Abs Diet

Definition

    The Abs diet is a six-week plan that combines nutrition and exercise. It emphasizes 12 power foods that are the staples of the diet. It focuses on building muscle through strength training, aerobic exercises, and a dietary balance of proteins, carbohydrates, and fat. An updated version of the diet (the New Abs Diet) was released in 2010, and there is also a version targeted for women.

Origins

    David Zinczenko, editor of Men's Health, developed the diet in 2004. He introduced it in the magazine and in his book The Abs Diet: The Six-Week Plan to Flatten Your Stomach and Keep You Lean for Life. Zinczenko says he grew up as an overweight child and by age 14 was 5 ft. 10 in. (1.8 m) tall and weighed 212 lb. (96 kg). He learned about fitness while in the U.S. Naval Reserve and nutrition from his tenure at Men's Health.

    Despite its name, the diet does not specifically target abdominal fat. Exercise helps the body burn excess fat but it is not possible to target specific areas of fat, such as the abdomen. Diet and exercise help eliminate excess fat from all areas. If the bulk of a person's fat is around the belly, then that is where the greatest amount of fat-burning will occur. The Abs diet is designed to provide the necessary vitamins, minerals, and fiber for good health, while it promotes building muscle that helps increase the body's fat burning process.

Description

    The Abs diet claims it will allow people to lose weight—primarily fat—while developing a leaner abdomen and increasing muscle tone, strength, general health, and sexual health. The diet has two components: exercise and nutrition. There are six general guidelines that are the basic principles of the diet. These are:

• eat six meals a day
• drink smoothies regularly
• know what to drink and what not to drink
• do not count calories
• eat anything for one meal a week
• focus on the Abs diet 12 power foods

    The diet strongly recommends its followers eat six meals a day to help maintain what researchers call an energy balance. This is the number of calories burned in an hour versus the number of calories taken in. Georgia State University researchers found that when the hourly surplus or deficit of calories is 300–500 at any given time, the body is most susceptible to burning fat and building lean muscle mass. To stay within this range, Zinczenko recommends the following daily meal schedule: breakfast, mid-morning snack, lunch, midafternoon snack, dinner, and evening snack.

    Another guideline is to drink smoothies regularly in place of a meal or snack. Smoothies are mixtures of low-fat milk and yogurt prepared in a blender with ingredients such as ice, protein powder, fruits, and peanut butter. Although there are no definitive studies, some researchers suggest that the calcium in the milk and yogurt helps to burn body fat and restricts the amount of fat produced by the body.

    A third guideline details what to drink and not to drink. Drinking eight glasses of water daily is recommended. The benefits of 64 ounces of water are that it helps to alleviate hunger pangs, flushes waste products from the body, and delivers nutrients to muscles. Other acceptable drinks are low-fat milk, green tea, and no more than two glasses of diet soda a day. Alcohol is not recommended since it does not help to make a person feel full. It also decreases by one-third the body's ability to burn fat and makes the body store more of the fat from food. In addition, it decreases the production of testosterone and human growth hormone that help burn fat and increase muscle mass.

    Although burning calories is required to lose fat, Zinczenko says calorie counting makes people lose focus and motivation. The foods allowed on the diet are energy-efficient and help curb feelings of hunger, according to Zinczenko.

    People following the diet are allowed to cheat for one meal a week. The meal should include foods that the dieter misses most, including items high in carbohydrates and fats. This helps prevent feelings of burn-out or frustration that are often experienced when dieting, at least in the early stages.

The last guideline is to focus on the 12 power foods of the diet to help meet core nutritional requirements. The 12 power foods are:

• almonds and other nuts (unsalted and unsmoked)
• beans (except refried and baked)
• green vegetables, including spinach, broccoli, Brussels sprouts, and asparagus
• non-fat or low-fat dairy products
• instant oatmeal (unsweetened and unflavored)
• eggs and egg substitute products
• lean meats, including turkey, chicken, fish, and beef
• peanut butter
• olive oil
• whole-grain breads and cereals
• whey protein powder
• berries

    Other foods that can be eaten often include almond butter, apples, avocados, bananas, bean dips, brown rice, Canadian bacon, canola oil, cashew butter, citrus fruit and juices, edamame, fruit juices (sugar-free), garlic, hummus, lentils, mushrooms, melons, pasta (whole-wheat), peaches, peanut oil, peas, peppers (green, yellow, and orange), popcorn (fat-free), pretzels (whole-wheat), pumpkin seeds, sesame oil, shellfish, soup (broth-based), sunflower seeds, sweet potatoes, tomatoes, and yellow wax beans.

    Adequate exercise is as important as good nutrition in losing fat and flattening the stomach in the Abs diet. It includes strength training three times a week, abdominal exercises two or three days a week, and optional aerobic exercises two or three times a week. There are three basic principles to the exercise program: leave at least 48 hours between weight workouts of the same body part; do no exercises one day a week; and warm up for five minutes before exercising by jogging lightly, riding a stationary bike, jumping rope, or doing jumping jacks. There are three components of the plan that target different types of exercise:

• Strength training—Total-body workouts three days a week, with one workout placing extra emphasis on the leg muscles.
• Cardiovascular exercises—Do these twice a week in between strength training days. Activities include cycling, running, swimming, brisk walking, and stair climbing.
• Abdominal (ab) exercises—Do ab exercises two or three times a week, before strength training workouts.

     GETTING STARTED. People who are not already exercising should do light strengthening exercises three days a week for the first two weeks. One sample routine is to alternate between three sets of 8–10 pushups and three sets of 15–20 squats with no weights. Rest for one minute between sets. When it becomes easy to do 10 or more pushups and 20 or more squats, increase the number of pushups and add weights to the squats, using either a barbell or dumbbells. The weights routine should be followed by 30 minutes of brisk walking.

    People who already exercise regularly should consider switching from their current workout routine to the Abs diet workout for at least the first few weeks, according to Zinczenko. For maximum results, it is best to change the workout routine every month to keep the body from adapting to a repetitious routine that can slow muscle development. The Abs diet suggests the basic workout be done on Mondays and Wednesdays, starting with one set of an ab exercise from each of the five categories of abdominal regions. Follow this with two circuits of one set of the core exercises in the order listed. On Tuesdays and Thursdays, do 20–30 minutes of cardiovascular exercise. On Friday, do the Monday and Wednesday workout, but replace the ab exercises with traveling lunges, 10–12 repetitions (reps), and step-ups, 10–12 reps each leg. Do two complete circuits.

    ABDOMINAL EXERCISES. These exercises strengthen the abdominal muscles in five regions: upper abs, 12–15 reps; lower abs, 6–12 reps; obliques, 10 each side; transverse abdominis, 5–10 reps; and lower back, 12–15 reps. The following are exercises for each of the five abdominal regions. Upper abs: traditional crunch and modified raised-feet crunch; lower abs: figure-eight crunch and bent-leg knee raise; transverse abdominis: two-point bridge and Swiss ball pull-in; obliques: medicine ball torso rotation and two-handed wood chop; lower back: twisting back extension and Swiss ball Superman.

    CORE EXERCISES. These are the basic exercises that promote muscle strength: squat, 10–12 reps; bench press, 10 reps; pulldown, 10 reps; military press, 10 reps; upright row, 10 reps; triceps pushdown, 10–12 reps; leg extension, 10–12 reps; biceps curl, 10 reps; and leg curl, 10–12 reps.

Function

    The primary purpose of the Abs diet is to help people, especially men, develop a lean, flat, and hard stomach—referred to in fitness circles as a “six-pack”—and maintain a healthy weight and lifestyle. The diet is designed to promote a longer and healthier life by helping prevent cancer, heart disease, high blood pressure, diabetes, and other diseases. These diseases are more prevalent in overweight and obese people compared to people who maintain a normal or below normal weight. The diet is also designed to promote a healthier sex life in men since some of the causes of erectile dysfunction are obesity, heart disease, and diabetes.

Benefits

    Excessive fat, especially around the belly, is a major risk factor for heart disease, high blood pressure, high LDL (“bad”) cholesterol, diabetes, erectile dysfunction, and other diseases. By reducing or eliminating excess body fat, people can live healthier and longer lives. The health benefits increase when regular exercise is added. People on the Abs diet can expect to lose up to 12 lb. (5.4 kg) in the first two weeks followed by 5–8 lb. (2.3–3.6 kg) in the next two weeks, according to Juliette Kellow, a registered dietitian who reviews diets for Weight Loss Resources (http://www.weightlossresources.co.uk).

    Most diets include cardiovascular (aerobic) exercise as part of a weight loss routine. Studies have shown that people who engage in aerobic exercise burn more calories than people who do strength training or weightlifting. However, additional research indicates that the fat-burning metabolic effects of aerobic exercise last 30–60 minutes, while the metabolic effects of strength training last up to 48 hours. Also, the Abs diet promotes increased muscle mass, which increases metabolism so that the body burns up to 50 calories per day for every pound of muscle. Adding 10 lb. (4.5 kg) of muscle can burn up to 500 extra calories each day.

Precautions

    Overall, the Abs diet is healthy and poses no known dangers. Some of the items listed in the 12 power foods can contain high amounts of sodium, such as canned and frozen vegetables, instant oatmeal, and peanut butter. People who want to limit salt intake or who have high blood pressure may want to avoid these foods. Since exercise is a main component of the diet, people with arthritis or back, knee, or other joint problems should discuss the diet with their physicians before starting exercise. People who are allergic to peanuts or nuts should avoid foods containing these products.

    The diet does not address whether it is suitable for vegetarians or vegans. Menus in the book do not have meatless options. However, 8 of the 12 power foods do not contain meat or animal products. All of the protein required in the diet can be obtained by adding more beans and legumes and by replacing meat with soy protein sources, such as tofu or meat substitutes that are high in protein.

Risks

    Since the diet includes a rigorous and regular exercise program, people with heart disease or other health problems should consult their physicians before going on the diet. Men with erectile dysfunction should discuss their condition with their physicians, urologists, or endocrinologists. Also, one of the 12 power foods is nuts, so people with peanut or other nut allergies should eliminate or modify the nut component of the diet.

Research and general acceptance

    There is no specific research that proves the Abs diet delivers on what it promises: fat loss, muscle gain, increased sex drive, and six-pack abs. It is also unclear whether the diet will help people maintain a healthy weight once the initial weight is lost. The book contains many anecdotal stories of success, but there are no scientific studies that document the claims.

    Zinczenko, along with fellow author Matt Goulding, also published a popular book called Eat This, Not That! There are a variety of titles in this series, which educate readers on making healthy food choices in restaurants, the supermarket, and at home.

Resources

Zinczenko, David. The New Abs Diet for Women: The Six-Week Plan to Flatten Your Stomach and Keep You Lean for Life. Emmaus, PA: Rodale, 2011.

Zinczenko, David, and Ted Spiker. The Abs Diet Eat Right Every Time Guide. Emmaus, PA: Rodale, 2005.

———. The Abs Diet Get Fit Stay Fit Plan: The Exercise Program to Flatten Your Belly, Reshape Your Body, and Give You Abs for Life! Emmaus, PA: Rodale, 2005.

———. The Abs Diet 6-Minute Meals for 6-Pack Abs: More Than 150 Great-Tasting Recipes to Melt Away Fat! Emmaus, PA: Rodale, 2006.

———. The New Abs Diet: The Six-Week Plan to Flatten Your Stomach and Keep You Lean for Life. Emmaus, PA: Rodale, 2010.

Aceto, Chris. “Build Muscle, Stay Lean! Open Up Our Nutritional Toolbox and Head to the Job Site: Your Kitchen Table. This State-of-the-Art Diet Plan Will Help You Add Muscle Without Gaining Fat.” Muscle & Fitness (November 2006): 110–14.

———. “Protein & Carbs: Carbohydrates and Protein Have Been Misunderstood For Years. Here Are the Top 10 Myths That Plague Your Diet—And Your Physique.” Muscle & Fitness (September 2005): 100–104.

Donnelly, Allan. “Critical Condition: Need to Get Ripped in a Hurry? Mark Dugdale's Fast-Track Nutritional Overhaul Will Help You Drop Body Fat in Five Easy Steps.” Flex (October 2006): 216–20.

Horn, Beth. “M & F Blueprint: 6 Weeks to a Six-Pack; Build Awesome Abs With This Step-By-Step Training and Diet Program.” Muscle & Fitness (May 2002): 142–45.

Zinczenko, David. “Abs Diet.” Men's Health (Jul–Aug 2004): 154.

———. “Eat Right Every Time.” Men's Health (Jan–Feb 2005): 130.

———. “7 Days to a 6-Pack.” Men's Health (September 2004): 158.

“The Abs Diet.” http://www.absdiet.com (accessed August 7, 2012).

Truex, Leslie. “The Abs Diet.” Livestrong.com. http://www.livestrong.com/article/488677-the-abs-diet (accessed August 7, 2012).

U.S. News & World Report. “The Abs Diet.” http://health.usnews.com/best-diet/abs-diet (accessed August 16, 2012).

Zinczenko, David. “The 7-Day Abs Diet Meal Plan.” Men's Health.com. http://www.menshealth.com/nutrition/abs-diet-weekly-meal-plan-recipes (accessed August 16, 2012).

Academy of Nutrition and Dietetics, 120 South Riverside Plz., Ste. 2000, Chicago, IL 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www.eatright.org.

Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, 3101 Park Center Drive, 10th Fl., Alexandria, VA 22302, (703) 305-7600, Fax: (703) 305-3300, support@cnpp.usda.gov, http://www.cnpp.usda.gov.

Ken R. WellsStacey Chamberlin

The Only 5 Exercises You'll Ever Need

     It sounds like a bad infomercial: Get ripped in less time! We're conditioned to believe that jaw-dropping, body-transforming results are achieved only by putting in the hours. But if you've been adhering to the muscle-isolating back-and-bi, chest-and-tri gospel, the truth is, you're doing it wrong.

"Your brain doesn't think in single 'muscles,' it thinks in terms of movement patterns," says Pat Davidson, Ph.D., director of training methodology at Peak Performance , a private fitness studio in New York City. "Human evolution led to five basic movements, which encompass nearly all of our everyday motions." Meaning your workout needs just five exercises, one from each of these categories: push (pressing away from you), pull (tugging toward you), hip-hinge (bending from the middle), squat (flexing at the knee), and plank (stabilizing your core).

     It's the approach Davidson takes when drawing up the regimens of Peak's celebrity clients, including Gerard Butler, 50 Cent , and Jimmy Fallon. The time-crunched love it because it's an efficient and effective workout—more taxing on the muscles, leading to increased strength and a faster metabolism. Plus, you're not lost when your trainer isn't around. "If you know the basics, it's incredibly simple to build your own workout," Davidson says.

     Still—like martinis and porn—there can be too much of a good thing. "It's stressful to the entire body," says Jason Hartman, trainer to many U.S. Olympic bobsled and skeleton athletes and the U.S. Army Special Forces. "That means that if you overdo them, you'll just beat yourself up. Do this style of workout no more than three or four times a week." Mix and match the moves at right and feel okay about taking the less-time-consuming way out.

• • •

How It Works

Pick one move from each of these categories. Then do 2 sets of 12 reps. Change up the moves but repeat the plan 3 or 4 times a week. For cardio extra credit, see the add-ons below.

PUSH

The Ultimate: Bench Press

Lie face-up on a bench, holding a heavy barbell at your sternum, hands shoulder-width apart, elbows bent into sides. Extend arms, pushing bar directly above chest. Pause, then lower barbell to start.

The Alternates: Push-up, dumbbell shoulder press, single-arm kettlebell press, push press

PULL

The Ultimate: Pull-up

Hang from a bar with palms facing away from you, arms straight, knees bent so feet don't touch floor. Bend elbows, pulling chest toward bar. Slowly lower yourself to start.

The Alternates: Dumbbell row, TRX row, chin-up, cable row, lat pull-down

HIP-HINGE

The Ultimate: Deadlift

Set a heavy barbell on the floor in front of you. Push hips back as you bend forward, grabbing the bar with hands more than shoulder-width apart, palms facing body. Keep back straight as you stand up, lifting the bar and thrusting hips forward. Slowly lower bar to start.

The Alternates: Kettlebell swing, Romanian deadlift, trap-bar deadlift

SQUAT

The Ultimate: Split Squat

Stand on your right leg, left foot resting on a bench or box behind you, and hold a heavy dumbbell in each hand. Bend right knee, lowering body until left knee hovers just above the ground. Straighten right leg, returning to start. Complete all the reps on one side before switching legs.

The Alternates: Barbell squat, lunge, goblet squat, reverse lunge

PLANK

The Ultimate: Farmer's Walk

Stand up straight holding a heavy dumbbell in each hand, palms facing body. Maintain your posture as you walk 20 meters. Turn, repeat, returning to start.

The Alternates: Plank, bird dog, side plank, suitcase carry

• • •

Fat-Burning Finishers

To check off cardio, too (and send your metabolism into even higher gear), add one of these five-minute bursts to your five-move session, suggests Davidson. "Make it the worst five minutes of your life," he says. The results: less fat, more definition.

Do More Reps

Load a barbell with a weight that's about 70 percent of what you can lift one time, then choose one of the five movements and perform as many reps as you can—without breaking form.

Go Farther

On a rowing machine, row as many meters as possible in 5 minutes. With each workout, attempt to increase that distance by one percent.

Sprint up a Hill

Set a treadmill to a slight incline, about 3 percent. Run as fast as you can for 30 seconds, aiming for 10 miles per hour. Jog for 30 seconds at 5 mph. Repeat for 5 minutes.

7 Reasons You're Not Getting Stronger

    Exercise is supposed to be a stress release, not something that creates more tension in your life. Yet that’s exactly what ends up happening when gains in strength and size begin to sputter. And without utilizing trial and error and critical thinking in your training, the road back to continual success can be long and frustrating.

     If obvious causes for stalled progress have already been considered — namely, you’re inconsistent with how your train, eat, and rest — perhaps one of these seven reasons have been overlooked.

1. Your Mechanics Are Off

    When you’ve hit a wall there’s no better time to take a step back and rethink the way in which your body is moving compared to how it should be moving during specific exercises.

   “The brain is a sophisticated thing that — if you allow it — will try to find the most efficient way to move through space while using the least amount of resistance,” says Dr. Paul Juris, Executive Director of the Cybex Research Institute. “So in many cases what people do is find solutions that limit the loading of the joints and therefore the muscle, and that’s not necessarily creating the best opportunity to make the system work harder. Take an overhead press with a cable as an example. If the cable is aligned straight through the center of the shoulder joint, biomechanically that’s not placing the load on the shoulder. So those muscles around the shoulder aren’t going to work very hard despite the fact that you’re moving in a way that it looks like you’re doing the exercise properly. Finding the right source to help you iron out kinks isn’t always an easy task. Unfortunately biomechanics isn’t something that’s taught very much in the fitness industry, but finding someone who knows it would be very helpful to you.”

2. You’re Switching Things Up Too Often

     Yes, your body is an adaptive organism that’ll stop responding if you fail to increase demands. But changing every aspect of every workout on a daily basis isn’t necessary, according to Dr. Juris. “Repeated stimulus over a 30-day period can help you get comfortable, confident, and learn the task more effectively,” he says. “However, there is value to changing the loading schemes. So, on some days work with higher loads and fewer reps, or lighter loads and more reps. I also like to throw in a speed day with lighter loads and fast reps.”

3. You Might Have Hit Your Strength Ceiling

   We hate to be the bearer of bad news, but there is going to come a point where you simply can’t get any stronger. If that weren’t the case, gyms would be overcrowded with Incredible Hulks curling Smart cars.

    “As human beings we all have our own genetic ceiling,” says Dr. Juris. “So there’s only so much we can do without getting into some unsavory things.”

Read: potentially hazardous or unhealthy methods to spur muscle growth.

4. You Only Do What You Enjoy

    Often, instead of embracing what pushes our bodies to grow — maybe it’s performing Olympic lifts or running the rack — we find something less demanding, intense, or time consuming takes its place.

   “I believe people have a tendency to do what they’re good at or enjoy,” says NASM-certified personal trainer Mike Giliotti. “So when I train my clients, I do the exact opposite. You don’t like squats? Well we start them. You don’t like deadlifts? Now we will do extra sets. When I see a weakness, I go right at it. Face your fear and break your wall. I really find this to be effective both mentally and physically.”

5. Your Ego Is In The Way

     Weightlifting can be an amorphous term. It’s your responsibility to figure out the necessary principals and methods needed to achieve your specific objective. So if you have not defined an end game, there’s no way you can accomplish your goal.

    “’Powerlifting’ is lifting the most weight possible and has no concern with body composition, conditioning or the way the physique looks,” explains John Rowley, certified personal trainer and author of The Power of Positive Fitness. “So when you look at it from this perspective you can see why people don’t make gains in the gym. They avoid the bench press or other movements because they think they should be doing these big lifts. So if they can’t do 325 lbs. they skip the exercise when they should really be focusing on what the weight can do for their muscle — not the weight on the bar.”

6. You Have No Idea What ‘Supramaximal Training’ Is

    Supramaximal effort, defined as something that exceeds what is considered maximal, can make the body adapt by exposing it to a higher set of demands.

   “While time under tension (TUT) is important for both strength and hypertrophy goals, it is the relationship of TUT to the resistance used that is truly important,” explains NSCA Certified Strength and Conditioning Specialist Brian Durbin, owner of Fitness Together of Mt. Pleasant, S.C. “An important note for those looking to increase muscle strength and hypertrophy is the TUT as a result from supramaximal training using eccentric (when the muscles lengthen) loading. The TUT component of eccentric loading days can be an excellent plateau-breaking tool and can also be invaluable for pushing the muscles and the nervous system to a new level of performance.”

Durbin suggests incorporating two days of eccentric supramaximal training for a two-week cycle. “It can completely revolutionize a training program and catapult results forward,” he adds.

7. You’re Putting In Too Much O.T.

     This especially applies to newcomers, but can be also become an issue when gym vets’ see their lifts flatline; they begin to overcompensate by adding more sets or reps.

    “Putting muscle on requires you to lift weight correctly and with efficiency,” explains Rowley. “The key is get in, get the job done and get out. Newbies can confuse gains with time in the gym because it makes sense to them; however, I like to use the common analogy of the marathon runner versus the sprinter. You can train easy and long or hard and short. Hard and short adds muscle, but a long and hard session doesn’t do much for muscle gains.”

5 Ways to Make Your Workout Work Harder

     You know the basics: Do resistance training on alternate days, include core exercises in your routine, and stretch only after you’re warmed up. But once you’ve met your original goals, it’s time to raise the bar. Getting faster, stronger, and more flexible takes more than just doing more of the same. Here’s how tweaking your approach can bring your results to the next level.

Speed

     Traditional methods of boosting speed include sprints and intervals, during which you alternate fast runs with slower “rest” periods. But another way to really shave off time is by adding plyometrics to your workout, says Tom Holland, certified strength and conditioning specialist and author of Beat the Gym. Also known as “jump training,” plyometrics involve explosive movements that require muscles to lengthen and then immediately contract, much like a spring. “Plyometrics improves running economy, which means you expend less energy with each stride,” says Holland. The rapid-fire movements train you to accelerate quicker, increasing overall speed and efficiency. A simple way to incorporate plyometrics into your workout is with jump squats.

     How to do it: Stand with feet hip-width apart and hands clasped behind your head. Keeping your weight on your heels, squat down until your thighs are parallel to the floor. Pause in the squat, then jump up as high as possible, absorbing the impact of the landing by pushing your hips back and bending your knees before immediately jumping up again. Do two or three sets of 15 reps.

Endurance

     Being able to finish a 10k or just make it through your entire cycling class largely depends upon your core strength, says Holland. “Your core is involved in the transfer of energy to your arms and legs. So in the later stages of an event or workout, that energy transfer will be thrown off if your core is weak.” In addition to the traditional plank, try this challenging CrossFit-inspired move called The Hollow Rock.

     How to do it: Lie on your back with your arms extended overhead by your ears. Engage your core and begin rocking your entire body by lifting your feet and legs up and then raising your upper body and arms while lowering your legs. Your body should move like a rocking chair and your abs should feel challenged throughout the movement. Start with 20 to 30 seconds and work up to two minutes.

Muscle Definition

     It’s frustrating when you train hard and still don’t see the muscle tone and definition you want. Fine-tuning your diet can help by increasing lean tissue and decreasing body fat. Even if you have a relatively healthy diet already, cleaning it up a bit more can help reveal the underlying muscle you’ve built, says Amy Goodson, R.D., board certified specialist in sport dietetics and co-author of Swim, Bike, Run—Eat. “The cleaner you eat, the leaner you will be.”

     How to do it: For a sculpted look, focus on eating protein at each meal and snack and decreasing salt and sugar. Lean protein (fish, low-fat dairy, eggs, and lean meat) helps you repair and build muscle after workouts and feel full faster, keeping calories in check. Salt and sugar, on the other hand, can cause bloating, hiding those hard-earned muscles. If you sweat a lot during a long event, such as a marathon, replace your electrolytes during and after your workout and cut back on salt later in the day, suggests Goodson.

Flexibility

     Traditional stretching will help you get more limber. But you can take it to the next level by targeting tight spots with a foam roller or massage ball. This releases the fascia, connective tissue that supports the muscle (think of the white covering on a chicken breast), loosening tight areas and allowing for greater flexibility. A recent study in Medicine & Science in Sports & Exercise showed that foam rolling unravels trigger points (tiny knots that develop in overworked muscles), relieving muscle spasms and allowing for better circulation, according to author David Behm, Ph.D. Used after a workout, the roller can also ease muscle soreness.

     How to do it: Lie on a massage ball or foam roller and apply pressure until you find a trigger point (a knot or tight area), says Ashley Turner, star of the Element: Stretch, Release & Restore Yoga Kit DVD. Hold at the trigger point for 20 to 60 seconds or until you feel it release. “Be sure to pinpoint areas above and below the site of specific aches and pains, as often pain in one spot is an indicator of tension somewhere else in the body,” says Turner.

Strength

     The general rule for strength gains is the same regardless of the muscle group you target: You must use enough weight or resistance to overload the muscle beyond its usual limits. (You can also add an extra day of resistance training to your weekly routine and/or increase the number of sets you do within each workout.) Aside from upgrading to heavier weights, you can increase the intensity of your usual body-weight moves with specific tweaks, such as raising a leg during planks or standing exercises like bicep curls. Irv Rubenstein, Ph.D., an exercise physiologist in Nashville, TN, recommends the following technique to amp up one of the best all-around exercises, the pushup.

     How to do it: Try a super-slow pushup: On your knees or toes, instead of pumping out reps, time yourself to make each rep last a full 30 seconds. Take 15 seconds to lower yourself and 15 seconds to push back up. “It will bring a quiver to your body and make your core work hard to hold proper form,” says Rubenstein. Do this at the beginning of your upper body routine.

Aging and Nutrition

     Aging Americans will make up an unprecedented proportion of the population as the 78 million baby boomers reach age 50. The baby boomers, those born between 1946 and 1964, will first reach age 65 in 2011, transforming the 35 million people over age 65 in 2000 to an estimated 69 million by 2030. With improved health care, socioeconomic status, and health behaviors, people 85 and over are expected to be the fastest-growing group of elderly persons, tripling from 4 million in 2000 to about 14 million by 2040. Growth in the elderly population has led to two subgroups: the young-old (55 to 74 years) and the old-old (75 and older). Still, elderly people remain the most diverse segment of American society.

     A nutritious daily diet is one factor that can assist people who are 55 and older in maintaining optimal levels of health and preventing or delaying the onset of disease. The Dietary Reference Intakes (DRI) are the quantities of nutrients that form the basis for planning and assessing diets. The DRIs include the Recommended Dietary Allowances (RDA), the nutrient levels that meet the requirement for nearly all (97–98%) healthy people. Two sets of RDAs exist for elderly individuals, one for those 51 to 70 years of age, and one for those over 70 years of age.

     According to the RDAs, elderly people have the same nutrient requirements as their younger counterparts, yet most need fewer calories. Vitamins D and B6, and calcium, are exceptions and are needed in greater amounts for those 51 years old and older. Therefore, a nutrient-dense diet, with fewer calorie-laden foods, becomes more crucial at older ages of the life cycle. In general, women have nutrient requirements similar to men, though they require fewer calories. Therefore, elderly women must be especially careful to select nutrient-dense foods.

     The best way to establish a nutrient-dense diet is to balance a variety of food choices (in moderation) that are adequate to meet nutritional and caloric needs. The Food Guide Pyramid (FGP) is helpful to guide food selection and daily serving totals. An FGP specifically for those over 70 years of age recommends 1,200–1,600 calories from whole-grain foods, a variety of colored fruits and vegetables, low-fat dairy products, lean meats, fish and poultry, and eight glasses of fluid daily. Food labels help put single servings of food into the FGP. Results of national dietary surveys have led some experts to recommend calcium supplements and a one-a-day type of multiple vitamin. Other health food supplements are not generally needed and can be very expensive for those on fixed incomes.

Nutrition Screening Initiative

      Elderly individuals are at increased risk for problems that affect their nutritional status. The nationwide Nutrition Screening Initiative (NSI) categorizes these problems as those affecting functional, social, or financial status and access to food and drink. These problems can affect quality of life and theElderly people face unique nutritional challenges. Although age can diminish appetite and physical mobility, the body still requires as many nutrients as a younger adult's. [Photograph by Owen Franken. Corbis. Reproduced by permission.]ability to perform activities of daily living, including eating. The DETERMINE checklist is the NSI tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

     Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

Dietary Problems

     Some elderly individuals encounter dietary problems, making them less able to select, purchase, prepare, eat, digest, absorb, and use food. An inability to consume an adequate daily diet places the elderly person at increased risk for medical, physical, and functional problems. Therefore, it is important to intervene to correct any dietary problems that may exist. Examples of dietary problems, and interventions to improve the problems, are described below.

     Choose more fruit and vegetable juices, soft canned fruits, and creamed or mashed cooked vegetables; eggs, milk dishes (like creamed soups), cheese, and yogurt; and cooked cereals when chewing meat or fresh fruits and vegetables are difficult. Chop, stew, steam, or grate hard foods.

Choose more fruit and vegetable juices, soft canned fruits, and non-gas-forming vegetables rather than gas-producing vegetables like cabbage or broccoli. If digesting milk is a problem, use cultured dairy products like yogurt or add lactaid to milk. If milk continues to be problematic, consider a daily calcium supplement.

     Shop by phone to find grocery stores that deliver in your area. Find volunteer or paid help in your area. Ask family or neighbors to help. See yellow pages under "Home Health Services" for assistance.

     Use a microwave. Cook and freeze in batches. Relocate to a facility where other's cook, such as a family member's home or an assisted-living home environment.

     Increase the flavor of food by adding spices and herbs, lemon juice, or meat sauces. Discuss medications with your physician, particularly if they are causing appetite or taste changes.

Use coupons, unit pricing, and shopping lists. Plan and prepare ahead, freezing several meals at once. Buy more generic or store-brand foods and foods on sale. Find food assistance programs or sources for free and reduced-price meals, such as churches, Meals On Wheels, Congregate Dining, and Food Stamps. Buy more low-cost foods, such as dried beans and peas, rice, pasta, canned tuna, and peanut butter.

Social Problems

     Invite a friend or neighbor over or have a standing date to eat out with friends or family. Buy smaller sizes to avoid the repetition of leftovers. Set the table attractively and play music softly. Participate in Congregate Dining in your area.

     Research has shown a correlation between living alone and having lower quality diets. Men may be at greater risk because they are less experienced with planning, shopping, and preparing meals. Women may feel less motivated to prepare meals when there is no one to share them with. Ways to improve social interaction during meals and improve the experience of dining alone include: participating with others, such as at churches or Congregate Dining sites, eating by a window, using good china, eating in a park or on one's porch, garnishing meals, and trying various frozen or prepared dinners.

     When living alone challenges an elderly person's health, he or she can investigate the continuum of care, including adult day care, in-home care, retirement communities, residential care or assisted living, intermediate care, and nursing homes or convalescent hospitals.

Medical, Physical, and Functional Problems

     Many chronic medical conditions, such as osteoporosis, arthritis, depression, and diabetes have nutritional consequences. Loss of body water, lean body mass, and bone mass; decline of the immune response; over- and underweight; malnutrition; and declining taste, smell, and thirst are among the problems that affect physical strength, functional ability, and vitality. At times, specialized diets or medical nutrition therapy are needed; these are Many elderly people live alone and may have less nutritious diets than those living with a partner. Programs such as Meals On Wheels can help prevent poor nutrition caused by loneliness. Best planned with a registered dietitian. In addition, medications can affect the absorption and use of nutrients. Lists of food and drug interactions are available from a pharmacist or from a registered dietitian who can coordinate advice about medications with specialized dietary information.

SEE ALSO DIETARY REFERENCE INTAKES; MEALS ON WHEELS; MENOPAUSE; NUTRIENT-DRUG INTERACTIONS; OSTEOPOROSIS; RECOMMENDED DIETARY ALLOWANCES.

Sally Weerts

Bibliography

Davis, M. (2000). "Living Arrangements Affect Dietary Quality for U.S. Adults Aged 50 Years and Older: NHANES III 1988–1994." The Journal of Nutrition 130(9): 2256–2264.

Fletcher, R. H. (2002). "Vitamins for Chronic Disease Prevention in Adults: Clinical Applications." Journal of the American Medical Association 287(23): 3127–3129.

Healthy Heart Diet

Definition

     A healthy heart diet is an eating plan designed to keep blood cholesterol low and prevent the risk of heart disease. This is usually achieved by eating foods that are low in saturated fat, total fat, cholesterol, and sodium. Some diets help people lower their cholesterol levels.

Origins

     The healthy heart diet is the result of ongoing nutrition research by organizations including the United States Department of Agriculture (USDA) and the American Heart Association (AHA). The department first issued dietary recommendations for Americans in an 1894 Farmer’s Bulletin, according to the 1996 USDA report Dietary Recommendations and How They Have Changed Over Time.

     The 1894 recommendations came from W.O. Atwater, first director of the USDA’s Office of Experiment Stations. He proposed a diet for American men based on protein, carbohydrate, fat, and mineral matter. In a 1902 Farmer’s Bulletin, he warned about the danger of a dieting consisting of too much protein or fuel ingredients (carbohydrates and fat). “The evils of overeating may not be felt at once, but sooner or later they are sure to appear—perhaps in an excessive amount of fatty tissue, perhaps in general debility, perhaps in actual disease,” Atwater cautioned.

    More was known about nutrients in 1941 when the USDA first issued the Recommended Dietary Allowances (RDAs). The allowance allowances covered areas like calorie intake and nine essential nutrients: protein, iron, calcium, vitamins A and D, thiamin, riboflavin, niacin, and ascorbic acid (Vitamin C). The USDA also released national food guides during the 1940s. The guides provided a foundation diet with recommendations for foods that contained the majority of nutrients. The guide was modified in 1956 with recommended minimum portions from food groups that the USDA called the “Big Four”: milk, meats, fruits and vegetables, and grain products.

     The guides remained in effect until the 1970s when an increasing amount of research showed a relationship between the over-consumption of fat, saturated fat, cholesterol, and sodium and the risk of chronic diseases such as heart disease and stroke. In 1979, the USDA guide included the Big Four and a fifth category that included fats, sweets, and alcoholic beverages.

     The following year, the USDA and the Department of Health and Human Services (HHS) issued the first edition of Nutrition and Your Health: Dietary Guidelines for Americans. The recommendations for healthy Americans age 2 and older included consuming a variety of foods, avoiding too much fat, saturated fat, cholesterol, and sodium. Those guidelines were recommended for people older than age 2 because younger children need more calories and fat in their diet to aid in their growth and development.

   The USDA and HHS update the federal guidelines every five years. The 1990 edition recommended a diet low in fat, saturated fat, and cholesterol. Salt and sugars were to be consumed in moderation. In Dietary Guidelines for Americans 2005, the federal departments featured more specific recommendations.

     The recommendations for healthy Americans came from two departments that are part of the National Institutes of Health (NIH). Within NIH is the National Heart, Lung, and Blood Institute (NHLBI), which was formed by Congress in 1948. In the 21st Century, the institute’s focus on heart disease included the creation of a Heart Healthy Diet to keep cholesterol low and the Therapeutic Lifestyles Changes (TLC) Diet to help people lower their blood cholesterol.

     Furthermore, the American Heart Association (AHA)has long been concerned with educating the public about the relationship between diet and heart health. The association started in 1924 as an outgrowth of local organizations including the Association for the Prevention and Relief of Heart Disease in New York City. That group was founded in 1915 and consisted of physicians and social workers.

     The national organization’s public education activities include issuing nutritional guidelines that are periodically revised. The title of the association’s “2006 Diet and Lifestyle Recommendations” reflected the importance of diet and physical activity on health,

    

Description

     Healthy heart diets share fundamental elements about how to prevent heart disease. The process starts with an understanding of why some foods should be avoided and others are beneficial to the heart. The first step is for the person to be aware of how food affects heart health.

    The heart is a muscle, and the body’s muscles require a steady supply of oxygen and nutrients. This supply is brought to the heart by blood in the coronary arteries. Healthy heart diets are designed to keep the coronary arteries open for the delivery of oxygen and nutrients. When the arteries become narrow or clogged, the heart will not receive enough blood. This blockage causes coronary heart diseases. If the heart doesn’t receive enough of the blood containing oxygen, the person feels a chest pain, which is known as angina. If the coronary artery is totally blocked off and no blood reaches the heart, the person experiences a heart attack.

    The narrowing or clogging of the arteries is designated as atherosclerosis when the blockage is caused by deposits of cholesterol and fat. Cholesterol is a soft, waxy substance that is similar to fats (lipids). Cholesterol occurs naturally and is found throughout the body in the bloodstream and cells.

Cholesterol is used by the body to produce VitaminD, hormones, and the bile acids that dissolve food, according to NHBLI. However, the body doesn’t need much cholesterol to perform those functions, and the extra cholesterol is deposited in the arteries.

    Cholesterol and fats don’t dissolve in the bloodstream and are moved through the body by lipoproteins. These are a combination of a lipid (fat) surrounded by a protein, according to the American Heart Association. Total cholesterol consists of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very-low density lipoprotein (VLDL).

     VLDL carries triglycerides, a form of blood fat that could affect the heart. LDL is known as “bad” cholesterol, and HDL is called “good” cholesterol. HDL may help the body by clearing fat from the blood and removing extra cholesterol, according to the AHA.

The body produces LDL and receives more of it from food. When foods rich in cholesterol and some fats are consumed, the body creates more LDL. The dietary cholesterol comes from animal products such as meat. Also contributing to the LDL build-up are foods that are high in trans fats and saturated fats.

     Food contains three types of fats that should be monitored on a healthy heart diet:

• Saturated fat is the popular term for saturated fatty acid. Saturated fat tends to raise cholesterol levels and is found in meat, poultry, whole-milk dairy products including cheese and butter, cocoa butter, lard, and tropical vegetable oils like coconut and palms oils. Saturated fat remains solid at room temperature.
• Trans fat is a type of vegetable oil that was processed to make the liquid more solid. The process called hydrogenation produces hydrogenated and partially hydrogenated vegetable oils. These oils are found in stick margarine, vegetable shortening, commercial fried food, and baked goods such as cookies and crackers.
• Unsaturated fats include polyunsaturated fats and monosaturated fats. Polyunsaturated fats are found in fish, walnuts, corn oil, and safflower oil. Mono-saturated fats are found avocadoes, olives, olive oil, canola oil, and peanut oil.

     Sodium and salt are sometimes used interchangeably in information about healthy heart diets. The AHA recommends that people consume less than 2,300 milligrams of salt per day. This amounts to about 1 teaspoon of salt. Some organizations recommend a slightly higher amount of less than 2,400 milligrams. The recommended amount is for healthy people and may be lower for people with some health conditions.

    The diets of most Americans contain too much salt, and processed foods are generally the source of this sodium. A diet high in salt tends to raise blood pressure, and this could lead to heart disease, stroke, and kidney damage.

     Reducing the amount of sodium in a diet will lower blood pressure, and aid in reaching healthy cholesterol levels. In addition, foods high in potassium counteract some of the effect of sodium on blood pressure, according to the USDA guidelines.

     The federal government and the American Heart Association are among the organizations that provide recommendations for a healthy lifestyle. The recommendations frequently parallel those of the healthy heart diet, a plan that emphasizes the consumption of less fat, less cholesterol, and less sodium. There is also agreement that diets should include fiber-rich foods like fruits, vegetables, and whole-grain products.

     Guidelines also focus on the importance of regular physical activity to prevent or lower the risk of conditions like heart disease. Generally, people are advised to exercise at least 30 minutes most days of the week. While some recommendations are designed for healthy people, the guidelines also apply to a healthy heart diet. There may be more specific instructions in plans to lower cholesterol levels.

DIETARY GUIDELINES FOR AMERICANS 2005. Nutrition and Your Health: Dietary Guidelines for Americans defines a healthy eating plan as one that:

• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
• Includes lean meats, poultry, fish, beans, eggs, and nuts.
• Is low in saturated fats, trans fats, cholesterol, salt, and added sugars.
• The total fat intake should be between 20% to 35% of the daily calories consumed.

     People can create a diet with those foods by using online tools like the USDA’s MyPyramid Plan and calculators on the NHBLI pages for the Heart Healthy and TLC diets. Someone Internet sites produce an individualized plan with specific calorie amounts, recommended foods, serving portions, and a system to track physical activity.

     AMERICAN HEART ASSOCIATION 2006 DIET AND LIFESTYLE RECOMMENDATIONS. The heart association’s plan starts with the person determining how many calories are needed to maintain a healthy weight. People are advised not to eat more calories then they burn through activity. They should create a meal plan that includes:

• A variety of vegetables and fruits and unrefined, whole-grain food.
• Fish at least twice a week. Oily fish such as salmon, trout, and herring contain omega-3 fatty acids. These acids may help reduce the risk of fatal coronary disease.
• Lean meats and poultry without skin. These proteins should be prepared them without added saturated and trans fat.
• Less than 300 milligrams of cholesterol each day.
• A moderate amount of alcohol, with one drink per day for women and two drinks per day for men.
• Dairy products that are fat-free, 1% fat, and low-fat dairy.
• Food containing little or no salt.The association advises the public to cut back on:
• Foods containing partially hydrogenated vegetable oils to reduce trans fat in their diets.
• Foods high in dietary cholesterol.
• Beverages and foods with added sugars.

     The association certifies grocery products that meet the organization’s standards. Certification on packaging is indicated by a red heart with a white check mark inside. Products with that symbol meet association criteria for recommended amounts of saturated fat and cholesterol for healthy people above the age of 2. The standard-certification designation is based on one serving that contains 1 gram or less of saturated fat, 20 milligrams or less of cholesterol, and 480 milligrams or less of sodium. The wholegrains certification is issued to foods containing those quantities and an amount of whole-grain at a proportion of 51% by weight with reference to the amount customarily consumed.

     THE NHBLI HEART HEALTHY DIET. The NHBLI website in the spring of 2007 featured heart healthy diet guidelines and an online tool to create a personal eating plan. The online activity starts with the person providing information about height, weight, gender, age, and level of physical activity. This action generates a recommendation for a daily calorie allowance. That allowance is used to determine the percentage of total fat and saturated fat permitted at that calorie level. The consumer then receives prompts to select food choices for three meals and a snack.

     As information is received, the person sees the amounts of calories, fat, total fat, cholesterol, and sodium that would be consumed. After the final entry is made, the nutritional information is totaled. The total is compared with the recommended amounts. Along with that data are recommendations on how to modify the meal plan to lower fat and cholesterol consumption.

Meal planning on the heart healthy diet is based on these guidelines:

• A person should eat just enough calories to achieve or maintain a healthy weight and reduce blood cholesterol level. A doctor or registered dietitian can determine what a reasonable calorie level.
• Saturated fat should account for 8 to 10% of the day’s total calories.
• Total fat should be 30% or less of the day’s total calories.
• Dietary cholesterol should be limited to less than 300 milligrams per day.
• Sodium intake should be limited to 2,400 milligrams a day.

     THE TLC DIET. The Therapeutic Lifestyles Changes (TLC) Diet helps to lower the cholesterol of people who have a heart disease or at risk of developing one. The TLC section of the NHLBI contains online tools similar to those for the Healthy Heart diet. The guidelines for the low-saturated fat, low-cholesterol TLC diet are:

• The person should eat just enough calories to achieve or maintain a healthy weight and reduce the blood cholesterol level.
• Saturated fat should account for less than 7% of the daily total calorie total.
• Fat consumed amounts to 25 to 35%% of the day’s total calories.
• The person should eat less than 200 milligrams of dietary cholesterol per day.
• Sodium intake should be limited to 2,400 milligrams per day.

Function

      A healthy heart diet helps people age 2 and older reduce the risk of cardiac disease. This is achieved by the consumption of foods that keep total cholesterol and LDL cholesterol at healthy levels. A healthy heart diet may involve lowering cholesterol levels by reducing the amount of foods high in cholesterol, fat, and sodium. At the same time, people work to increase HDL levels through diet and exercise.

      The healthy heart diet is a lifelong process that starts with education about the effects of food on the heart. People on this diet learn to make wise food choices, relying on information including the nutritional labels on processed food. The labels provide information about the calories, fats, sodium, and sugar in a single serving of the product.

Benefits

     The benefits of a healthy heart diet are that people lower their cholesterol levels and reduce their risks of cardiovascular disease. A healthy heart diet is a preventive plan for people age 2 and older since high cholesterol could become an issue in childhood. Parents who place their children on healthy heart diets not only help them with physical health, they give their children with the basics for a lifetime of healthy habits.

     Diet and regular physical activity keep cholesterol at healthy levels. The healthy heart diet that is also a weight loss plan will help obese and overweight people shed excess pounds. Smoking is another risk factor that will be lowered when people stop smoking. Diabetes and high blood pressure also put people at risk for heart disease. Both may be treated with medication, and people diagnosed with those conditions will benefit from a healthy heart diet.

     Factors like heredity can’t be changed, so people with a family history of high cholesterol or early heart disease should prescribe to a heart healthy diet. The NHLBI defined the person at risk as someone with a father or brother diagnosed with this condition before the age 55. There is also a risk to someone with a mother or sister with this condition before age 65.

     Furthermore, cholesterol levels rise as a person ages. The level rises in men at age 45 and older. For women, the increase is generally seen at age 55 and older, according to NHLBI.

Precautions

     A healthy heart diet is safe for people age 2 and older. However, some people may to consult with their doctor before eating some foods such as fish. The United States Food and Drug Administration and the Environmental Protection Agency in 2004 warned pregnant women and nursing mothers to limit their consumption of fish and shellfish to 12 ounces (340.2 grams) per week. The warning was issued because of the risk that toxins in seafood would cause developmental problems in babies and children. Furthermore, women who are pregnant or nursing should not eat shark, marlin, and swordfish because of the high mercury content in these fish.

Risks

     When following a healthy heart diet, people need to be aware of the nutritional content of the foods they consume. They need to evaluate that information and make wise food choices. For example, the AHA points out that nuts and seeds are cholesterol-free sources of protein and a source of unsaturated fat. However, nuts and seeds are high in calories. Furthermore, frozen meals that are low in calories and fat should be examined for their sodium content.

     Those foods can be part of a healthy heart diet. However, people need to observe nutritional recommendations for daily fat, sodium, and calorie allowances. Otherwise, their diet will aggravate a condition like high blood pressure or obesity.

Research and general acceptance

     More than a century ago, W.O. Atwater of the UDSA cautioned about the dangers of overeating. His warning proved accurate. Cardiovascular disease (CVD) was the leading cause of death in the United States in each year since 1900, with the exception of 1918, according to the American Heart Association’s Heart Disease and Stroke Statistics—2007 Update. The heart association compiles that report in conjunction with government agencies.

     According to the report, nearly 2,400 Americans die of CVD each day. That amounts to an average of one death every 36 seconds. In addition, an estimated 79,400,000 American adults (one in three) have one or more types of cardiovascular disease. Of those, 37,500,000 were estimated to be age 65 or older.

     By the 1970s, research showed the link between chronic diseases like heart disease and stroke and a diet high in fat, saturated fat, cholesterol, and sodium. Research in the decades since then has affirmed the connection between poor diet and disease.

     During those years, Americans ate more of the foods that put them at risk for heart disease. The average calorie consumption rose 16% between 1970 and 2003, according to USDA figures cited in the heart association report.

     Information from the National Health and Nutrition Examination Survey for 1999-2000 indicated that Americans have not yet accepted the nutritional guidelines of a heart health diet. According to the report:

• The average daily intake of total fat in was 79 grams, with men averaging 91 grams and women averaging 67 grams.
• The average daily intake of saturated fat was 27 grams, with 31 grams for men and 23 grams for women.
• The average amount of dietary fiber consumed was 15.6 grams, below the recommended amount of 25 grams or more. Men ate 17.8 grams of fiber and women consumed 13.6 grams.

     In the 21st century, obesity in the United States is considered an epidemic. Federal agencies and organizations are responding with a range of programs to promote the benefits of a healthy heart diet.

Resources

American Heart Association. The new American Heart Association Cookbook. Clarkson Potter/Publishers, 2004.

American Dietetic Association, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606. (800) 877-1600. http://eatright.org.

American Heart Association National Center, 7272 Greenville Ave., Dallas, TX 75231. (800) 242-8721. http://www.americanheart.org..

National Heart, Lung, and Blood Institute. Choosing Foods on the Heart Healthy Diet.http://www.nhlbisup-port.com/cgi-bin/chd1/diet1.cgi. (April 21, 2007).

National Heart, Lung, and Blood Institute. Introduction to the TLC Diet. http://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi. (April 21, 2007).

United States Department of Agriculture. MyPyramid Plan. http://www.mypyramid.gov/mypyramid/index.aspx. (April 21, 2007).

American Heart Association. American heart Association’s Heart Disease and Stroke Statistics— 2007 Update http://www.americanheart.org/presenter.jhtml?identifier=1200026. (April 9, 2007).

Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion. Physical Activity and Good Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity At A Glance 2007. http://www.cdc.gov/nccdphp/publications/aag/dnpa.htm. (April 9, 2007).

Davis, Carole and Sallo, Etta; U.S. Department of Agriculture Dietary Recommendations and How They Have Changed Over Time. http://www.ers.usda.gov/publications/aib750/aib750b.pdf. (April 21, 2007).

U.S. Department of Agriculture and the Department of Health and Human Services. Dietary Guidelines for Americans 2005. http://www.health.gov/dietaryguidelines/dga2005/document. (April 9, 2007).

Liz Swain.

Acne Diet

Definition

     The acne diet—or, more accurately, the acne-free diet—is a way of eating that claims to improve or eliminate acne. There is some debate in the medical community about the impact of diet on acne; however, there is a body of evidence to support the idea that certain foods affect the skin.

     By reviewing research from over 40 years, doctors such as dermatologist Dean Goodless have  developed a set of recommendations regarding foods that may prevent acne. Goodless presents his recommendations in his book The Acne-Free Diet Plan. He suggests eating a diet low in fat and high in fiber along with avoiding peanut products, fried foods, excessive salt, dairy products, foods high in refined sugars, and high-carbohydrate foods.

Origins

     Most cultures had folk remedies to help clear the skin, but it was not until the later part of the twentieth century that serious scientific research began to confirm or disprove these folk tales and myths. One of the earliest studies about food and acne focused on chocolate, based on the belief that chocolate contributed to acne. (The study found that chocolate did not increase acne breakouts, and other studies since have confirmed this finding.) Other studies have investigated ethnic groups and communities where there is little or no incidence of acne, such as in the Pacific Islands and Africa. When the diets of these areas were compared to the typical Western diet, there were nutritionally significant differences: the ethnic groups with very low incidence of acne ate predominately plant-based diets that were low in fat and virtually sugar free, whereas the Western diets were heavy in meats, saturated fat, refined sugar, and processed foods. By studying these differences, doctors and researchers developed suggestions for dietary changes to improve or eliminate acne.

Description

     Acne is caused when glands in the skin called sebaceous glands begin to form a sticky oil called sebum. These glands are stimulated by hormones that become active at puberty, which is why acne occurs most often in adolescence, when these hormones are produced in abundance. The oils formed by the sebaceous glands hold dead skin cells, preventing them from being sloughed off. As these cells die, they create the perfect environment for bacteria to grow. When these bacteria, called acne vulgaris, become too plentiful, they will attempt to erupt from the skin, causing a pimple. Sometimes, when the bacteria grow, the body sends white blood cells to fight the infection. This natural reaction can cause large, painful cysts to form in the deeper layers of skin.

     Opinions vary in the medical community as to whether or not diet plays a significant role in acne. Some dietary changes that have been proposed to help prevent acne breakouts include:

• Eat 20 to 30 grams of fiber every day. Fiber helps keep the colon clean and may remove toxins from the body before they reach the skin.
• Eat a low-fat diet. High fat consumption may elevate hormone levels in the body that cause blemishes on the skin.
• Avoid peanut products. Peanut products were found to cause acne flare ups in a study of 500 adolescents.
• Avoid fried foods.
• Limit salt intake, especially table salt or iodized salt. Many people with acne have elevated levels of iodine, found in table salt, in their bloodstream during acne flare-ups.
• Avoid dairy products such as milk, cheese, and ice cream.

     Other vitamins and minerals proposed to affect acne include vitamins A, E, and B; selenium; zinc; omega-3 fatty acids; and chromium.

     Many high-carbohydrate foods are believed to worsen acne, due to the spike in blood sugar caused by eating white sugar or refined carbs. This spike raises the level of insulin in the body, and elevated insulin levels may increase production of acne-causing hormones. However, some carbohydrates, such as those made with whole grains, digest more slowly than others, causing a gradual (as opposed to rapid) rise in blood sugar after eating. A system known as the glycemic index ranks carbohydrates and other foods according to the effect they have on blood sugar.

     The glycemic index ranks foods based on a scale of 0–100. Foods with higher glycemic index ratings break down quickly and cause a sharp spike in blood sugar. When blood sugar rises quickly, the body produces a surge of insulin to lower the amount of glucose (sugar) in the blood. Insulin is a hormone that helps the body take glucose out of the bloodstream and put it into cells, where it can be used for energy or stored in fat. Foods with lower glycemic index ratings break down more slowly and cause a more gradual rise in blood sugar, meaning that less insulin will be needed.

Foods that have a high glycemic index rating include:

• white bread
• white rice
• white potatoes, depending on how they are cooked
• beer
• corn products and some products containing refined sugars

     Foods with moderate glycemic index ratings include:

• whole grain breads and pastas
• brown rice
• sweet potatoes
• green peas
• many fruits (especially when eaten alone)
• yogurt

     Low glycemic index foods may be enjoyed often without worsening acne. These include:

• rye grain
• nuts
• legumes such as black beans and lentils
• green vegetables
• apricots
• cherries

     Foods that are high in fiber tend to have lower glycemic index numbers, because fiber takes longer to digest. Studies have shown that the presence of healthy fats, such as olive oil, can also slow digestion and keep blood sugar from rising too quickly.

Function

     Eliminating certain foods from the diet and increasing the amount of specific vitamins and minerals may help reduce the amount of sebum produced and prevent acne breakouts. However, the interaction between diet and acne is not a simple cause-and-effect relationship—if an oily food is eaten, the oil does not travel to the skin or cause it to be oily. However, high levels of fat in the blood may effect the production of hormones such as testosterone, and higher levels of hormones may cause acne to worsen.

Benefits

     Habits such as limiting sodium, processed foods, and saturated fats (found in fried foods) and increasing intake of whole grains, vegetables, and fiber are in line with federal dietary recommendations and support overall health. However, foods such as fruits and low-fat dairy products provide important nutrients like calcium and vitamin C, and eliminating entire food groups could potentially lead to vitamin or mineral deficiencies. People interested in the acne diet should consult with a physician or registered dietitian before starting the diet.

Precautions

     Some acne diets suggest zinc or vitamin A supplementation. People should always consult with their physicians before taking any supplements or other drugs. Zinc supplements can cause stomach upset, and authors of acne diet plans recommend no more than 30 mg of zinc per day to avoid this.

Pregnant women or those who may become pregnant should not take vitamin A supplements or any medications containing vitamin A, as excessive amounts of vitamin A may cause birth defects.

     Limiting the amount of dairy products in the diet may limit the amount of calcium consumed. A calcium supplement may be needed to ensure that daily dietary calcium requirements are met.

     Dietary supplements could potentially interact with medications prescribed for acne. Some acne medications contain retinol, a form of vitamin A. Taking a vitamin A supplement with these prescriptions can cause a dangerous buildup of vitamin A in the body.Dietary supplements

Risks

     There are few risks associated with an acne diet. Most relate to taking dietary supplements. Zinc may prevent the body from absorbing enough copper. To avoid this, consumers should look for supplements that specifically state that they do not prevent copper absorption.

    Vitamin A is a fat-soluble vitamin. That means that excess vitamin A is stored in the body rather than eliminated in the urine. Many acne prescriptions contain concentrated forms of vitamin A, but too much vitamin A can be toxic. Consult a doctor before taking vitamin A supplements.

Research and general acceptance

     There is no consensus on whether or not diet plays a role in causing or preventing acne. Many dermatologists do not believe that diet has a significant effect on acne. Early studies about diet and acne focused on specific foods believed to trigger acne breakouts. Most of these studies found no evidence that individual foods cause acne.

     Studies of the diets of ethnic groups that have a low incidence of acne form the basis of most of the acne diets. Studies of the diets of tribes in New Guinea, Paraguay, and the Bantu of South Africa, all of whom have little or no acne, found that they ate a primarily plant-based diet. Similar studies on populations in Japan and Korea support these findings.

     A 2005 study of over 45,000 nurses claimed a link between the amount of dairy products consumed and severity of acne; women who reported consuming higher amounts of dairy products also reported more severe acne. However, of the women who drank at least two glasses of milk a day, only 8% experienced more severe breakouts.

     The theory with the strongest support is that foods high on the glycemic index contribute to acne. Studies have shown that half of acne patients tested had abnormal glucose levels, and in another study, 80% of premenstrual women with acne had abnormal glucose metabolism. This data and others that show a high-carbohydrate diet increases the levels of testosterone in the blood have led to the recommendation of limiting consumption of refined carbohydrates as a means of treating acne.

     Several studies have compared the results of zinc supplementation with oral antibiotic therapy to resolved acne and found zinc to be almost as effective as the antibiotic tetracycline.

Resources

Goodless, Dean R. The Acne-Free Diet. Celebration, FL: New Paradigm Dermatology, 2005.

Logan, Alan C., and Valori Treloar. The Clear Skin Diet. Nashville: Cumberland House, 2007.

Perricone, Nicholas. The Acne Prescription: The Perricone Program for Clear and Healthy Skin at Every Age. New York: HarperCollins, 2003.

Adebamowo, C.A., et al. “High School Dietary Intake and Teenage Acne.” Journal of the American Academy of Dermatology 52, no. 2 (2005): 207–14.

Bae, Y.S., et al. “Innovative Uses for Zinc in Dermatology.” Dermatologic Clinics 28, no. 3 (2010): 587–97.

Bowe, Whitney P., Smita S. Joshi, and Alan R. Shalita. “Diet and Acne.” Journal of the American Academy of Dermatology 63, no. 1 (2010): 124–41.

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American Academy of Dermatology, 930 E Woodfield Rd., Schaumburg, IL 60173, (847) 240-1280, (866) 503-SKIN (7546), Fax: (847) 240-1859, MRC@aad.org, http://www.aad.org.

Deborah L. Nurmi, MS