Dummies, 4th Edition (Wiley). (Don’t have one? Get one. I wrote it. It’s goooooood.)

Another good guide to vitamins and minerals is the ingredients label on any reputable brand of one-pill-a-day supplements. Or you can bookmark this page, turn to Chapter 16, and check out one of the totally excellent nutritional Web sites you find there.

Are you back? Good. I want to spend a minute covering why you should avoid fad diets, or as I like to label ’em, funny food plans. You know the ones I mean. These diets often base their recommendations on, oh, maybe one study, and it’s often a dubious one. Seventeen overweight hamsters in Ohio lost weight after three months on a diet of nothing but apricots, peaches, and clam juice. Here are a few ways to spot fad diets:

� These diets are never endorsed by reputable organizations such as the American Heart Association or the American Dietetic Association. Instead, they use testimonials from people who may mean well but have no real nutrition expertise (like the Northeastern Ohio Hamster Owners Association).

� The diet plans go against generally accepted nutritional advice. (I’m no hamster expert, but I’m guessing that these furry creatures need nutrients other than those supplied by apricots, peaches, and clam juice.)

30 + 30 = ??

The perfect example of a silly food plan is the one that promises to take off 30 pounds in 30 days, a formula chosen presumably because some months do have 30 days and the numbers sound good together.

According to the American Society of Bariatric Physicians (weight loss experts), this promise is an empty one because:

� To lose 1 pound of body weight, you must cut out 3,500 calories.

� To lose 30 pounds in 30 days, you must cut out 105,000 calories (30 × 3,500 calories =

105,000 calories).

� If you normally get 2,800 calories a day — more than most American women and

some men eat every day — you only take in 84,000 calories in 30 days.

� If you were to stop eating entirely for 30 days, you would still need to get rid of another 21,000 calories to reach the 105,000 mark.

Any volunteers?

Forget the pound a day business. A slow but steady loss of 5 pounds in that same 30-day period means cutting just 17,500 calories (5 × 3,500 calories = 17,500 calories). Divide 17,500 by 30, and you come up with 580 calories a day, a reduction most serious weight-loss programs can handle.

Now can I see a show of hands from volunteers?

Do yourself a favor. Fight fad diets. Who wants to eat 50 grapefruits a day anyway? You should be eating a variety of healthy, tasty foods while you’re eating less.

Making the menu marvelous

A healthful food plan, even one designed to take off pounds, includes many different foods. Yes, broccoli is packed with anti-cancer phytochemicals (com- pounds found naturally in plants), plus vitamin A, vitamin C, the heart- healthy B vitamin folate, carbohydrates, and dietary fiber. But man (and woman) can’t live by green florets alone.

Food variety is important to weight loss. Food is meant to be enjoyed — yes, even low-calorie food. When your weight-loss menu is interesting and tastes good, sticking to it is less of a chore. Besides, human beings are omnivores, which means they have digestive tracts equipped to handle foods from plants and animals. Although vegetarianism certainly can be a healthful choice, maybe even a moral one for folks who don’t want to consume animals, your body has the ability to metabolize and use all kinds of food: meat, dairy, grains, fruits, and veggies. Why not go for it?

Living happily ever after

Here’s one from the depressing-but-true file: Most people who take off weight put it back on again within three years. The only way to succeed at losing weight — which means taking it off and keeping it off — is to change your mind along with your menu. The goal isn’t a quick 10 pounds off your hips. The goal is a lifelong healthful weight.

To reach this goal, organizations such as the American Heart Association, the American Diabetes Association, and the American Dietetic Association, their international counterparts, and all the relevant governmental agencies across the globe offer pretty much the same prescription: Eat less, eat a variety of foods, get the nutrients you need, step up your exercise time, and take the time you need to lose pounds safely.

Boring? Yup. Sensible? Yup. A way to succeed? Without a doubt.

Tossing Out the Scales

Now that I’ve spent an entire chapter talking about weight and how weight gain may adversely affect your cholesterol levels and, by implication, your risk of heart disease, I’m slamming on the breaks. I’m going to reverse engines and back-peddle a bit to mention those special times when weight doesn’t seem to matter at all. The truth is that most people pick up pounds as they grow older, and many manage to stay healthy anyway.

One way to explain this seemingly odd situation among an older population is to suggest that people who’ve experienced weight-related illnesses have already gone to their reward. The ones left standing (or sitting) are older folks whose general health is so good that weight is irrelevant. A second possibility is that individual human beings really are individuals with unique bundles of genes and possibilities. Trying to make these unique individuals fit into strict, predictable categories is like trying to map the stars in the sky. It works, but only up to a point.

For example, the experts who invented BMI admit that its value in predicting weight-related health risks depends to some extent on age. In your 30s, a lower BMI is clearly linked to better health. In your 70s (and later), no convincing evidence supports the idea that BMI and/or weight itself makes a difference. In fact, some recent studies suggest that a higher BMI (below the obesity mark, of course) is protective for women of a certain age. In between, the relationship between BMI — or weight — and health is, well, in between — more important early on, less important later in life.

The inescapable conclusion? Human beings are more diverse and complicated than any weight and health charts. Case closed.

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