Resistance Exercise

Author: Richard Weil, MEd, CDE
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

What is resistance exercise?

Resistance exercise is any exercise where muscles contract against an external resistance with the objective of increasing strength, tone, mass, and/or muscular endurance. The resistance can come from dumbbells, weight machines, elastic tubing or bands, cinder blocks, cans of soup, your own body weight (for example, pushups), or any other object that forces your muscles to contract. Results occur when you train consistently over time.

What are types of resistance exercise?

There are several types or styles of resistance exercise. Power lifting (a weight-lifting competition in which participants compete in the squat, dead lift, and bench press), Olympic weight lifting (the type you see on TV where athletes lift the weight overhead), strength training (lifting weights to get stronger), and weight lifting (the sport of lifting heavy weight, typically fewer than six repetitions). Weight lifting should not be confused with "weight training," which is the general lifting that you do at the gym. I'll discuss the basic principles of all resistance exercise in this article.

What is progressive overload?

One of the fundamentals of resistance exercise is the principle of progressive overload. Progressive overload means that you increase the workload gradually over time as your muscles accommodate to the resistance with the objective of gaining strength and/or mass. For example, suppose that you've been lifting biceps curls for two weeks with 12 pounds, 10 repetitions, and then at week three, 12 pounds is easy and you can lift more. According to the principle of progressive overload, at this point, you would increase the weight if strength improvement is your goal. Your strength will remain the same if you keep the weight the same.

What is volitional fatigue?

Another fundamental of resistance exercise is to lift each set to volitional fatigue. Volitional fatigue is the point in the set where you can't lift one more rep without cheating it up (using momentum, leaning way back, etc.). Although there isn't a large body of research to prove that lifting every set to volitional fatigue is necessary for maximal benefit, most strength and fitness professionals agree that working to exhaustion changes muscle fibers in a way that leads to significant growth.

What are sets and repetitions (reps)?

Sets and reps are the terms used to describe the number of times you perform an exercise. A rep is the number of times you perform a specific exercise, and a set is the number of cycles of reps that you complete. For example, suppose you complete 15 reps of a bench press. You would say you've completed "one set of 15 reps." A set can be any number of reps, so if you complete 10 reps of a bench press, you would say you've completed "one set of 10 reps," and if you complete just five reps, then that would be "one set of five reps."

How many sets should I do?

Research is clear that beginners can develop as much strength performing one set per exercise as they can performing three sets. This is because beginners typically start off with a low level of strength which leaves room for improvement (called an "adaptive window"). Muscles respond quickly to resistance exercise in untrained individuals because the adaptive window is large. This is great news because the motivation to continue working out is reinforced by immediate and significant improvement. However, after three to four months, strength gains will level off and then multiple sets (three to five per exercise) are necessary if more improvement is desired.

How do I go about lifting for strength?

Muscular strength is gained when you lift heavy. For pure strength development, keep the resistance heavy enough so that you cannot lift more than eight reps, and then follow the progressive overload principle and increase the weight when you can lift more then eight. Expect your reps to drop whenever you increase the weight. For example, suppose you've been doing 10 reps of bench presses with 175 pounds and you increase the weight to 190 pounds. Because the weight is heavier, you will lift fewer reps, but as your muscles accommodate, you will again be able to lift more reps. When strength is your priority, you can experiment with heavy days. Heavy days are when you lift as much as you can one time. This is called a one-repetition maximum (a 10-rep maximum would be the weight you can lift 10 times to fatigue). Heavy days are challenging, so I don't recommend them more than once a week so that your muscles have time to recover and grow.

How do I go about lifting for tone and endurance?

Tone and endurance is maximized when you keep the weight light enough to lift 12-15 reps. Again, the principle of progressive overload applies. That is, increase the weight when 15 reps become easy.

Lifting for strength, tone, and endurance (general conditioning)

Keeping the reps in the eight-to-12 range emphasizes a combination of strength, tone, and endurance. This is a realistic quantity of training for most individuals. The recommendation in the American College of Sports Medicine Position Stand, "Progression Models in Resistance Training for Healthy Adults," is for beginners to lift eight to 12 reps, and for the range to widen to one to 12 reps for intermediate and advanced training. Although research supports the eight to 12 recommendation, I believe it's prudent for beginners to start with 12-15 reps to reduce the risk of injury, and then the weight can be increased after a few weeks when the muscles have accommodated. Keep in mind that strength, tone, and some mass still accrue by training with reps in the 12-15 range, and so you don't have to lift heavier than that if you prefer not to. You can read the entire ACSM position stand document here: www.acsm-msse.org/pt/pt-core/template-journal/msse/media/0202.pdf.

How many days should I lift?

Beginners, because of their wide adaptive window, will accrue significant benefits with two to three days of training. Advanced lifters need at least three days per week, and typically more for significant gains because they are already so strong (more benefit takes more effort). It's not uncommon for bodybuilders and other strength athletes to train four to five days per week.

How do I know how much weight to lift?

Trial and error is the way to determine how much weight to lift. Select a weight that looks close to what you think you can lift based on your goals. If general conditioning is your goal, then select a weight you think you can lift eight to 12 reps (or 12-15 reps for beginners). If you can lift it 25 times with ease, then it's too light, and if you can lift it only four times, then it's too heavy. There are no formulas to calculate this. Simply decide what your goal is so you know how many reps to lift, take a guess by looking at the weights, and then give it a try. You'll get good at this quickly.

How much do I increase?

Unlike aerobic conditioning where duration and intensity is increased by 10%, increases in the weight you lift aren't prescribed with such precision, partly because muscle groups vary so much in size and strength, and partly because of the practical matter of the weights available at the gym. Typically you increase to whatever dumbbell is next on the rack (or plate on a weight machine), and so if you're lifting 12 pounds with biceps curls, then the next dumbbell available is usually 15 pounds. There is an option to increase in smaller increments with dumbbells by using an accessory called a donut, a magnetic 1¼ pound weight that attaches to the end of the dumbbell (they come in other weights besides 1¼ pounds as well). Weight machines have half weights for the same purpose. Ask your gym manager to purchase donuts if they don't have them.

Free weights vs. machines

Dumbbells and barbells are free weights. They are "free," or untethered, unlike a weight machine where the weight stack is connected by cables to cams and pulleys and only move in one direction. There are advantages to both styles of lifting.

Weight machines:

1. Weight machines are easy to learn and use.

2. There are some exercises you can do with a machine that you can't do with a dumbbell. For instance, cable rows would be difficult to replicate with free weights. You could do bent over dumbbell rows, but they won't be quite the same. For my money, cable rows feel smoother than any exercise in the gym!

Free weights:

How important is the order in which I perform my exercises?

Research shows that the order of exercises can significantly affect strength development, and so it is standard practice to set up a resistance-training routine to work large muscle groups before smaller ones. The reason is that a small muscle group that fatigues first will be the weakest link in the chain and prevent large muscle groups from working to full capacity. For example, if you isolate and fatigue your biceps muscles with curls, and then try to do lat pull-downs (which use biceps, shoulders and back), you won't be able to do as much work for your shoulders and back because your biceps will already be fatigued. In the starter programs below, you will see examples of working large to small muscle groups.

What are weight-lifting splits?

A split refers to the practice of dividing workouts by muscle group. For example, you can work all upper body muscles on one day and lower body on another. Or you could work all the pushing muscles (triceps, pecs, anterior shoulder) on one day, and the pulling muscles (biceps, lats, rhomboids, posterior shoulder) on another. There are many possible combinations of splits, and I suggest that you experiment to find what works best for you. In the starter programs below, you will see examples of a split.

How much should I rest between sets and between days?

The amount of time you rest between sets can significantly affect your results. Rest up to three minutes between sets if pure strength development is your priority, and one to two minutes if muscular endurance and tone is your priority. Three minutes permits the muscles to recover from fatigue so that you can generate enough energy to perform another maximal lift on the next set. Benefits are not discreet. That is, there is carryover from one style to another, so that if you rest just one minute between sets, you will still increase endurance and tone, and if you rest three minutes between sets, you will still gain endurance and tone. The number of days that you rest between workouts can also affect your results. The standard advice is to rest two days between workouts. This makes sense if you push hard, since the muscles need time to recover and grow. In fact, it can take up to five days for muscles to fully recover from a tough workout, and if you push too hard, you might experience symptoms of overtraining (fatigue, loss of strength, inability to lift 100%, chronic soreness, and persistent injuries). It's okay to lift two days in a row. Experienced lifters do it all the time by splitting their workout so that they work one muscle group per day. For example, they might work their upper body on one day, and legs on another, or back muscles on one day, and chest muscles on the next. Experiment with different splits until you find what works best for you.

The golden rule is to remember that muscles recover and grow during downtime, not when you train, and so it's important to take time off. You know you need more rest if you have any symptoms of overtraining.

I wrote a response to this question in the Ask the Experts section that you can find here: www.medicinenet.com/script/main/art.asp?articlekey=77873. I mentioned in my response that there is no research to show the proper form for any resistance exercise. People are built and move differently, and so you need to listen to your body when you perform resistance exercises and make sure that you feel it in the muscles that you want to work. The basics rules I propose in my response are (1) take your time and lift mindfully, (2) feel it in the belly of the muscle you're trying to work, and not in the joints, and (3) select weights that your body can handle without having to cheat or force the weight up (leaning way back, using momentum, etc.).

What are the benefits of weight lifting? Is it ever too late to start?

New benefits of resistance exercise seem to be discovered all the time. Research to date shows that resistance exercise is associated with improvements in all of the following:

• muscular strength and endurance
• functional capacity and ability (falling, climbing stairs)
• blood pressure
• osteoporosis
• sarcopenia (loss of muscle as we age)
• low back pain
• insulin resistance and glucose metabolism
• resting metabolic rate
• body fat
• psychological well-being

Is it ever too late?

It's never too late to start a resistance-exercise program. In a classic study in a Boston nursing home, 100 residents ranging from 72 to 98 years of age performed resistance exercise three times a week for 10 weeks. Muscle strength increased 113%, walking speed increased by almost 12%, and thigh-muscle area increased 2.7%!

Weight-lifting programs

You'll find two starter programs below. They are broken up by muscle group and are three days per week. You can experiment with splits, exercises, and the number of days per week. I suggest 12-15 repetitions and one to three sets per exercise for beginners (remember, you can gain significant strength with just one set). I've included more than one exercise for each muscle group. You can stick with one exercise if you like, or experiment with more than one. Use the principle of progressive overload and increase the weight when you can perform 15 reps easily. If you're using elastic tubing, start with the tube that you can lift 12-15 times to fatigue, and then increase when you get stronger.

Day 1: Chest (bench press with bar or dumbbell press, flies, pushups), triceps (bench dips, kickbacks)

Day 2: Back (bent-over rows), biceps (curls, standing or seated)

Day 3: Shoulders (lateral raises, front raises), legs (squats, lunges)

Here's a different split.

Day 1: Chest (bench press with bar or dumbbell press, flies, pushups), back (bent-over rows, pull-downs)

Day 2: Biceps (curls, standing or seated), triceps (bench dips, kickbacks)

Day 3: Shoulders (lateral raises, front raises), legs (squats, lunges)

It's worth it!

Resistance exercise is worth it. You'll gain strength, endurance, and confidence. It's feels great to feel strong, and I encourage you to give it a try! Remember, it's never too late to start!

Last Editorial Review: 4/19/2007

Dangerous Supplements

By Consumer Reports
Tue, Aug 03, 2010

We Americans do love our dietary supplements. More than half of the adult population have taken them to stay healthy, lose weight, gain an edge in sports or in the bedroom, and avoid using prescription drugs. In 2009, we spent $26.7 billion on them, according to the Nutrition Business Journal, a trade publication.

What consumers might not realize, though, is that supplement manufacturers routinely, and legally, sell their products without first having to demonstrate that they are safe and effective. The Food and Drug Administration has not made full use of even the meager authority granted it by the industry--friendly 1994 Dietary Supplement Health and Education Act (DSHEA).

MORE FROM CONSUMER REPORTS

• 11 supplements to consider
• How to choose the right multivitamin

As a result, the supplement marketplace is not as safe as it should be.

• We have identified a dozen supplement ingredients that we think consumers should avoid because of health risks, including cardiovascular, liver, and kidney problems. We found products with those ingredients readily available in stores and online.

• Because of inadequate quality control and inspection, supplements contaminated with heavy metals, pesticides, or prescription drugs have been sold to unsuspecting consumers. And FDA rules covering manufacturing quality don’t apply to the companies that supply herbs, vitamins, and other raw ingredients.

• China, which has repeatedly been caught exporting contaminated products, is a major supplier of raw supplement ingredients. The FDA has yet to inspect a single factory there.

The lack of oversight leaves consumers like John Coolidge, 55, of Signal Mountain, Tenn., vulnerable. He started taking a supplement called Total Body Formula to improve his general health. But instead, he says, beginning in February 2008, he experienced one symptom after another: diarrhea, joint pain, hair loss, lung problems, and fingernails and toenails that fell off. “It just tore me up,” he said.

Eventually, hundreds of other reports of adverse reactions to the product came to the attention of the FDA, which inspected the manufacturer’s facilities and tested the contents of the products. Most of the samples contained more than 200 times the labeled amount of selenium and up to 17 times the recommended intake of chromium, according to the FDA.

In March 2008 the distributor voluntarily recalled the products involved. Coolidge is suing multiple companies for compensatory damages; they have denied the claims in court papers. His nails and hair have grown back, but he said he still suffers from serious breathing problems.

The Dirty Dozen

Working with experts from the Natural Medicines Comprehensive Database, an independent research group, we identified a group of ingredients (out of nearly 1,100 in the database) linked to serious adverse events by clinical research or case reports. To come up with our dozen finalists, we also considered factors such as whether the ingredients were effective for their purported uses and how readily available they were to consumers. We then shopped for them online and in stores near our Yonkers, N.Y., headquarters and easily found all of them for sale in June 2010.

The dozen are aconite, bitter orange, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germanium, greater celandine, kava, lobelia, and yohimbe. The FDA has warned about at least eight of them, some as long ago as 1993.

Why are they still for sale? Two national retailers we contacted about specific supplements said they carried them because the FDA has not banned them. The agency has “the authority to immediately remove them from the market, and we would follow the FDA recommendation,” said a spokeswoman for the Vitamin Shoppe chain.

Most of the products we bought had warning labels, but not all did. A bottle of silver we purchased was labeled “perfectly safe,” with an asterisked note that said the FDA had not evaluated the claim. In fact, the FDA issued a consumer advisory about silver (including colloidal silver) in 2009, with good reason: Sold for its supposed immune system “support,” it can permanently turn skin bluish-gray.

Janis Dowd, 56, of Bartlesville, Okla., says she started taking colloidal silver in 2000 after reading online that it would keep her Lyme disease from returning. She says her skin changed color so gradually that she didn’t notice, but others did. “They kept saying, ‘You look a little blue.’”

Laser treatments have erased almost all the discoloration from Dowd’s face and neck, but she said it’s not feasible to treat the rest of her body.

Under the DSHEA, it is difficult for the FDA to put together strong enough evidence to order products off the market. To date, it has banned only one ingredient, ephedrine alkaloids. That effort dragged on for a decade, during which ephedra weight-loss products were implicated in thousands of adverse events, including deaths. Instead of attempting any more outright bans, the agency issued warnings, detained imported products, and asked companies to recall products it considered unsafe.

Consumer Reports has no relationship with any advertisers on Yahoo!

Copyright © 2006-2010 Consumers Union of U.S., Inc. No reproduction, in whole or in part, without written permission.

Natural Ways to Boost Your Metabolism

• by LIVESTRONG.COM, on Wed May 26, 2010 1:03pm PDT

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A fast metabolism is critical to burning fat and managing body weight. While some dieters use diet pills to speed up their metabolisms, the risks and side effects of these drugs make them risky. You can use some safe and natural methods to speed up your metabolism.

Gain Muscle

The American Council on Exercise recommends resistance training for weight management. Think of your muscles as your body's engine. The bigger your engine, the more energy you can burn. Muscle, unlike fat, is active tissue that raises your metabolism just by being there. Adding a resistance training program is a sure method of naturally raising your metabolism. To make the most out of your time in the gym, train three days per week, training your entire body during each session. Use basic, compound exercises such as the leg press and shoulder press.

Keep Hydrated

Inadequate water intake can slow your metabolism. Water is responsible for several metabolic processes, including digestion, waste management and temperature regulation. The Mayo Clinic recommends drinking 2 liters of water daily. You can fight hunger as well as raise your metabolism by drinking a glass before each meal. To provide an extra boost, make sure your water is ice cold. Your body burns extra calories heating it up to room temperature.

Cardiovascular Exercise

Cardiovascular exercises such as walking, jogging and cycling are all effective ways to burn calories and keep your metabolism stoked. If you are just starting out, use a low-impact, low-intensity exercise such as brisk walking or moderate cycling. With more experience, you can graduate to jogging or intense cycling like spinning.

Coffee

Whether you realize it or not, you might already be waking up to an effective natural metabolism booster. The caffeine naturally present in coffee raises metabolism and can improve fat oxidation. Drinking a cup before exercise can also improve alertness and help fight fatigue.

References

• The American Council on Exercise: Strength Training 101
• The Mayo Clinic: Water: How Much Should You Drink Every Day?

LIVESTRONG.COM is designed to inspire people to change their lives, help themselves and help others. For more on this topic, visit http://www.livestrong.com.

Related Articles on LIVESTRONG.com:

• 10 Ways to Boost Your Metabolism
• Simple Ways to Boost Your Metabolism
• Healthy Ways to Boost Your Metabolism

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About this Author
Based in the Greater New York area, David Kirschen is a 15-year veteran of the fitness industry. He is co-author of "The Business and Practice of Personal Training" and has lectured to countless fitness professionals. Kirschen holds a degree in physical education from SUNY Cortland.

Why You Can't Lose Those Last 10 Pounds

by: Stephen Perrine and Heather Hurlock

Why traditional diets don’t work anymore

Because high school biology was likely a while back, here’s a quick refresher: The endocrine system is made up of all the glands and cells that produce the hormones that regulate our bodies. Growth and development, sexual function, reproductive processes, mood, sleep, hunger, stress, metabolism and the way our bodies use food — it’s all controlled by hormones. So whether you’re tall or short, lean or heavy — that’s all determined in a big way by your endocrine system.

But your endocrine system is a finely tuned instrument that can easily be thrown off-kilter. "Obesogens are thought to act by hijacking the regulatory systems that control body weight," says Frederick vom Saal, Ph.D., curators’ professor of biological sciences at the University of Missouri. That’s why endocrine disruptors are so good at making us fat — and that’s why diet advice doesn’t always work — because even strictly following the smartest traditional advice won’t lower your obesogen exposure. See, an apple a day may have kept the doctor away 250 years ago when Benjamin Franklin included the phrase in his almanac. But if that apple comes loaded with obesity-promoting chemicals — nine of the ten most commonly used pesticides are obesogens, and apples are one of the most pesticide-laden foods out there — then Ben’s advice is way out of date.

The obesogen effect is the reason why traditional diet advice — choose chicken over beef, eat more fish, load up on fruits and vegetables — may not work anymore. This is why we’re calling for a New American Diet.

See, while digging up all of this research on obesogens we’ve discovered some good news: There’s no reason why all of our favorite foods — from steak to burgers, from pasta to ice cream — can’t be part of a reasonable weight-loss program. We just need to get rid of old thinking. We can reverse the obesogen effect if we simply adopt these four simple laws of leanness:

Leanness Law No. 1: Know When to Go Organic
The average American is exposed to 10 to 13 different pesticides through food, beverages and drinking water every day and nine of the ten most common pesticides are EDCs. But according to a recent study in the journal Environmental Health Perspectives, eating an organic diet for just five days can reduce circulating pesticide EDCs to non-detectable or near non-detectable levels.

Of course, organic foods can be expensive. But not all organics are created equal—many foods have such low levels of pesticides that buying organic just isn’t worth it. The Environmental Working Group (EWG) calculated that you can reduce your pesticide exposure nearly 80 percent simply by choosing organic for the 12 fruits and vegetables shown in their tests to contain the highest levels of pesticides. They call them "The Dirty Dozen," and (starting with the worst) they are celery, peaches, strawberries, apples, blueberries (domestic), nectarines, sweet bell peppers, spinach, kale/collard greens, cherries, potatoes and grapes (imported). And you can feel good about buying the following 15 conventionally grown fruits and vegetables that the EWG dubbed "The Clean Fifteen," because they were shown to have little pesticide residue: onions, avocado, sweet corn (frozen), pineapples, mango, sweet peas (frozen), asparagus, kiwi fruit, cabbage, eggplant, cantaloupe (domestic), watermelon, grapefruit, sweet potatoes and honeydew melon.

Leanness Law No. 2: Don’t Eat Plastic
This ought to be a no-brainer. Indeed, you’re probably already thinking, Well, I don’t generally eat plastic. Ah, but you do. Chances are that you’re among the 93 percent of Americans with detectable levels of bisphenol-A (BPA) in their bodies, and that you’re also among the 75 percent of Americans with detectable levels of phthalates. Both are synthetic chemicals found in plastics that mimic estrogen — essentially, artificial female hormones. And like pesticides, these plastic-based chemicals trick our bodies into storing fat and not building or retaining muscle. Decreasing your exposure to plastic-based obesogens will maximize your chances both of losing unwanted flab and of building lean muscle mass. Here’s how: 1) Never heat food in plastic containers or put plastic items in the dishwasher, which can damage them and increase leaching. BPA leaches from polycarbonate sports bottles 55 times faster when exposed to boiling liquids as opposed to cold ones, according to a study in the journal Toxicology Letters. 2) Avoid buying fatty foods like meats that are packaged in plastic wrap because EDCs are stored in fatty tissue. The plastic wrap used at the supermarket is mostly PVC, whereas the plastic wrap you buy to wrap things at home is increasingly made from polyethylene. 3) Cut down on canned goods by choosing tuna in a pouch over canned tuna. And get any canned and jarred foods from Eden Organic, one of the only companies that doesn’t have BPA in its cans.

Leanness Law No. 3: Go Lean
Always choose pasture-raised meats, which, studies show, have less fat than their confined, grain-fed counterparts and none of the weight-promoting hormones. Plus, grass-fed beef contains 60 percent more omega-3s, 200 percent more vitamin E and two to three times more conjugated linoleic acid (CLA, a near-magic nutrient that helps ward off heart disease, cancer and diabetes, and can help you lose weight, according to a study in the American Journal of Clinical Nutrition) than conventional beef. If you must choose a conventional cut of beef, choose lean cuts top sirloin, 95 percent lean ground beef, bottom round roast, eye round roast, top round roast or sirloin tip steak. Bison burgers and veggie burgers are also great substitutes when grass-fed beef isn’t available. And select sustainable lean fish with low toxic loads (meaning low levels of toxins like mercury and PCBs). A study in the journal Occupational and Environmental Medicine found that even though the pesticide DDT was banned in 1973, the chemical and its breakdown product DDE can still be found today in fatty fish. Bigger fish eat smaller fish, and so carry a much higher toxic load.

Avoid ahi or bigeye tuna, tilefish, swordfish, shark, king mackerel, marlin and orange roughy — and focus on smaller fish like anchovies, Atlantic herring and mackerel, and wild-caught Alaskan salmon. Choose farmed rainbow trout, farmed mussels, anchovies, scallops (bay, farmed), Pacific cod, Pacific Halibut, Tuna (canned light) and mahimahi. Also, when you cook the fish, broil, poach, grill, boil or bake instead of pan-frying — this will allow contaminants from the fatty portions of fish to drain out.

Leanness Law No. 4: Filter Your Water
The best way to eliminate EDCs from your tap water is an activated carbon water filter. Available for faucets and pitchers, and as under-the-sink units, these filters remove most pesticides and industrial pollutants. Check the label to make sure the filter meets the NSF/American National Standards Institute’s standard 53, indicating that it treats water for both health and aesthetic concerns. Try The Brita Aqualux ($28, brita.com), Pur Horizontal faucet filter ($49, purwaterfilter.com) and Kenmore’s under-sink system ($60, kenmore.com). However, if you have perchlorate (a component of rocket fuel!) in your water (you can find out by asking your municipal water supplier for a copy of its most recent water-quality report) you’ll need a reverse osmosis filter. But for every five gallons of treated water they create per day, they discharge 40 to 90 gallons of wastewater, so make sure it’s necessary before purchasing one.

4 Reasons Diets Fail

By Joy Bauer, M.S., R.D., C.D.N.
Jun 30, 2010

So many of the weight loss clients I've worked with one-on-one in my New York City practice admit to being professional dieters. They've tried every weight loss plan, scheme, and promise under the sun and failed miserably over and over again. And 9 times out of 10, their attempts flop because of one--or some combination--of the four reasons I discuss below. That being said, awareness is key and if you know what mistakes to watch out for, you're already a step ahead of the pack. Here's what you need to know--and can do--to immediately boost your chance of long-term success.

Reason #1: You're not fully committed.

I always tell clients at our first session together: Weight loss is at least 50 percent attitude. If you're not truly ready to make a full-time commitment to losing weight, chances of long-term success are pretty slim. That's because when efforts are half-hearted from the get-go, people typically lose interest in their diet soon after they start. The sad truth is, it's not really worth starting a weight loss program if your head isn't in the game.

How to Prevail:

My best advice is to do some serious soul-searching and identify a significant and enduring source of personal motivation for finally shedding the extra weight. Maybe it's to better manage health conditions... or to be around for your kids and grandkids... or to finally feel more comfortable in your own skin and boost your energy level.

The bottom line is that this motivation has to come from within YOU. Then, strengthen your resolve and recharge your motivation every single day with positive self talk and daily or weekly goals. I think long term goals are terrific, but short term goals can be even more powerful because they reinforce success every step of the way.

Reason #2: You expect miracles.

Individuals who launch a new diet with unreasonable expectations regarding how much weight they're going to lose each week--or who have an unrealistic goal weight in mind--are signing themselves up for trouble. If you can't match your desired pace of weight loss, you'll more than likely end up terribly disappointed and quickly jump ship.

How to Prevail:

Though you'll probably see a dramatic drop on the scale during the first few weeks on a new diet, most people eventually average out at a loss of one to three pounds per week for the duration of their plan. And if they do shed pounds more quickly than that--say, by fasting for long stretches of time--they're more likely to gain the weight back... and then some.

I know television shows and infomercial success stories lead you to believe that you can melt off fat in a matter of weeks, but the truth is, successful weight loss is a slow and steady process. If you can accept this fact and buckle down for the long haul, you will ultimately be handsomely rewarded with better health, a smashing figure, and newfound confidence.

Reason #3: Your plan isn't sustainable.

If you're following an extreme weight loss plan that doesn't even slightly resemble "normal" eating, there's a good chance your efforts won't last. And, in my opinion, subsisting entirely on shakes, smoothies, cookies, or tonics isn't normal eating. When you view a diet as a short-term deviation from your typical eating habits, rather than a long-term lifestyle change, you will almost certainly have a hard time maintaining your weight loss.

How to Prevail:

A diet should be based on appropriate amounts of healthy foods that keep you feeling satisfied and energized--not cranky and deprived. Most importantly, a diet should be viewed as a launching pad for a long-term lifestyle change. That's because to lose weight and keep it off forever, you really will have to permanently change your eating habits. With that in mind, it's important to choose an eating plan that you can easily transition into lifetime maintenance.

And while I can appreciate how provocative some of these quick-fix, restrictive diet plans can be, they truly are a set-up for failure and yo-yo dieting. Without fail, every restrictive plan has a calorific binge waiting right around the corner. Not the way to go for long term success. Instead, a food plan you can stick with for life is key.

Reason #4: You can't forgive your slip-ups.

This is an incredibly common diet pitfall. When people inevitably give into temptation and subsequently "fall of the wagon" for one meal or one day, they tell themselves they've blown their diet and throw in the towel for good. To be successful, you have to learn to overcome these temporary setbacks. You can't let one binge or one "off day" turn into a full week, or month, of splurging. Unfortunately, it can be incredibly difficult for some individuals to break this cycle of negative thinking.

How to Prevail:

Don't dwell on your mistakes. Instead, shake it off and get right back on track at your very next meal... or the very next day. And always remember, nobody gains weight from one rich dinner or a single slice of cake. The real trouble starts when you allow that one "splurge" to snowball into an all-out eating frenzy. Take it one meal at a time and learn to forgive yourself; every dieter has slip-ups, but the successful ones know how to keep those occasional lapses contained.

Aromatase Inhibitor FAQs: Hormone Therapy (Arimidex, Femara, and Aromasin) for Breast Cancer

Q. I've been on tamoxifen for a couple of years, and now my doctor is switching me to an aromatase inhibitor. I understand how tamoxifen works, but this AI is a whole new thing... how does it work?

A. Aromatase inhibitors (pronounced aroma-tase: just like it looks) come in three basic flavors: Femara® (letrozole), Arimidex® (anastrozole), and Aromasin® (exemestane). They're all known as third-generation AIs, meaning they're the third round of this type of drug to be developed-and the most successful so far.

AI's are the current drug of choice for postmenopausal women with ER- or PR-receptive (estrogen or progesterone receptive) breast cancer-either following a 2-3 year course of tamoxifen, or right out of the gate, post-surgery/chemo/radiation.

So, how does an AI work, exactly? Aromatase is an enzyme that turns the hormone androgen into estrogen. No aromatase = no estrogen. No estrogen = breast cancer cells can't grow (in women with hormone-receptive cancer). An aromatase inhibitor does exactly what it says: it inhibits the enzyme from doing its job. How? By binding itself, either temporarily (Arimidex, Femara) or permanently (Aromasin) to aromatase so that it becomes dysfunctional, and can't turn androgen into estrogen.

Tamoxifen works by preventing estrogen from binding to breast cancer cells and helping them grow. But an AI will actually reduce the amount of estrogen in your body by 90% to 95% - though only in postmenopausal women, which is why AIs are only recommended for women who've stopped having their period. Women whose ovaries are still active, who are still menstruating, produce too much estrogen for AIs to be effective. Thus, the decision for a woman having hormone therapy to start right in on an AI (vs. taking tamoxifen for awhile) may depend on whether her chemotherapy-induced menopause is permanent, or only temporary. If permanent, her doctor might start her on an AI right away. If temporary, and she remains pre-menopausal, she's not a candidate for an AI.

Q. How does the doctor decide whether I should take Aromasin, Arimidex, or Femara? Are they basically all the same, just made by different drug manufacturers?

A. They're all similar, but not exactly the same. Aromasin binds permanently to aromatase. Arimidex and Femara can bind with aromatase, then let go (this is called "reversible binding.") But they're so aggressive that their presence in your body means they will invariably shoulder any aromatase out of the way-kind of like that pushy person who always manages to get a seat in musical chairs.

Understand that all of these third-generation AIs are still very new, and results of long-term clinical trials are barely starting to come in. Some of the larger clinical trials include testing the effectiveness of tamoxifen vs. Arimidex (the ATAC trial, completed in 2005); Femara given after 5 years of tamoxifen vs. no further treatment after 5 years of tamoxifen (MA-17 trial, ended prematurely in 2003 when the results clearly showed Femara reducing recurrence risk significantly); and 5 years of Femara vs. 5 years of tamoxifen, head to head (the BIG trial, completed in 2005). All three trials showed the AI having a significant advantage over tamoxifen. Remember, all of these trials involve post-menopausal women, NOT pre-menopausal.

At this point, there's less data on Aromasin. One study, just completed this year, showed that women who take tamoxifen for 2-3 years, then switch to Aromasin for 2-3 years do better long-term than women who take tamoxifen alone for 5 years. Aromasin seems to extend tamoxifen's benefits. Another large trial, the TEAM trial, is comparing 5 years of Aromasin, taken right out of the gate (no tamoxifen) vs. tamoxifen followed by Aromasin. Results are expected next year.

WHEW! With all that data, how DO physicians decide what to give you? Well, depends on your doctor. There's a lot of data comparing tamoxifen and AIs, but very little comparing the three AIs to one another, in terms of benefits and side effects. It's known that Femara inhibits (suppresses) 99% of aromatase in the body, while Arimidex and Aromasin trail by a couple of percentage points. For some doctors, that's reason enough to recommend Femara. On the other hand, it's been shown that Femara and Aromasin (but not Arimidex) can raise cholesterol levels, thus possibly increasing a woman's risk of heart attack and stroke very slightly; so women at risk for stroke or heart problems may be guided towards Arimidex. Some researchers feel, however, that it is not possible to differentiate which of these drugs truly raise cholesterol and that this may be a problem of trial design - that the raising of cholesterol is probably a "class effect" seen in all three aromatase inhibitors.

Some doctors (mine, for example) feel that Arimidex, which is the "weakest" of the three, actually provides some added benefit by NOT suppressing as much aromatase. They feel that a tiny bit of estrogen in your body is better than none at all. They claim that it doesn't increase your risk of recurrence, and provides other health benefits. So they'll recommend Arimidex ahead of Femara or Aromasin.

As far as FDA approvals go, Arimidex is approved for women with breast cancer that hasn't metastasized past the lymph nodes (early stage disease). Femara is approved for women with early stage disease who've completed 5 years of tamoxifen. And Aromasin has FDA approval for women with early-stage cancer who've completed 2-3 years of tamoxifen; and for women with metastatic cancer who haven't responded to tamoxifen.

Q. Well, I can see why it's not a cut-and-dried decision, which one to take. Sounds like their benefits are pretty similar; but what about their side effects?

A. Actually, their side effects are pretty similar, too, with some minor differences. Many doctors will switch a woman from one AI to another to another based on her reaction to each one, choosing the one that ultimately gives her the fewest negative side effects.

Here are the side effects that are common to all AIs. Remember, YOU may not experience these; every woman's experience with a particular drug is hers and hers alone.

• joint and muscle pain;
• hot flashes;
• vaginal dryness, which can lead to yeast infections and painful intercourse;
• loss of bone density, leading towards osteoporosis;
• insomnia;
• weight gain.

Of these side effects, joint, muscle, and bone pain are the most widely experienced and troublesome. About a third of women who take an AI don't (or barely) experience this side effect; about a third have stiffness and pain upon first getting up in the morning, but once they get going they're fine; and about a third have more frequent or severe pain. As many as 20% of the women in some studies stopped taking AIs because of pain. Which is a shame, because AIs have absolutely been shown to help prevent both breast cancer recurrence, and death from breast cancer.

If you start taking one AI and find the side effects bothersome, ask your doctor if you can switch to one of the others; you may have a better experience.

One of tamoxifen's side effects, risk of uterine or endometrial cancer, is notably absent in AIs: thankfully, none have been shown to lead to another cancer.

Q. And how long will I take whichever aromatase inhibitor it is I end up taking?

A. Just like tamoxifen, you'll take one pill every day. Studies have shown that it's important to take your AI regularly-even more important than it is to take tamoxifen regularly. Don't forget to take it, or let your prescription run out, or otherwise get caught short-taking that little white pill EVERY day is the only way to get its full benefit.

As for how long you'll take it - news at 11. At this point, all of us taking AIs are guinea pigs. (Physician's Note: Doctors might interject here that taking an FDA approved drug after an informed discussion with a licensed and treating physician does not meet their opinion of "guinea pig." Participating in important clinical trials can make a significant different in the way we treat breast cancer, so don't let fear of being a "guinea pig" dissuade you from making an otherwise informed choice about clinical trials). Is 5 years best for aromatase inhibitor use? Is 7 years better? How about 10 years? There just hasn't been sufficient data collected (yet) to draw hard and fast conclusions. You'll probably be on your AI for 3 years minimum, if you're switching over from tamoxifen; or for 5 years minimum, if you haven't taken tamoxifen. Beyond that, who knows? By 2 or 3 or 5 years from now, more studies will have been completed, and there'll be better data on which your oncologist can base his recommendations. Good luck!

The Chocolate Milk Diet

By David Zinczenko, with Matt Goulding - Posted on Thu, May 13, 2010, 9:52 pm PDT

Eat This, Not That
by David Zinczenko, with Matt Goulding a Yahoo! Health Expert for Nutrition

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Imagine if everything you needed to know about weight loss, you learned in kindergarten. Well, if your teacher gave you chocolate milk as a lunchtime treat, she was (unknowingly) giving you one of the most powerful weight-loss tools in the nutritional universe. Turns out this childhood staple may be the ideal vehicle for your body’s most neglected nutritional needs. Each bottle delivers a package of micro- and macronutrients that can help you shake off body flab and replace it with firm muscle. And when you served it ice-cold, the creamy sweetness flows across your tongue with all the pleasure of a milk shake. Yum.

That’s the crux of what I'm calling "The Chocolate Milk Diet," which isn’t a diet at all. It’s essentially three eight-ounce servings of chocolate milk consumed at key points throughout your day: one when you wake up, a second before you exercise, and a third directly after your workout. Or, if it's your day off, just pattern them for morning, afternoon, and night. Sounds good, right? It is, and that’s why it’s so easy. But is this a free ticket to eat as much fried chicken as you want throughout the rest of the day? Unfortunately not, but alongside a healthy diet, it can help you drop lots of belly fat fast. Here are the four reasons why:

Secret #1: The Calcium Effect

Researchers have known for years about the role that calcium plays in building strong bones, but a more recent development deals with they way it affects your belly. A series of studies have shown that calcium can actually impede your body’s ability to absorb fat, and when researchers in Nebraska analyzed five of these studies, they were able to estimate that consuming 1,000 mg more calcium can translate to losing nearly 18 pounds of flab. What’s more, other studies have shown that dairy foods offer the most readily absorbable calcium you can find. Knock back three servings of brown cow and you’ll reach that crucial 1,000 mg threshold. At that point, any other calcium that you eat or drink is a bonus.

Bonus Tip: Everything is not as it seems in the world of fat and calories. Click here to see the 30 “Healthy” Foods that Aren’t. You'll be shocked by the pounds of fat you may unwittingly gain while thinking that you're eating healthy.

Secret #2: The Vitamin D Factor

All the calcium in the world isn’t going to help you if you don’t get a good dose of vitamin D to go with it. That’s because vitamin D is responsible for moving calcium from your food to your body, which means if you’re running low on D, you’re probably also missing the calcium you need to stay slim. Other symptoms of the D deficiency are weak muscles, easily breakable bones, and depression—not a great combo for success. Now here’s why this is significant: Most experts agree that the average American isn’t getting enough D. Some estimate that only half the population is meeting the requirement and one study published in the journal Pediatrics found that 70 percent of American children had low levels of D in their diet. The thing is, your body makes vitamin D naturally when you expose your skin to sunlight, but most people spend too much time indoors to benefit. And intentionally spending more time in the sun could put you at risk for skin cancer. The solution? Drink up. Chocolate milk, like most milk, is fortified with vitamin D.

One caveat here: Drink 1% chocolate milk. Vitamin D won't work without a little fat to help break it down. You want to skip the whole milk, too, as it has too many calories to make it a regular habit. The best option is 1%, or low-fat chocolate milk. It has the fat you need to absorb crucial vitamins, yet at three cups a day, it will save you 120 calories over whole milk.

Bonus Tip: Everything you need to know about cereal is right here: America's Best and Worst Cereals. Keep the sugar down and the fiber up for a perfect start to your day.

Secret #3: The Endurance Boost

If you want to lose the gut, you’ve got to exercise—no surprise there. But here’s a fact that’s not so obvious: Drinking chocolate milk can improve your gains. In a study published in The International Journal of Sport Nutrition and Exercise Metabolism, subjects given chocolate milk before hopping on the stationary bikes were able to ride 49 percent longer than subjects given a generic carbohydrate-replacement beverage. And on top of that, they pedaled even harder. Total work performed by the chocolate-milk group was greater than the work performed by subjects drinking carbohydrate-replacement drinks or electrolyte-fortified sports drinks. The reason? Milk has naturally occurring electrolytes that keep you hydrated—more hydrated then water, in fact, which I revealed recently on my Twitter account—and its natural sweetness helps push more energy into your muscles. Another study from 2009 found similar results, but it went one step further by asking participants which beverage they thought tasted better. Not surprisingly, 100% chose chocolate milk.

Bonus Tip: Discover more loveable liquids by browsing through our Best Beers slideshow. Or, if you’d rather avoid the calories altogether, then you’ll want to read The Worst Beverages in the Supermarket. Again, the point is to make weight-loss easy and fun, without ever worrying about going on a diet again.

Secret #4: The Protein-Body-Weight Connection

Want to know the secret to staying thin? You need more muscle. That’s because muscle burns more calories than fat, so for every new muscle fiber you create, your resting metabolism receives another surge of fat-torching energy. And chocolate milk can help you do that. Researchers have determined that the ideal protein load for building muscle is 10 to 20 grams, half before and half after your workout. How much protein will you find in low-fat chocolate milk? Eight grams per cup. (That means one serving before your workout and one serving after will give you a total of 16 grams of highly effective whey protein—a perfect serving.) Add that to the extra cup you drank first thing in the morning and you’re looking at a turbocharged metabolism that keeps you burning calories all day long.

And don’t forget, you can still melt those 18 pounds of belly fat without giving up your favorite foods. You just need to make smart swaps, and we’ve got 10 new ones right here. You'll lose weight faster than ever—again, with ever dieting again.

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