Blood Pressure and the Brain – risk for Alzheimer’s?

Provided by Psychology Today

The next time a nurse inflates a blood pressure cuff around your bicep, pay attention. Those numbers are not just important for your heart, but for your brain as well.

It's becoming increasingly clear that high blood pressure, or hypertension, is at the root of much cognitive decline that has previously been attributed to aging. The more that scientists scrutinize brain function, and especially memory, the more they conclude that we have the ability to keep our memory and spirit strong well into old age. But it depends on how well we nourish our brain throughout life.

Hypertension is defined as blood pressure of 140/90 or above. The first number is the measurement of the blood's force against artery walls when the heart is beating. The second number is the pressure between beats. A person is hypertensive if either number is too high.

Most people think salt is the culprit in high blood pressure. In the vast majority of hypertensives, salt isn't the root of the problem. Only about one third of people with high blood pressure are what doctors call "salt sensitive."

"The rest of the folks can eat all the salt they want without seeing much change in their blood pressure," says Shari Waldstein, Ph.D., associate professor of psychology at the University of Maryland at Baltimore County, who studies the cognitive consequences of hypertension. People whose diets are not to blame can pinpoint the problem through a trial of medications that target differing pathways in the body. Blood pressure is affected by many of the body's systems, including kidney function, hormones such as insulin and the sympathetic and parasympathetic nervous systems.

Regardless of cause, high blood pressure is extremely dangerous, especially for people who don't know they have it, typically people who rarely see a doctor. Hypertension has few symptoms; some sufferers complain of headaches, nosebleeds or shortness of breath but for the most part the body suffers in silence.

High blood pressure does its damage by weakening the blood vessels, over time leading the inner lining to slough off. Vessels can be weakened to the point that they tear, causing sudden death or disability via a stroke or aneurysm. Hypertension can also lead to heart attacks.

But long before it creates a health emergency, hypertension takes a subtle toll on mental faculties. It can reduce attention, learning, memory and decision-making skills in ways that can be clearly seen in studies.

"Generally, whatever problems impact cardiovascular health also affect cognitive functioning," says Merrill Elias, Ph.D., a professor of epidemiology at Boston University who has studied hypertension for 35 years.

Indeed, some researchers now believe that a substantial amount of age-related mental decline has little to do with age and much to do with blood pressure. Waldstein says there's a large body of research linking hypertension directly to brain function, but scientists don't yet know how it causes damage at the cellular level.

Elias says high blood pressure exerts a constant stress on the brain and cardiovascular system that appears to be cumulative. "It's more of a problem for people who don't go to the doctor," he says. "Just think of it as your brain taking a hit every day."

The damage to the brain can come in a variety of forms. In the elderly, more than half of whom suffer from hypertension, the damage can be detected on MRIs in the form of "white matter lesions." These are pinpoint lesions in the brain's message-carrying axons that affect cognitive function, especially weakening memory and reasoning and significantly impacting quality of life.

High blood pressure can also cause small strokes that may go unnoticed, but which diminish the brain's capacity to function. Other people who have chronic hypertension actually have small spots on their brain where the tissue is dead, says Elias.

But that doesn't mean that high blood pressure is a disease of old age. For one thing, many people who are in their 20s and 30s suffer from it as well. It's especially important for younger people to control their blood pressure so that the damage doesn't start early and snowball over time.

But neither is high blood pressure inevitable with age. Blood pressure can be kept in check by keeping cholesterol low, not smoking and limiting salt. But perhaps the most important factor is keeping obesity at bay, a struggle most Americans are not winning.

"Weight is a biggie," says Elias. "The more you weigh, the more pressure there is."

Too much belly fat can be downright risky

By Michael Jensen, M.D., an endocrinology specialist at Mayo Clinic, Rochester, Minn.,

If you are carrying a few extra pounds — whether in the form of belly fat, love handles, a beer gut or potbelly — you're not alone. In recent years, the number of people who are overweight has increased dramatically worldwide. Two-thirds of American men are overweight or obese. But this is one case where following the crowd is not the best idea, because extra weight — especially belly fat — can be downright risky. And while women often put on extra pounds in the hips, thighs and legs, men are much more likely to gain belly fat.

How can you tell if you have too much belly fat?

Not surprisingly, how big around you are at the waist is a good indicator of whether you have too much belly fat. Although measurements that compare your hip and waist circumference (waist-to-hip ratio) or compare your height and weight (body mass index) are more precise and can be useful for research, your waist size alone can give you a pretty good idea of how much belly fat you have.

For most men, the risk factors for heart disease and other diseases increase with a waist size over 40 inches (102 centimeters).

To accurately measure your waist:

• Place a tape measure around your bare abdomen just above your hipbone.
• The tape measure should be snug — but not so tight it pushes into your skin.
• Check to make sure the tape measure is level all the way around.
• Relax, and measure your waist after you breathe out — no sucking in your belly!

Can you reduce belly fat with sit-ups?

Sit-ups will make your abdominal muscles stronger, sure. And, you may look thinner by building your abdominal muscles because you can hold in your belly fat better. But strengthening your stomach muscles alone will not specifically reduce belly fat.

There are no particular "spot" exercises that are best at reducing belly fat. But most people do lose belly fat before losing fat in other parts of their body when they get more exercise of any kind.

Is belly fat inherited?

While some men are more likely to put on extra pounds because of their genes, for the vast majority of men, the problem has a lot more to do with lifestyle than inherited traits. Simply put, when you take in more calories than you burn — the excess calories are stored as fat.

We've had a huge change in our environment. Men — and women — used to have much more active lifestyles. But our lifestyles today allow us to live and work with virtually no opportunity for physical activity. About 60 percent of American adults get no vigorous exercise in their leisure time at all. We are also eating larger amounts of high-calorie foods than we used to, such as "fast food" that is high in fat and carbohydrates. People are responding to this change in the way you'd expect — by gaining weight. Men need to be more active — to get out and keep moving.

Can you really get a beer belly from drinking?

We do know that there is a link between drinking excess alcohol and gaining belly fat — the "beer belly." However, it isn't just beer that can increase belly fat. Drinking too much of any kind of alcohol can have that effect. We know that alcohol is high in calories and increases appetite, but still aren't exactly sure why drinking too much causes increased belly fat in particular.

If you drink, the key is to drink in moderation. While increased belly fat is most noticeable in people who drink to excess, keeping it to less than two drinks a day will reduce the amount of calories you consume and help you avoid putting on belly fat. It is also better for your overall health.

Turning dreams of a baby into reality

Many couples experience fertility problems. Sometimes, having a child does not always happen as easily as expected. Unfortunately for many people, conceiving can be difficult.

Samitivej Sriracha Hospital in collaboration with Superior Assisted Reproduction Technology (A.R.T) from Sydney, Australia offers excellence in clinical expertise and state-of-the-art technology for fertility treatments to couples who are having fertility problems.

Since the first IVF baby over 29 years ago, assisted reproductive technology has been greatly enhanced, leading to better outcomes for couples desiring children. Present technology includes IVF or in vitro fertilization, a method of assisted reproduction where fertilization of a woman’s eggs is done outside of her body. The sperm provided by the male partner is afterwards mixed with eggs that have been aspirated from the woman’s ovaries. After a few days, one or more fertilized eggs are then transferred to the woman’s uterus (womb), with the hope that pregnancy will occur. This procedure has helped hundreds of couples to conceive and have healthy babies.

In addition to this, embryo testing for diagnosis of any genetic disorders before putting it back into the womb is also possible. This technique is called PGD or Pre-implantation Genetic Diagnosis. This involves the genetic testing of embryos created through IVF for harmful, heritable genetic conditions known to be present in the family of the couple seeking treatment. It allows couples previously at risk of producing a child with a genetic disorder to select the best quality embryo without a genetic disease for transfer.

Through the use of superior facilities and techniques Samitivej Sriracha Hospital offers fertility treatments that are customized to fit the individual patient and maximize her chances of pregnancy. These are treatments that help infertile couples not only conceive, but also help those who carry a mutation for single gene disorders such as beta thalassemia to have a healthy baby. Couples, who have an existing child with a variety of disorders, can select an embryo which is a HLA (Human leukocyte antigen) match to the child with the disorder. After the birth of the new baby, cord blood can be donated for stem-cell extraction to aid in the treatment of the baby’s elder sister or brother.

At Samitivej Hospital in Sriracha, one hour South of Bangkok, patients are treated with compassion and understanding as we work with couples to fulfill their dreams of building a family. These treatments will benefit not only couples with infertility problems but also couples requiring gender selection for medical reasons. These would also greatly benefit patients who have experienced repeated miscarriages or couples carrying a genetic disorder. Samitivej has now enabled couples to choose from a wide range of state-of-the art fertility techniques that would help patients turn their dreams of a baby into reality.

Avoiding unnecessary surgery

By Herb Denenberg

Here are more guidelines for avoiding unnecessary surgery and getting only high quality surgery you actually need.

1. Check out the hospital. In selecting a surgeon, remember that he will usually be tied to one or possibly several hospitals. So make sure both the surgeon and the hospitals where he is admitted to practice deliver quality care. Consumers' Checkbook publishes one of the best rating systems on hospitals: Consumers' Checkbook Guide to Hospitals, with rating of 4,500 hospitals. It rated hospitals in the 71 major Metropolitan Statistical Areas in the nation. Checkbook has a Web site at www.checkbook.org. You can see the ratings on the top 50 hospitals at www.modernmaturity.org.

The Checkbook ratings of 4,500 hospitals are based on medical and surgical mortality, accreditation score from the national organization that rates all hospitals, the opinions of physicians and the training programs available to the hospital's doctors.

The Joint Commission on Accreditation of Healthcare Organizations reviews hospitals against established standards, and after inspections, it rates them. The hospitals studied by Checkbook had ratings of 71 to 100. The commission has a Web site with information on hospitals and how to select them (www.jcao.org) as does the American Hospital Association (www.aha.org). The commission also maintains a site of hospitals out of this country at www.jointcommissioninternational.com. There is also a book on medical tourism (going out of the country to get surgery or other care). It is by Josef Woodman and is entitled Patients Beyond Borders. However, medical tourism is a subject beyond the scope of this guide.

There are many other books and periodicals that rate hospitals. One of the best-known ratings is published by the magazine, U.S. News and World Report.

More and more surgery is now carried out in doctors' offices and outpatient clinics, some of it quite substantial and serious. For example, there are plastic surgeons that do most of their work in their own office. This should be approached with special caution, because unlike a hospital-based or hospital-related facility, the doctors' offices are subject to little or no regulation. These surgeons may be top quality, but make sure they have the emergency-room type capabilities on premises in case something goes wrong.

2. Make your visit to the doctor count. Often the excitement and stress of a visit to a doctor means that the patient remembers little or nothing. So take a long a relative or friend who can perhaps take notes or help you remember what is said. You may want to also take notes or perhaps tape record the entire visit. A doctor should not object to that, as they know better than others how little many patients remember from a visit.

Take a list of questions with you and get answers to all of them. For example, what will the surgery be likely to accomplish and what are the chances of success? What are the other benefits and risks? How long does it take to recover, and what is your situation likely to be during the recovery process? If you don't understand something, ask the doctor to explain it again. If you are in doubt about your understanding, try to restate the doctor's answer and ask whether you got it right.

You want to know how many times the surgeon has performed the operation, and what has his success rate been. The same for the hospital because it is well established that especially for complex operations, practice makes perfect.

Depending on your insurance situation, you may want a clear understanding about fees. This is most important in the case of uninsured surgery, most notably plastic surgery, which is rarely covered. If the fees seem to high, don't hesitate to ask the doctor if some adjustment downward is possible.

3. Get a second opinion. And if you think you need more information or advice, don't hesitate to get a second, a third or whatever it takes. When your life and health are on the line, invest in what it takes to get the right medical outcome. Many insurance companies and HMOs will pay for second opinions and even multiple opinions beyond the second one. In some cases, they may require a second opinion as a condition of paying for the operation.

A second opinion serves multiple functions. It sheds light on whether the initial recommendation makes sense or is the best alternative. It also educates the patient in the process, providing additional understanding, raising questions that need to be answered, and clarifying alternatives and risks. It may also educate the surgeon when he has the benefit of other opinions.

But you have to make sure the second opinion isn't just a rubber stamp of the first opinion. You don't want the surgeon's partner or other associate giving the second opinion. You should try for a totally independent opinion and perhaps another viewpoint. So you may want to go to another office or to a doctor admitted at other hospitals. In some cases, you may want to go out of town.

Keep in mind that doctors are extremely reluctant to criticize a fellow practitioner. So sometimes it is a good idea not to let them know what the recommendation was that you are checking.

But you want that second opinion from a true expert. Many advise going to one of the academic medical centers of excellence. Here in eastern Pennsylvania, you have access to some of the nation's leading surgeons and leading institutions in Philadelphia, Baltimore, New York and even beyond if necessary.

You may want to get opinions from different kinds of specialists. For example, urologists are likely to recommend surgery for prostate cancer. Radiologists and radiation oncologists are most likely to recommend radiation. Other specialists might recommend hormone treatment, perhaps no treatment at all or perhaps some other treatment.

Some hospitals have so-called second opinion services to bring together a large interdisciplinary team of doctors and other health-care providers to render a second opinion (or perhaps multiple opinions if the team doesn't agree). This is an efficient method of getting many different viewpoints from many different experts wrapped into a second opinion. For example, the Lehigh Valley Hospital and Health Network maintains a Urologic Cancer Second Opinion Service. The main drawback of this approach, despite obvious advantages, is that the group usually comes from the same hospital.

Experts agree that second opinions often change the initial thinking of the patient. The Johns Hopkins Family Health Book cites a study showing that the rate of Caesarian sections dipped from 18 to 11 percent when second opinions were required. Even if the second opinion doesn't change the decision, as we've seen, it is still likely to add to the understanding of the medical problem and better equip the patient to make a sound decision and also to carry through with the recommended treatment.

Another kind of second opinion involves the pathology report. Just as doctors often disagree over the need for surgery, there can be dramatic disagreement over a pathology report. One expert may say it's cancer, the other that it is not. So the second opinion on pathology is sometimes as important or even more important than the surgery opinion itself. Whenever findings are ambiguous or otherwise subject to doubt, a second opinion on pathology is a good idea.

When opinions differ, the patient has to make an informed decision, often with the help of the family doctor, other advisers and the doctors whose opinions are in conflict.

4. Be especially on guard if one of the operations most often unnecessarily performed is proposed for you. Among those, according to Charles Inlander of the People's Medical Society, are hysterectomies, Caesarian sections, cataract surgery and prostatectomy (removal of the prostate).

Some critics would add that women should also be especially wary of surgery because of the surgical statistics involving operations performed only on females, which seem to be done in excessive numbers. Laurence and Weinhouse, in their book Outrageous Practices, write, "A list of the country's most common inpatient operations is dominated by surgery performed exclusively on women. ... That the most common operations in the country are procedures for which only half the population is eligible is truly astonishing."

5. The patient, not the doctor or surgeon, is supposed to - and is entitled to - make the decision on whether to have surgery. Listen to the experts. But remember, it's still your decision. You're the one that will have to live the consequences of surgery, whether good or bad. You also want the decision to reflect your values and objectives. You're entitled to have the facts you need and you're entitled to decide whether or not to go ahead with the surgery. As the title of the old television show goes, "This is your life."

Herb Denenberg, a former Pennsylvania insurance commissioner and professor at the Wharton School, is a longtime Philadelphia journalist and consumer advocate. He is also a member of the Institute of Medicine of the National Academy of Sciences. His column appears daily in The Bulletin. You can reach him at advocate@thebulletin.us.

It's not just what you eat, but also what you write

It's scientifically proven: The key isn't just what you eat, it's what you write.

If you're anything like me, you have no idea how much food you take in on a day-to-day basis. Thanks to multitasking, grabbing grub on the go, parking myself in front of the TV while munching, and various other weight-loss crimes, I often barely register that I'm eating. Take last week: I was totally oblivious that I was popping jelly beans into my mouth until my nephew complained that I was about to polish off his bag (sorry again, Jake). It's tough to watch every mouthful you eat, even if you're an expert. Researchers at Louisiana State University asked dietitians to estimate their daily caloric intake — and even the professionals low balled the number by 10 percent. That may explain why it's so hard to shed pounds, no matter how good the plan is.

But there's a simple solution: Keep a food diary. Studies show that a journal doesn't just aid weight loss — it turbo-charges it. When researchers from Kaiser Permanente Center for Health Research followed more than 2,000 dieters who were encouraged to record meals and snacks, they found that the single best predictor of whether a participant would drop weight was whether the person kept a food diary. It trumped exercise habits, age, and body mass index. The number of pounds people lost was directly related to the number of days they wrote in their log. (It's no coincidence that Weight Watchers, one of the most successful diet programs, asks participants to track what they eat.)

Here are five more reasons to start a journal today — even if you swore off diaries in middle school.

1. You'll get a reality check about how many calories you consume.

Americans typically underestimate their daily intake by about 25 percent, reports nutritionist Carrie Latt Wiatt, author of Portion Savvy. The situation gets even more complicated when you eat out. In a 2006 study led by Cornell University, 105 diners in fast-food restaurants were asked how many calories were in their orders. For the small items, almost everyone guessed correctly; for the larger orders, the diners underestimated the calories by a whopping 38 percent. It may be an issue of perception, says study author Brian Wansink, Ph.D. The larger the quantity, the harder it is to make an accurate guess — the same is true for distances and heights.

Even professionals can be tricked by hefty portion sizes. When an NYU researcher asked 200 dietitians to estimate the calorie count of four popular restaurant dishes, the experts lowballed the number for each by a whopping 250 to 700 calories.

So stop assuming and start calculating. A good manual, like the classic Calorie King Fat & Carbohydrate Counter, makes it easy by giving you the calorie counts and fat grams for a huge number of foods. Or try nutritiondata.com, which also lists the stats for many foods.

2. You'll cut back on between-meal munching.

Make a mental checklist of what you ate yesterday. Sure, you can probably remember breakfast, lunch, and dinner — but what about that mini Snickers you snatched from your coworker's stash? Or that spoonful of mashed potatoes you took off your husband's plate?

It's easy to overlook bites, licks, and tastes (known as "BLTs" to professionals). But that's a huge mistake — there are 25 calories, on average, in each mouthful. Translation: Six little bites a day add up to around 15 extra pounds a year.

"I remember one client who was keeping a diary and couldn't understand why she wasn't losing weight," says Bethany Thayer, R.D., spokesperson for the American Dietetic Association. "We were discussing the problem when she took out a peppermint. I asked her how many she ate every day, and she said, ‘A bag.' They're nine calories each, but the whole bag is several hundred."

Writing everything down can also help you make smarter food choices. If you often order a Starbucks Grande Dulce de Leche Latte, entering the data will bring you face-to-face with the fact that your beloved drink packs 440 calories, versus 23 calories for the same-size regular coffee with milk.

3. You'll discover where your diet detours.

"I thought I ate a lot of vegetables — it seemed like I was constantly cooking spinach, broccoli, or Brussels sprouts," says Melissa Smith, a 32-year-old mom from Omaha who's been keeping a food diary for the past 18 months. "But looking back over a few weeks of my journal, I was surprised to realize that I was only eating veggies once or twice a week." So she made salads a regular part of dinner and noticed that it helped her eat less of her entrée. Her analysis and follow-up action paid off: She's lost more than 27 pounds.

A balanced diet is the key to weight loss, says Suzanne Farrell, R.D., who owns Cherry Creek Nutrition in Denver. "Whole grains, low-fat dairy, green vegetables, orange veggies, beans, nuts — science shows that we need to eat these regularly to reach a healthy body weight. So when I flip through my clients' journals, I always look for what I'm not seeing."

To find out how many servings of each food group you should be eating, go to mypyramid.gov. This tool will calculate the correct portions based on your age, gender, height, weight, and level of physical activity. It'll also tell you the number of calories you should aim for daily to lose weight.

4. You'll learn why you pig out.

Experts suggest that, to help break bad habits, you record not only what you eat, but the circumstances that prompt you to eat. For example, maybe you indulge in more sweets at work because you sit close to the vending machine. Maybe you have a milkshake several times a week because you pass Wendy's on the way home. Or maybe every time you worry about money, you retreat into the kitchen for chips.

When you begin to notice these patterns, you can figure out ways to change them. If the vending machine is a constant temptation, stock your desk drawers with fruit and granola bars. If you can't resist a fast-food sign, MapQuest a new route to work. If you eat when you're under pressure, steer clear of snacks and take a short walk instead (it's a scientifically proven stress buster).

Another bonus: "When you increase awareness of what's going into your mouth," says Thayer, "you'll feel fuller sooner than if you were just mindlessly munching."

5. You'll see real results — quickly.

Your food diary can be as revealing as the one you kept in fifth grade. For example, to get a glimpse into how much you've improved your diet, compare the entries in week one (Twinkie-filled) to week four or five (ideally, veggie-filled). You can also discover which decisions translated into pounds lost — for instance, that week you had fish for dinner twice might've helped you lose weight.

Food journals also let you give yourself credit where credit is due (personally, I reward myself with a gold star each day I resist eating candy). And that positive reinforcement is essential for shedding pounds.

How to Write Off Pounds: A Cheat Sheet to Get Your Food Diary Started

Choose Your Medium

If you're using pen and paper, buy a regular spiral notebook. Or go for a pre-organized book like the DietMinder. Computer addicts should check out online journals, such as myfooddiary.com ($9 per month) and nutrihand.com (free for a basic plan; $10 per month for extras). If you can't live without your PDA, visit weightbydate.com and download the software (starting at $19).

Start Recording

The crucial info to write down: the time you ate, what you ate, and how much you ate. Make a habit of jotting notes right after you eat. "If you wait until the end of the day, it's too easy to leave things out," warns Suzanne Farrell, R.D. Tracking your diet online? Remember to take paper with you to restaurants, so you can write down every ingredient and calculate its nutritional content afterward.

You may also want to invest in measuring cups — they'll help you learn what a one-and-a-half-cup portion looks like (it's a lot less than you think) — as well as a calorie-counter book and a calculator. Armed with these tools, you can track your calories like a nutritionist would.

Get Personal

Customize your diary so it reflects the info that's most useful to you. For example, if you're someone who eats whenever food is in front of you, create columns in your journal to rate how hungry you were before and afterward. If you snack your way through hard days, add a column to describe how you were feeling when you ate. Trying to figure out when you're most drawn to junk food? Record where you were when you indulged and what was going on at the time. Also, if you're trying to break a specific habit, like scarfing down ice cream at night, create a column for that, so you can give yourself a star for each day you resist the urge.

Be Honest

Include every single bite, lick, and taste (anything larger than a crumb counts). And don't forget to keep track of your sips. Even the most diligent diarists often forget to include the glass of white wine they had at dinner (120 calories) and their 3 p.m. can of Coke (155 calories).

Find Your Favorites

Counting calories is easier for creatures of habit: If you have a bowl of cereal for breakfast almost every morning or a turkey sandwich three times a week, you won't have to look up the number each time.

Keep Your Diary Close

"I'm forgetful, so I always need to put the journal where I can see it — on my kitchen table, on my desk at work. I carry it a lot in my hand, too, as a reminder," says Melissa Smith, 32, of Omaha, who lost 25 pounds keeping a food diary.

You can also try this trick from Maryellen Mealey, 42, of Chicago, who lost big (188 pounds) keeping a journal: "I made a deal with myself that I wouldn't eat anything unless I wrote it down first. It's obsessive, but I'm a mindless snacker and putting everything in the book really helped me be more conscious," she says.

Examine the Evidence

No matter how diligent you are, a food log won't help in the behavior-changing department if you don't analyze it. At night, sit down and calculate how many calories you consumed. Tally up what food groups you're eating, and make adjustments. (A big plus of online tools is that they do a lot of the analysis for you, totaling everything with a click of a button and often giving you charts to show what you can improve.)

You may also want to consult a registered dietitian. A professional may see things in your diary that you don't (cost: usually $50 to $300 for an initial consultation). A two-year study from Fred Hutchinson Cancer Research Center in Seattle showed that participants who consulted a dietitian had better success keeping off weight than those who followed their usual diet.

Reward Yourself

"I read that it takes 28 days to build a habit," says Mealey. "So when I have a new goal — like eating veggies more often — I do it for a month, then treat myself by shopping or going to a movie with a friend. Rewards give me an incentive to keep going."

Weight loss - just the facts

Keeping is simple is the best way to not only lose weight, but keep it off, too. There are some clear-cut certainties, rules, unchanging facts and formulas regarding weight loss that really never vary. If followed, you will lose weight.

So, for just a moment let’s look only at the facts - take emotion, psychology, and personal history out of the equation, and let’s look at the simple rules of weight loss.

Just the Facts:

1. If you spend more calories than you take in, you will lose weight. Just like your bank account, if you spend more than you put in, your bank account or, in this case your body, will shrink.

2. Adding (more) exercise, and not changing your diet at all, will cause weight loss only if you are burning more calories than you are taking in (as it states in rule 1). So if you are exercising enough to push the equation over to the deficit column (where you are basically in the red with calories - spending more than you are taking in), then you will begin to lose weight.

3. Reducing your food/caloric intake and not adding exercise will result in weight loss only if you have reduced food intake enough to tip the energy balance to the negative, whereby you are taking in less than you are expending.

4. Obviously, adding exercise, and reducing your caloric intake, will make it more likely that your equation will swing over to the negative – the weight loss side. And of course, the greater the difference between intake and expenditure, the faster the weight loss (or gain, depending on which way the equation swings).

To maximize your health and weight loss benefits, add exercise and reduce food intake.

I am not belittling the difficulty of losing weight, but there is a kind of simplicity to the plain facts. Still, few of us, if any, are able to be totally objective and mathematical about weight loss.

We have managed (or our society has) to make our bodies and our weight, emotional and social and psychological subjects, making it tough to take weight off simply, and harder to keep it off. And believe me, I understand, I am no different from you.

But I do realize one thing: Whether you are agonizing over losing 2 lbs or 200 lbs, looking at weight loss as a formula can provide you with some simple, practical, and effective steps that can be taken. And just knowing that this formula is fact, and works, just looking at the black and white of it and seeing that there are absolute and realistic steps that will lead to weight loss, may help someone, maybe you, who is struggling with body issues and weight loss.

So if you can, even for a brief period of time, separate out the discomfort, frustration, personal reasoning, and self resentment from prior attempts at weight loss that have failed, you may find the objective willingness to just keep moving forward in the equation – taking out a few calories here, adding a little exercise there, and so on – until the weight starts to fall away. And it will, if you stick to the rules.

I hope this helps you stay, or get back on, your road to better fitness.

Peace and Happy Trails-
Debbie Rocker

British woman had a 4cm hole in her heart

A woman dismissed as lazy by her PE teachers at school has survived for 23 years with a 1.5in (4cm) hole in her heart.

Louise Banks would collapse during physical exercise and was branded a "fainty child".

The condition, dismissed as epilepsy by doctors, could have killed her.

But a new GP sent her for an ultrasound scan which revealed the hole, four times bigger than that normally considered a large defect.

Miss Banks, 23, had open heart surgery and is now home in Exeter, Devon, with her partner Matthew Folland, 30, and their son Ben, four.

She is looking forward to a normal life, playing sport and dancing.

She said: "I always knew there was something wrong, I could feel my heart start and stop. It was like a baby wriggling in my chest.

"I don't feel angry with the doctors for missing it."