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Diet Myths

 Thin people are automatically healthier than fat people.

 A fat is a fat is a fat. All fat is equally damaging.

 Your ideal blood pressure is anything less than 140/90.

It doesn’t matter whether you’re just trying to shave a few inches from your waist or trying to morph your slushy belly into an ice-hard one, the fact remains: It’s hard to forget about body fat. You see it when you get dressed, get washed, and get jiggy You feel it when you sit down, when you walk upstairs, when you bend over to lick the last cake crumbs off the plate. And if you’re a person who’s struggled with weight for a lifetime, you likely stress about fat more than you stress about money, relationships, or anesthesia-free colonoscopies.

Fat is constantly right in our faces. And on our minds. And wrapped around our necks and arms. And hanging from our bellies, raining from our rears, and gyrating during twist contests. But you know what?

Oftentimes, we forget about fat. We eat a lot of food at one meal and go back to do it right again—because we don’t see the health risks in the same way we see a slightly larger chin in the mirror. Now that our digestive journey is over, and you’ve learned how fat is stored, it’s time to explore what that excess stored fat can do—to your heart, to your arteries, to your entire body.

Most of us assume that you have to be as skinny as a coaxial cable to be healthy, but the truth is that plenty of so-called thin people are less fit and less healthy than so-called heavy people. YOU-reka! That’s right: It’s actually better to be fat and have few risk factors for bad health than it is to be thin and have a high number of health-related risk factors. Now, that’s not to say we’re ordering a round of fried pickles for everyone. When all else is equal, carrying extra fat will more likely increase your risk of heart attacks, strokes, and diabetes. But our point is that we want you to stop thinking about pounds and pounds only; we’d rather you start thinking about the numbers that really matter—especially to your husbands, wives, children, parents, and friends. The real story of your body isn’t measured by scales or wolf whistles. It’s measured by your waist size—and what fat does inside your blood and arteries.

What Fat’s Got to Do with It

Here’s how many of us assess our health: If the pain’s not severe enough to call the paramedics, then we tough it out, go on our way, and write off most of our general feel-bad symptoms to fatigue, stress, age, or the jug of vanilla fudge we downed during CSI. The problem with that approach? You’re probably more in tune with the fall TV schedule than you are with your own body Of course, if you’re overweight, the extra fat is sure to manifest itself in some outward side effects like lack of energy or lack of self-esteem. But many of the risk factors associated with carrying too much fat don’t have any outward symptoms at all—meaning that the only way to tell whether being overweight is threatening your life is by taking a microscope underneath the flub and chub and focusing on what’s happening at your body’s most core levels.

Sure, you know that fat lives on your hips, but it also lives in your blood. If you were to take a vial of blood and let it sit (we don’t recommend doing this at home), you’d see a layer of clotty cream that would rise to the top of the vial, sort of like tiramisu. That’s fat. How did it get there? (Half credit if your answer was tiramisu.) It’s absorbed via your intestines. But the key player is the omentum. And why should we care about that organ that sounds like it’s missing the letter m? Because the omentum can store fat that is quickly accessible to the liver (meaning it can cause lousy cholesterol and triglyceride levels to rise) and also sucks insulin out of circulation (making your blood sugar rise)—meaning that this cream-converted fat sets up shop in the omentum and puts your organs within very close striking distance of a hammer.

See, fat is like real estate: it’s all about location, location, location. We all have three kinds of fat: fat in our bloodstream (called triglycerides), subcutaneous fat (which lies just underneath the skin’s surface), and that omentum fat. (The fourth fat, of course, is the fat in food). As you remember from the last chapter, the omentum is a fatty layer of tissue located inside the belly that hangs underneath the muscles in your stomach (it’s why some men with beer guts have hard-as-keg bellies—their fat is underneath the muscle).

Because this omentum fat is so close to your solid organs, it’s their best energy source. (Why go to the gas station on the other side of town when there’s a station at the next corner?) Think of the omentum fat as the obnoxious eighteen-wheeler on a crowded highway—elbowing out the stomach, pushing away other organs, and claiming all the space for itself (see Figure 5.1).

What’s most interesting—and encouraging—is that as soon as you make physiological changes to your omentum, your body starts seeing effects. That is, once your body senses it’s losing that fat, then your body’s blood-related numbers (cholesterol, blood pressure, blood sugar) start traveling in the healthy direction—within days, before you even notice any kind of physical sign of weight loss (especially when you consider that the size of your omentum is impossible to measure without a CT scan).

In addition, the fat released from the omentum travels to your liver rapidly and constantly as opposed to the more patient fat on your thighs. The processed material is then shipped to the arteries, where it is linked to health risks like high LDL (lousy) cholesterol. The other problem with omentum fat is that it secretes very little adiponectin, which is a stress- and inflammation-reducing chemical that’s related to the hunger-controlling hormone leptin. When you have less fat, you secrete more adiponectin, which produces a product that reduces inflammation. But more importantly, higher levels of adiponectin are related to lower levels of fat. So the more omentum fat you have, the less fat-regulating adiponectin you’ll produce. Those who have low levels of adiponectin have abdominal obesity, high blood pressure, high cholesterol, and other risk factors associated with coronary artery disease.

Those are the reasons why the fat in your thighs doesn’t matter as much to your health as does omentum fat (even if it matters for your bikini pride), and they help explain why omentum fat (or an “apple” body shape) is more harmful than subcutaneous fat (like thigh fat, which gives you a “pear” shape). Subcutaneous fat isn’t supplying a feeding tube to the rest of your vital internal organs, and it’s not messing up the levels of substances in your blood that are being supplied to your vital organs.

Figure 5.1 Belly Bully The omentum greedily bullies surrounding structures out of the way. The squished diaphragm and lungs make breathing difficult and the squashed kidney and its blood supply secrete hormones to raise the blood pressure in an effort to fight back.

FACTOID

Recent research shows that coffee doesn’t cause hypertension-but caffeinated sugar and diet drinks do. The reason? It may be the corn syrup or caramel coloring that’s responsible for the change. It’s something to keep in mind when considering caffeine as a potential waist-control drug.

The closer your waist is to ideal, the healthier your arteries and your immune system will be. The healthier your arterial and immune systems, the longer—and better—you’ll live. And the more energy you’ll have every day.

Highways to Health

Before you know what’s inside your arteries, you need to know how they’re structured—so you can see what kind of damage they can sustain and what kind they can’t. Made up of three layers, your arteries are the monorails of your body—they transport blood throughout your body and deliver nutrients to all of your organs (see Figure 5.2).

Inner layer: The innermost layer of your arteries (the intima) comes in contact with blood; it’s slippery like Teflon so blood can easily flow through. This normally smooth layer helps protect the muscular middle layer (the media) and is the layer most susceptible to attacks from outside sources.

Middle layer: The middle layer of your arteries supports the entire arterial structure by working a little like a hand squeezing a hose or a boa constrictor squeezing a neck. When you’re depressed or anxious, the layer can constrict, narrowing the amount of space where blood can flow through (the lumen). But it also has an advantage; it can release tension by dilating (the hand releasing the hose) to pull the Teflon layer outward and open up more space in the part of the artery where blood flows—say, when you exercise. When that happens, it allows more red cells, oxygen, and other nutrients through. You feel more energy when that layer functions like it did when you were nine years old.

Figure 5.2 Moving Through The artery has three layers—the inner to help blood move through the artery (intima), the outer (adventitia) to protect it from the outside, plus a middle, muscular layer (media). Damage to the inner layer hurts the tile-like layer of cells, injuring the delicate media layer.

Outer layer: The outer layer (the adventitia) shields the artery from the rest of your body like sausage casing; it holds the artery together from the outside.

Under normal circumstances, the inner layer is lined with delicate cells, and blood runs freely. Think of the structure as a tile wall—it’s a smooth wall made up of individual tiles connected together with little gaps throughout. In the tile wall, you have white gooey grout; in the artery, you have tight junctions holding the cells together.

Now, in your arteries, that wall will stay tight unless something comes along and starts chipping away at the junctions between those smooth cells. The most damaging tile buster—high blood pressure—is the arterial sledgehammer. But plenty of other pickaxes can chip away at the arterial lining: cholesterol, nicotine, high levels of blood sugar, stress, anger, and about forty other smaller risk factors, primarily stemming from lifestyle choices you make. The effect? They chip away and cause little nicks in the intima of your arteries, and those injuries trigger the anatomical starter’s pistol. As shown in Figure 5.3, the race to destroy—and repair—your arteries is on.

The Effects of Fat

For years, you’ve been used to looking down at a scale’s needle to determine your health. Wrong needle, bucko. What you need: a needle in the hands of someone who can draw your blood. With results from a simple blood test, you’ll find out what your current settings are and then be equipped with the data you need to take steps that will reset the settings to the factory originals.

Blood Pressure: These days, blood pressure machines are everywhere—at the pharmacy, in your gym, in mall kiosks. Even in Wal-Mart and McDonald’s. That’s good. Actually, it’s great. (Get your BP, hold the fries.)

Figure 5.3 Clog Jam Low-quality (LDL) cholesterol stimulates white blood cells to attack and the combatants are soaked up into the artery walls. The resulting toxic terrain creates rough patches, which are sealed off with platelets and blood clots that ultimately close off the artery completely and cause a blood-flow traffic jam—a heart attack.

Super HDL: The Future of Cholesterol Drugs

In a northern Italian village on Lake Garda, the villagers have low levels of HDL Science would tell us that, without high levels of the protective cholesterol-carrying protein, they should all be dying of coronary artery disease. But they aren’t. It turns out that these villagers have supercharged, Drano-like HDL (called apo-1a-Milano) to clear away the gunk from their arteries and allow blood to flow smoothly. This case study points to the next wave of cholesterol drugs: drugs that enhance HDL action to clear the bad LDL away, rather than those that work by lowering the LDL levels in the first place.

That’s because you need to track your blood pressure—your most crucial vital sign—even more diligently than Geraldo reacts to the news. High blood pressure still reigns as the leading cause of heart attack, stroke, heart failure, kidney failure, and impotence. While most of your other blood numbers reveal levels of substances inside your blood, your BP gauges how your blood travels through your body. Simply, blood pressure refers to the amount of force exerted by your blood on your arterial walls as it passes through. It’s measured through the systolic pressure (the pressure being exerted when the heart contracts; the top number) and the diastolic pressure (the pressure on your arteries when your heart is at rest).

Now, if the force of that pumping is too high, it’ll gouge holes in that smooth inner lining of your arteries (see Figure 5.4), causing those nicks in the tile wall that trigger a chain reaction of grouting, then destructive inflammation and clotting (which we’ll discuss in detail below). Think of it as the beating of a bongo. If you hit a bongo with your fingers, the drumhead will stay intact. But slug away with two baseball bats, and that bongo head will feel like a roach in an exterminator’s crosshairs. Your goal: Treat your arterial walls with a nice steady rhythm—let your blood tap tap tap them; not pound pound pound them. (Blood pressure fluctuates throughout the day; the goal is to have your total BP picture under control.)

Certainly, many factors can make your blood pressure soar higher than an Albert Pujols home run (stress, high levels of the mineral sodium, lack of the mineral calcium or potassium from not enough fruits and vegetables, lack of physical activity). But it’s also clear that being overweight leads directly to high blood pressure.

Figure 5.4 Pressure Situation With hypertension, the arteries squeeze down so tightly that the heart struggles to keep the blood moving forward. To compensate, the heart gets too thick, like a muscle-bound weight lifter. It becomes so stiff that it loses flexibility and can’t relax. If it can’t relax, blood has trouble traveling through the arteries, and the resulting high blood pressure damages the arteries.

This happens in part when the kidneys, squashed by fat, feign death unless they are fed with a higher blood pressure. (Your kidneys are the organ primarily responsible for regulating blood pressure.)

Luckily, you can reduce your blood pressure quickly and dramatically by addressing your waist issues. Losing 10 percent of the weight you’ve gained since you were eighteen (that’s only four pounds if you’ve gained forty) can result in a decrease of 7 mmHg (stands for millimeters of mercury to measure the partial pressure of a gas) from your systolic number and 4 mmHG from your diastolic one. The message is clear: Drop your waist and you’ll drop your BP.

Cholesterol: Hear the word cholesterol and you’re likely to think of eggs, heart attacks, and a mandate from your doctor. But cholesterol is part of your body’s arterial repair kit; it’s designed to help you, though it doesn’t always happen that way.

Let’s go back to those nicks in your arterial wall. Whether it’s BP, nicotine, or too many cheese curls that damage the wall, your body gets angrier than a cinched-up bull—because it doesn’t want the middle lining of the artery exposed to blood. So your body hires a handyman to patch up your nicks with grout, to cover the wounds in the inner lining.

What’s that grout? Cholesterol, but not just any ol’ cholesterol.

Your handyman—let’s call him Lester—carries two things: a bucket of grout and a spatula. The grout can come in the form of lousy cholesterol, which is carried by low-density lipoprotein (LDL). It’s big and puffy, and prone to breaking up and scattering bits of cholesterol when it hits the walls of the artery. When your LDL levels are too high to begin with (maybe from your diet or from your heredity), and then you nick the inner lining of one of your arteries, Lester goes crazy and slaps on more and more and more grout. He starts covering up the damage with the bad cholesterol—loads and loads of bad cholesterol.

But look inside Lester’s tool belt. He’s got a spatula that takes premium-grade grout in the form of cholesterol carried on high-density lipoprotein (it’s the healthy HDL cholesterol). Compact and powerful, the spatula works with this slick stuff to take the extra gunk away.

Now, if you have too much of that LDL grout (this can be familial but is primarily a result of eating the wrong kinds of foods—simple sugars and fats—and especially too much food) and not enough premium-version HDL grout (from not eating enough of the right kinds of foods and fats, not getting enough physical activity, or not having enough female hormones—yes, even men have them), it can lead to a chain of events that has potentially heart-stopping outcomes. We’ll call it fat’s domino effect.

Domino 1: Having too much bad cholesterol not only means you’ll have too much junk (plaque) in your arteries. It also means that LDL cholesterol will get into the middle layer of your artery. That cholesterol in the middle layer acts like a drunk fan with courtside seats, making the environment much more hostile than it’s used to being. The presence of LDL cholesterol in that middle layer stimulates the immune system to attract white-cell protectors to try to smooth out and calm down the rotten cholesterol.

Domino 2: Those white blood cells, in turn, spill some of their toxic contents that normally attack infections—and that causes generalized inflammation.

Domino 3: The toxic contents and cholesterol are soaked up by scavenger cells, building up blister-sized spaces in the walls of your arteries. They’re called foam cells—and they increase the size of the plaque, or grout, even more to make the artery surface rougher.

Domino 4: Sensing something’s wrong, your body responds with more inflammation, creating bulges and potholes in the wall, often in the area of weakness, where the initial nick was and a scar was trying to form over the dangerous plaque. If that plaque ruptures into the middle of your blood vessel, the next domino falls.

Domino 5: These rough patches in the wall then attract sticky blood platelets to form clots in your arteries. Normally, platelets are good (they help form scabs to heal wounds). But when they hit that rough patch in your arterial wall, they grab the lining and form a big clot on top of irritated, inflamed plaque. And this brings in more clotting proteins to the area that act to cement the platelets in place.

Domino 6: All of this gunk piles up faster and faster, and the inside of the arteries becomes so inflamed that the platelets and clots fill the entire artery. YOU-reka! This ruptured plaque process take minutes rather than decades, so you can influence its likelihood today by making the right choices about food.

Domino 7: The blood can’t get through the artery, and nourishment to the heart is shut off.

Game Over: The chain reaction triggers a heart attack (or, depending where the process happens, causes a stroke, memory loss, impotence, wrinkled skin, or any number of health problems that happen when blood flow malfunctions).

As you can see, it’s not the cholesterol by itself that’s so bad; it’s not having high enough levels of healthy and/or low enough lousy cholesterol to thwart the process before it even begins. And it’s not doing things like normalizing your blood pressure and blood sugar to help decrease the chance of developing nicks in the first place.

While genetics dictates some of your cholesterol level, your physical activity levels and poor foods choices—trans and saturated fats, simple sugar, and too many calories—really dictate whether Lester carries the right amount and kind of grout or moves the spatula fast enough to make for a nice, clean wall.

Blood Sugar: Yep, we know how it is. You don’t have diabetes, so you’re going to blow off thinking about blood sugar faster than a flight attendant blows off a flirty coach passenger. And that would be a mistake. Blood sugar is another substance that can nick your arteries if levels are too high. You may think your level is normal, but most blood sugar levels are recorded when you’ve fasted. Having “normal” levels for fasting (under 100 milligrams per deciliter, abbreviated 100 mg/dl) and for after meals (under 140 mg/dl) is important. Why? Because there’s a good chance that even with normal blood sugar levels, your blood sugar may rise significantly throughout the day as you eat. Studies show that men with a waist of 40 inches or more have twelve times the risk of getting diabetes compared with men with a waist smaller than 35 inches. For women, having a 37-inch waist is that much riskier than having a 32½-incher. (The most sensitive way to diagnose diabetes is to measure the blood sugar fasting, and again two hours after taking 75 grams of sugar—to see how your body can deal with the sugar.)

Many people think that diabetes is a purely genetic disease, and of course, it sure would be nice to blame Aunt Mabel for the medical condition, but it doesn’t quite work that way. For type 2 diabetes (type 1 is the juvenile form), your environment (that is, your lifestyle, your behaviors, your macaroons) is a much more dominant trait than genetics.

Yes, type 2 diabetes is a genetic disease. That is, if you are a twin and have an identical twin who gets type 2 diabetes, you have the genetics for it. And it’s a tough disease, too: Diabetes ages you one and a half years for every year you live. For example, if you get it at age thirty and live to sixty, you’re not really sixty. You have the energy and disability risks of a seventy-five-year-old.

Here’s how it works (see Figure 5.5): Insulin in your blood normally takes sugar and puts it into the cells, but in people with type 2 diabetes, the transfer of sugar into your muscle and fat cells is inhibited. While nice in coffee, that sugar in your blood chips away at your arterial wall by weakening the junctions between cells that form the surface lining of your arteries. Ultimately it allows holes to form in these junctions. By causing your insulin levels to go haywire and making proteins in your body less effective, sugar really behaves like nutritional cocaine.

Omentum fat (belly fat) contributes to type 2 diabetes by making it difficult to get glucose inside the cell and let insulin do what it does best: deliver glucose. Simply being overweight, especially having a waist greater than 37 inches (85 centimeters) for women and 40 inches (100 centimeters) for men, makes your body less sensitive to insulin; the insulin receptors on the cells don’t allow insulin to transmit the message enabling glucose transport into the cells, leaving the glucose to float around in your blood. That omentum fat is also selfish; it uses up the insulin so it can’t do its job (one study shows omentum fat sucks up a quarter of the insulin that passes through the blood supply).

Figure 5.5 Carried Away Resistance to the normal effects of insulin makes cells resistant to taking in glucose (sugar). This forces excess glucose to stay in the blood vessels, where it acts like debris to damage the Teflon-like surface of our inner roads. Cholesterol trucks bounce around and spill junk that ruins our blood highways.

FACTOID

Talk about being thick-skinned: One early sign of insulin resistance in a few people is the appearance of a brown, thick, velvety patch of skin behind your neck. This condition-called acanthosis nigricans-is an early sign of metabolic syndrome, which is associated with high blood pressure plus elevated levels of blood lipids and blood sugar.

So your blood sugar level remains high because the sugar isn’t being admitted to your cells readily and thus isn’t broken down properly, meaning that sugar will hang out in your blood like a truant skipping school and causing mischief.

So what? Well, having too much sugar in your blood is like having too much rain in a small pond—the flooding can cause damage for everything around it. Too much blood sugar can:

 Weaken the junctions between those smooth endothelial cells lining your arteries, making the Teflon-like lining more vulnerable to nicks.

 Increase the power of the hammer, to cause high blood pressure. (Sugar turns the hammer into a sledgehammer.)

 Cause your white blood cells to stop fighting infections, thus weakening your immune system.

 Trigger a chemical process in your red blood cells, which transport oxygen in your bloodstream, that causes the cells to want to hold onto oxygen more tightly. That keeps oxygen from getting to your tissues. When that happens, the glucose, like a lost puppy, attaches to whatever it can find—most likely, proteins in your blood and tissues. These proteins deposit in tissues, leading to the development of cataracts, joint abnormalities, and lung problems.

 Get into your nerves and cause a reaction that makes your nerves swell, become compressed, and lose their ability to function—usually in the parts of your body farthest from your brain: your hands and feet.

 Flip off a switch in your small blood vessels. Normally your body automatically regulates the flow of nutrients into your small blood vessels. They sort of work on backup (like a generator for when the power goes out), so they can function even when your big vessels might be experiencing problems. But high levels of glucose turn off that automatic regulation—and let a little high blood pressure make more of those nicks and tears in the junctions between cells in your smaller blood vessels. This is like asking someone to use a sledgehammer to do the job of a jeweler’s tool; it magnifies that effect and magnifies the size of the nick.

FACTOID

Monosodium glutamate (MSG), the additive found in many Chinese foods, may play a role in messing up the body’s metabolic systems. A taste enhancer, MSG is used to overstimulate (some say poison) the glutamine receptors of the brain, so we sense salt and sweets more (but not bitter and sour tastes, interestingly). The downside? That may cause us to eat more and to have higher insulin levels.

But here’s the thing. You can control your genes if you want to. To keep blood sugar levels down, you should avoid foods with simple sugar and lousy aging fats (trans and saturated fats). And about 1,000 calories’ worth of activity a week—about thirty minutes of walking a day and twenty minutes of the YOU Workout three days a week—causes your muscles to be so much more sensitive to insulin, which allows sugar to do its duty inside your cells, rather than cause havoc in your bloodstream. A little physical activity goes a long way.

Arterial Inflammation: When we think of our arteries and what can damage them, we tend to think of that clog: the hunk of junk that stops the flow of blood like a lemon seed in a straw. If there’s a roadblock in the way, then there’s no way for traffic to move through. But that’s only one mechanism for closing off blood flow. The other occurs through the process of inflammation. Typically, inflammation in our bodies makes us think of things that swell out—like a sprained ankle, or swollen gums, or the shiner from the 2 a.m. bar brawl. But when it comes to arterial inflammation, you have to think about swelling in. In response to all that clotting action we talked about with LDL cholesterol, inflammation occurs in the middle layer of your arteries. As the middle layer swells, it pushes into the inner layer because the outer sausage layer doesn’t give. That pushing into the inner layer reduces the size of the hole that blood can travel through (like drinking with a thinner straw). One of the ways we determine potential cardiovascular risks is by measuring chemicals in the blood that signal inflammation. C-reactive protein (CRP) is one such chemical; elevated CRP indicates an inflammatory reaction somewhere in your body, from a sinus infection to gum inflammation. If it’s high, your risk of heart disease is greater, because any significant inflammation in your body increases inflammation in your blood vessels.

Fat Chance: The Other Major Risks

We’re not here to lecture you and pummel you with brochurelike statistics about health risks. But to put fat in perspective, remember that it’s an all-body risk factor—with implications everywhere. Even if your numbers in some health categories are as perfect as a Michelle Kwan triple toe loop, you’re not risk-free. Being overweight or obese leads to the following:

Higher Risk of Cancer: The inflammation resulting from omentum fat also causes dysfunction in the system that protects you from cancer. In fact, there’s a direct correlation between waist size and an increased risk of hormonally sensitive tumors, such as breast cancer in women and prostate cancer in men. Fat contains an enzyme, aromatase, which converts adrenal hormones into a long-acting kind of estrogen, which can cause increased breast cancer risk.

Higher Risk of Sleep Apnea: Fat around your waist correlates with a thick neck, and that can obstruct your breathing (you’re at higher risk if your neck size is more than seventeen inches). In its benign form—snoring—you can still move air through your throat, but generate a kazoo sound that violates OSHA requirements and can cause permanent hearing loss and marital strife. In some cases, that obstruction worsens, until eventually no air can pass into the lungs for up to ten seconds at a time (see Figure 5.6). Fortunately, the body instinctively awakens prior to suffocation. As you get older, the tissue in your throat softens, and the area around your tonsils attracts fat. When you’re asleep, and your muscles fully relax, the tissue collapses, so there’s even less room in the back of your throat.

Sleep apnea makes you miss out on deep, restorative REM sleep. This leads to frequent awakenings at night (though your spouse may know it, you’ll probably never feel yourself waking), lack of sleep, and daytime drowsiness. You’re more likely to develop nick-causing high blood pressure (caused when your lungs hang onto carbon dioxide when you stop breathing) and, the bitter irony, you’re more likely to get fatter because of it. That’s because sleep apnea is like a series of rear-end collisions—one accident after another. The lack of sleep makes you tired. You feel like you need more energy. You eat foods that give you quick energy but also have high sugar and fat. You get fatter. You continue to have sleep apnea. And the cycle continues. (As an incentive to embrace a good eating plan, most people will lose fat first in their faces and throats; so with a waist reduction of a few inches you’ll probably be able to prevent or reduce these sleep problems by 30 percent early in your program.)

Figure 5.6 Bottle Neck Fat in the throat contributes to sleep apnea. In this condition, the airway is cut off during sleep, and breathing can stop for up to ten seconds at a time throughout the night.

Higher Risk of Joint Problems: While strong, your joints are like parents trying to squash constant whining; they can take only so much before they break down. Your knees are some of the most powerful joints in your body because you use them to both push off and absorb force. But they’re also prone to wear and tear if they have to carry a heavier load (that is, more fat in your body) than they’re designed to. When you gain ten pounds of body weight, it feels more like a thirty-pound weight to your knees while you’re walking. When you walk upstairs, the ten pounds of fat feel like seventy pounds to your knee joint. That extra weight makes you more vulnerable to developing joint-deteriorating conditions like osteoarthritis, which occurs when your joints get nicks in their smooth cartilage from bearing a load they’re not designed to carry.

When you reduce your omentum fat and your waist size, you’ll automatically reduce your risk in so many areas of your health. Even better, you’ll have the potential to see dramatic reductions in risk factors. YOU-reka! When overweight people (with an average weight of 225 pounds) lose about 7.5 percent of their body weight (about 17 pounds or four inches of waist size), they improve their HDL and LDL cholesterol levels, BP, and blood sugar numbers by—get this—20 percent. That’s nearly three times the benefit compared with percentage weight loss. Take the following steps to help you get there in terms of both inches and risk factors.

YOU TIPS!

Know Your Fats. Fat in foods, like bosses, comes in two broad categories: those that are good for your well-being and those that want you to suffer. The strongest influence you can have on your levels of cholesterol (not to mention your waist size) is by watching what fats you’re eating and what fats you’re banishing from your life and your gut. Above all, you want to avoid saturated and trans fats; a serving size should have no more than 4 grams of those two villains combined. They’re the foods most associated with long-term weight gain and clogging your arteries. Essentially, bad fats are ones that are solid at room temperature: animal fat, butter, stick margarine, lard. Trans fat contains cross-linked hydrogen bonds, which make it stable for long periods of time at room temperature. Eating trans fat leads to abnormalities in cholesterol (decreasing your good and increasing your bad), as well as increasing inflammation and damaging your arterial cells, which makes you more prone to clotting. (By the way, trans fat was originally designed for candle wax, but the market died with the advent of electricity.) The value of trans fats is that they have a long shelf life; the average food manufacturer would love to make foods with healthy fats if they could have the one-year shelf life that they can get from the unhealthy fats. The good fats, by contrast are the ones that are liquid at room temperature but get thick when they get cold, like olive oil. They help raise your HDL levels to clear away the guck. Far more important than the calories of fat are what fatty acids \can do to your cell functions, and how they influence arterial function and inflammation.

Super (Youthful) Fats: Facilitate Spatula Action

Stupid (Aging) Fats: Cause the Clogs, Clump Up the Spatula

Monounsaturated Fats. They come in two forms: omega-3 fatty acids and omega-6 fatty acids, in the form of fish (3s) and nut oils (3s and 6s). The omega-3s have been shown to improve arterial and brain function. They’re found in olive oil, canola oil, fish oils, flaxseeds, avocados, and nuts (especially walnuts). They’ve also been shown to reduce blood pressure and lipid levels when used in place of carbohydrates. Bottom line: Make about 30 percent to 40 percent of your fats the monounsaturated variety.

Trans Fat. This is the fat that contains hydrogenated vegetable oil. It’s the worst kind of fat and will stunt weight-loss efforts. Trans-fatty acids are in all kinds of food—especially when long shelf life is important—from buttered popcorn and cookies to chips and margarine. Bottom line: Say no. Stay away from them the way you’d avoid highways on the day before Thanksgiving. Clog city.

Polyunsaturated Fats. These are like monounsaturated except that they contain more than one unsaturated bond. They are usually present in vegetable oils and sesame oils. They may improve arterial and brain function, and will help keep up your satiety levels. Bottom line: Make 20 percent to 40 percent of your fats polyunsaturated.

Saturated Fats. Found in meats and dairy products, these fats will make you gain weight and clog your arteries. Bottom line: Limit saturated fat to lean sources like lean cuts of beef and low-fat dairy products. Aim for less than 4 grams of saturated fat per serving. Less than 20 grams, or less than 30 percent of your daily allotment, should be from saturated and/or trans fats combined.

Note: The best oil to have in your home is extra-virgin olive oil or organic (or cold-press) canola oil. For cooking, you can also use sesame or peanut oil. That’s because their smoking point-that is, the temperature at which the fat burns-is very high. Cook beyond it and you’ll end up with a burned, charcoal flavor. Once heated, oils can become rancid and also can generate toxic chemicals, so you lose the major benefit of eating these usually healthy foods. Also, it’s best to cook the food, rather than the oil. So don’t heat the oil directly in the pan; instead, roll your food in the oil first and then heat the food so the oil doesn’t become overheated.

Here are smoke points (in Fahrenheit) for some commonly used healthy oils:

Unrefined canola oil: 225°

Unrefined sunflower oil: 225°

Extra-virgin olive oil: 320°

Virgin olive oil: 420°

Sesame oil: 410°

Grape-seed oil: 420°

Refined peanut oil: 450°

Semirefined sesame oil: 450°

Clear It All Up. More and more evidence is showing that clog-free living is correlated with raising your amount of HDL to thwart the clot-triggering process. By raising your HDL, you increase the amount of healthy cholesterol that’s available to clear away the lousy cholesterol. Things that have been shown to effectively raise HDL include:

 Consuming healthy fats found in olive oil, fish, avocados, and walnuts.

 Walking or doing any physical activity for at least thirty minutes a day-no excuses.

 Taking niacin. Take 100 milligrams four times a day. Regular (and OTC) niacin is much cheaper than prescription niacin, and there seems to be a beneficial effect of extended-release doses. Sometimes higher doses are needed, in which case your doctor needs to peek at your liver function to ensure that you avoid the uncommon toxicity. To reduce flushing (feeling hot and light-headed), take an aspirin a half hour ahead of time and take the niacin as you go to bed. Do not increase the dose above this level without talking to your doctor, and check with your doctor before using niacin at any dose if you have a history of liver problems.

 Taking vitamin B5 (pantothenic acid). We recommend a dose of 300 milligrams a day to decrease LDL and raise HDL with no side effects yet known.

 Having one drink of alcohol every night. You should not be drinking just to get your HDL up, but if you do drink alcohol, stick to one drink, and you may see some small beneficial effects.

 Substituting protein or monounsaturated fat in place of carbs. Recent research suggests that this can help reduce BP and modify lipid levels.

Just Say Yes to This Drug. If there were one magic pill for fighting fat and saving lives, the pharmaceutical industry would send everyone from scale makers to diet-book authors into bankruptcy. There’s no pill that will do it all. (At least not yet. More on drug solutions in the appendix.) But that doesn’t mean you can’t use drugs to improve your health and reduce your cardiovascular risk factors. Our recommendation-and the closest thing to a pill with mystical powers-comes in the form of two baby aspirin (162 milligrams total) a day. You need two rather than one, since many folks are resistant to the lower dose. (There is no measurable increased risk of stomach problems in studies with this small increase in doses from 81 milligrams to 162 milligrams, and the reduction in heart attacks or ischemic strokes goes from around 13 percent to around 36 percent.) Aspirin makes platelets less sticky and decreases inflammation that occurs to narrow the space where blood flows through your arteries. And it’s been shown to reduce arterial aging and immune system aging, and that means decreasing your risk of everything from heart attack, strokes, and impotence to colon, rectal, and esophageal cancers, and maybe even breast and prostate cancers. To reduce the gastric side effects, drink a half glass of warm water before and after taking the pill. (See your doc if you have any history of serious bleeding, are taking blood thinners, or do extreme sports.)

Have Regular Readings. Not just with your book club or by an astrologer. These regular readings are about tracking your health numbers. Instead of measuring your success through the scale, the real measurement-and test-of your success is seeing whether you’ve reduced your cardiovascular risk, as evidenced in the following test readings:

Blood Pressure: Optimum level is 115/76. Blood pressure readings can be variable, so have your BP taken in the morning, during the day, and at night, as part of your normal activities (except for thirty minutes after exercise, when it will naturally be higher). Take the average of three readings to come up with your base number. After that, take readings every month to help you monitor your progress. (If BP is high, then you can track it daily.)

Lipid Profile Blood Test: Have one now to establish your baseline measurement, then have your blood analyzed every other year so that you and your doctor can watch changes and make appropriate adjustments to your eating and/or drug plan.

HDL (healthy) cholesterol: You’re at a low risk if your HDL is greater than 40 mg/dl. But like basketball players, the higher the better. In fact, if your HDL is over 100 mg/dl, the chances of heaving a heart attack or stroke related to lack of blood flow are smaller than the chance that a Hollywood celeb could walk through Boise unnoticed. (Except in some extremely rare cases where HDL malfunctions inside the body, there has never been a heart attack or stroke due to lack of blood flow reported in the entire medical literature in a person with a functional HDL over 100).

LDL (lousy) cholesterol: You’re at a low risk if your LDL is less than 100 mg/dl. By the way, research shows that for all women, and for men over sixty-five years old, the LDL number isn’t nearly as important as the HDL. So women and men over sixty-five don’t need to obsess too much over LDL levels unless their HDL levels are too low.

Fasting blood sugar: Below 100 mg/dl.

C-reactive protein: Below 1 mg/dl.

Get a Lift. Muscle isn’t just for football players, bouncers, and souped-up cars. Everyone benefits from adding some muscle to his or her body; in fact, adding some muscle will help lower your levels of blood sugar. The more muscle you have, the more you increase insulin receptivity—that is, the process by which insulin transports glucose into your cells. If you gain muscle and lose weight you change the chemistry of your cell membranes so that you absorb more glucose throughout your body rather than having it stay in your blood. You add muscle by doing strength exercises (more coming up in the YOU Workout).

Stop Freebasing Sugar. One thing that causes blood sugar to spike is, uh, sugar. That is, straight pure sugar-not eaten with any other substances like fat or protein around it. Though we recommend eating as few simple sugars as possible, if you do eat them, you should always be sure not to eat that candy bar or cookie dough by itself. Have a handful of nuts or some olive oil with bread first; that slows your stomach from emptying and will keep sugar levels from creating a pyrotechnical effect in your blood.

Go Chrome. Chromium, a mineral found in a variety of foods (especially mushrooms), seems to help control blood sugar. Taking 200 micrograms a day of the supplement chromium picolinate can help aid the uptake of insulin, to help your cells use blood sugar for fuel. Though the studies aren’t definitive at this point we recommend the supplement for waist-and blood sugar-control. Chromium increases your cells’ sensitivity to insulin and is depleted by refined sugars, white flour, and lack of exercise. One study showed users lost four pounds over ten weeks compared with no pounds in a control group. You should take it with magnesium, which reduces low-grade inflammation that can be associated with insulin resistance. A dose of 600 micrograms of chromium has been shown to be effective for those with type 2 diabetes, but for others, stick to the recommended dose of 200 micrograms. Just because a little is good doesn’t mean that taking a lot more is better. Taking too much chromium can hurt your kidneys.

Become Sensitive. Here’s a tantalizing observation: Cinnamon (with an m, not a b)seems to have an insulinlike effect, enhancing the satiety center in your brain while also reducing blood sugar and cholesterol levels. Just a half teaspoon a day can have some effect. Sprinkle it in cereal or on toast or add it to a smoothie.

Get in the Zone. Studies show that meditation has a statistically significant reduction of risk factors for coronary heart disease, such as blood pressure and insulin resistance. Find a quiet room, take a few minutes, close your eyes, and focus on one healthy word or phrase, like “om” (or “omega-3 fatty acids”).

YOU Test

Hey There, Good Looking, Can I Get Your Number?

In most cases, like a bike fall or a noodle-size hangnail, seeing your blood is not a good thing. But for our purposes, you need to look deep inside your blood to get an assessment of the effect of the extra weight you’re carrying. That’s where you’ll find all the numbers that indicate the risks that may be associated with carrying extra weight. If you don’t know these numbers, see your doctor for your latest blood results or request a blood test from your primary-care physician.

 Blood Pressure: _______(Measures the force of blood being pumped through your arteries. Ideal is 115/76)

 HDL Cholesterol: _______(Measures the amount of good clog-clearing cholesterol in your blood. Greater than 40 mg/dl is acceptable. And you’ve hit the lottery if you’re above 60 mg/dl.)

 LDL Cholesterol: _______(Measures the amount of bad clog-forming cholesterol in your blood. Ideal is less than 100 mg/dl if you have any risk factors of heart disease, or 130 gm/dl if you are otherwise healthy as a horse and your ancestors never suffered heart disease.)

 C-Reactive Protein: _______(Measures levels of inflammation in blood vessels, a marker for many types of diseases. Ideal in most labs is less than 1 mg/dl.)