You: On a Diet plus Collins GEM Calorie Counter Set. Michael Roizen F.

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

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

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

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

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

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

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

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

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

      FACTOID

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

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

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

      Fat Chance: The Other Major Risks

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

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

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

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

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

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

      When you reduce