Health and Wellness Exam 2

Treating Drug Addiction

1. Under the Affordable Care Act, all health insurance on the health insurance exchanges or provided by Medicaid must include services for treatment of substance use disorders. 2. Treatment is often characterized by episodes of short-term abstinence and relapse. a. Preventing relapse is an exceedingly complex medical goal.

Addiction

-Addiction is a chronic disease that disrupts brain systems that regulate motivation and reward -The American Psychiatric Association (APA) defines "addiction" as a chronic disorder with biological, psychological, social and environmental factors influencing its development and maintenance.. -Addictive behaviors are habits that are out of control and that negatively affect a person's health -There is a nearly uncontrollable pursuit of physical or psychological reward and/or relief through substance abuse or behaviors like gambling -Changes in brain chemistry underlie addiction. a. Certain activities, such as eating or gambling, may trigger the release of brain chemicals that produce pleasure in the same way that psychoactive drugs do. b. One brain change is tolerance, in which the body adapts so that the initial dose no longer produces the original emotional or psychological effects -Although brain chemistry seems to influence addiction, there is still a component of individual responsibility in addictive behavior. Other factors, such as lifestyle and personality traits, play key roles in the development of addictive behaviors

Psychoactive Drugs

-The drugs most often associated with addiction and impairment are psychoactive drugs, which alter a person's experiences or consciousness -Psychoactive drugs can cause intoxication, a state that can involve unpredictable physical and emotional changes

Alcoholism (Severe Alcohol Use Disorder)

1. Alcoholism is characterized by tolerance and withdrawal. 2. Patterns and Prevalence a. There are four common patterns of excessive drinking: i. Regular daily intake of large amounts ii. Regular heavy drinking limited to weekends iii. Long periods of sobriety interspersed with binges of daily heavy drinking lasting for weeks or months iv. Heavy drinking limited to periods of stress b. Once established, alcoholism often shows a pattern of exacerbations and remissions, although many alcoholics do achieve permanent abstinence.

The Development of Addiction

1. Many potentially addictive behaviors can be harmless or even beneficial if done appropriately and in moderation. 2. Addiction often starts when a person does something to bring pleasure or avoid pain. a. Reinforcement leads to increasing dependence on the behavior. b. Tolerance develops and the person needs more of the substance or behavior to feel the expected effect. c. Behavior no longer brings pleasure but repeating it is necessary to avoid withdrawal. 3. Many common behaviors are potentially addictive. Factors that influence whether they become problematic include personality, lifestyle, heredity, the social and physical environment, and the nature of the substance or behavior.

Risks Associated with Other Forms of Tobacco Use

1. Spit (Smokeless) Tobacco a. Smokeless or spit tobacco (chewing tobacco and snuff) allows nicotine and other additives, including carcinogens, to be absorbed through the gums and the lining of the mouth, providing a dose similar to that of cigarettes. i. Holding an average-size dip in the mouth for 30 minutes delivers about the same amount of nicotine as two to three cigarettes. b. More than 8.7 million adults aged 12 and older use smokeless tobacco. In 2017, almost 5% of twelfth graders had used smokeless tobacco in the past 30 days. c. Because of its nicotine content, spit tobacco is highly addictive. d. Health risks include the following: i. Damage to gums and lips (1) Leukoplakia, which can lead to oral cancer. ii. Gingivitis, recession of gums, and bone loss around the teeth iii. Dulled sense of taste and smell iv. Increased oral cancer risk by as much as 50 times 2. Cigars and Pipes a. Cigar smoking has increased steadily. i. Cigars are most popular among white males age 18 to 44, but women are also smoking cigars in record numbers. b. Cigars contain more tobacco than cigarettes and thus contain more nicotine and produce more tar when smoked. c. The health risks of cigars depend on the number of cigars smoked and whether the smoker inhales. d. Cigar and pipe smokers who don't inhale have lower risks for cardiovascular and respiratory disease than smokers. However, their risks are substantially higher than those of nonsmokers. e. Nicotine addiction is another concern. 3. Clove Cigarettes and Bidis a. Clove cigarettes contain almost twice as much tar, nicotine, and carbon monoxide as conventional cigarettes. They have been responsible for deaths and respiratory system injuries among young adults. b. Bidis are small cigarettes imported from India that contain up to four times the nicotine and twice the tar of American cigarettes. 4. Hookah a. Hookahs are water pipes used for smoking specially flavored tobacco. b. Typically this is a group practice, and the prevalence of hookah lounges has grown. c. Hookah use carries the same risk as cigarette smoking. i. May even result in absorption of higher concentrations of toxins. 5. E-Cigarettes a. An electronic cigarette, also called an e-cig, is a battery-powered device that resembles a real cigarette. b. The device contains nicotine, flavorings, and other compounds. c. Although advertised as a way to help smokers quit smoking, no evidence submitted to the FDA supports this claim. d. Researchers have found that e-cigs get hot enough to produce carcinogens and other toxic chemicals. They also produce nanoparticles, which are linked to asthma, stroke, and heart disease. e. Marketers of e-cigs claim that their devices can be used as a smoking-cessation product, but there is no evidence to support this. f. The rate of e-cigarette use among high school students increased by 900% from 2011 to 2015, but decreased slightly in 2016.

Groups of Psychoactive Drugs

The major psychoactive drugs are opioids; central nervous system (CNS) depressants; central nervous system stimulants; marijuana and other cannabis products; hallucinogens; and inhalants

Types of Fiber

a. There are two types of fiber: i. Soluble (viscous) fiber delays stomach emptying, slows the movement of glucose in blood after eating, and reduces absorption of cholesterol. (1) Found in oat bran, legumes ii. Insoluble fiber helps prevent constipation, hemorrhoids, and other digestive disorders. (1) Found in wheat bran, psyllium seed b. Dietary fiber is the nondigestible carbohydrates (and the noncarbohydrate substance lignin) that are naturally present in plants such as grains, fruits, legumes, and vegetables. c. Functional fiber is nondigestible carbohydrates that have either been isolated from natural sources or synthesized in a lab and then added to a food or dietary supplement. d. Total fiber is the sum of dietary and functional fiber in your diet. e. A high fiber diet can help reduce the risk of type 2 diabetes, heart disease, and pulmonary disease.

Tolerance and Withdrawal

a. Tolerance means that increasingly higher doses are needed to create the same effect. b. Sudden abstinence produces withdrawal symptoms, including severe cravings, insomnia, confusion, tremors, fatigue, muscle pains, headaches, nausea, irritability, anger, and depression.

Options for Quitting

1. A recent survey showed 68% of tobacco users want to quit, and 55% of those will make an attempt this year. No single method for breaking this addiction works for everyone. 2. Behavior Change a. Choosing to quit requires developing a strategy for success. There are many methods, including medications and support programs. i. Programs that combine group support with nicotine replacement therapy have rates of continued abstention as high as 35% after one year. b. Most smokers will experience both physical and psychological effects of nicotine withdrawal. i. Exercise can help with both. c. Free telephone quitlines with trained counselors are emerging as a popular and effective strategy to help people stop smoking. d. HHS has a national toll-free number to serve as a single access point for smokers: 1-800-QUITNOW. 3. Smoking Cessation Products a. There are drugs available that have proven successful in helping smokers quit. b. Chantix (Varinicline) i. Chantix works by reducing nicotine cravings, which eases withdrawal, and by blocking the pleasant effects of nicotine. It acts on neurotransmitter receptors in the brain. ii. It is not a nicotine replacement. iii. Side effects include nausea, headaches, vomiting, sleep disruptions, and changes in taste perception. Some people have more severe reactions such as depression and suicidal thoughts or actions. c. Zyban (Bupropion) i. Zyban is an antidepressant as well as a smoking cessation aid. ii. It eases the symptoms of nicotine withdrawal and reduces the urge to smoke. iii. Side effects are rare and can be managed by changing the dosage of the medication or when and how it is taken. d. Nicotine Replacement Products i. Nicotine replacement products are the most widely used smoking cessation products. ii. The user continues to get nicotine, so withdrawal symptoms and cravings are reduced. iii. Nicotine replacement is still harmful but provides a cleaner form of nicotine without the poisons and tars produced by burning tobacco. iv. They come in several forms: patches, gum, lozenges, nasal sprays, and inhalers. v. These products are effective but should be only one part of a complete smoking cessation program, which should include regular professional counseling and physician monitoring.

Alcohol Use during Pregnancy

1. Alcohol consumed during pregnancy crosses the placenta and harms the fetus. 2. Early in pregnancy, heavy drinking can cause spontaneous abortion (miscarriage). 3. Alcohol in early pregnancy can also cause fetal alcohol syndrome (FAS). i. FAS causes lifelong disability for the unborn child. 4. Alcohol can also cause alcohol-related neurodevelopmental disorder (ARND). i. Children appear physically normal but often have significant learning and behavioral disorders. 5. A study in 2015 report from the American Academy of Pediatrics stresses that no amount of alcohol at any point during pregnancy is considered safe. 6. Alcohol consumed by a nursing mother quickly enters the breast milk.

Metabolism and Excretion

1. Alcohol easily moves throughout most biological membranes and is distributed throughout most body tissues. 2. Alcohol metabolizes in the liver through several different processes. 3. About 2% to 10% is not metabolized but is excreted unchanged by lungs, kidneys, and sweat glands. a. Excreted alcohol forms the basis for breath and urine analyses of alcohol concentrations in the blood. 4. Alcohol readily enters the human brain. a. Alcohol changes the ability of brain cells to receive messages and disrupts networks within the brain. b. Chronic heavy use will make these changes permanent, changing both brain structure and function. c. Alcohol interferes with the production of new brain cells in unborn children, young children, adolescents, and young adults, whose brains are still developing

Alcohol Use Disorder: From Mild to Severe

1. Alcohol misuse is recurrent alcohol use that has negative consequences, such as drinking in dangerous situations or drinking patterns that result in academic, professional, interpersonal, or legal difficulties. 2. Severe alcohol use disorder, or alcoholism, refers to more extensive problems with alcohol use, usually involving physical tolerance and withdrawal. 3. Signs of impending problems with alcohol include these: a. Drinking alone or secretively b. Using alcohol deliberately and repeatedly to perform or get through difficult situations c. Using alcohol as a way to "self-medicate" in order to dull strong emotions or negative feelings d. Feeling uncomfortable on certain occasions when alcohol is not available e. Escalating alcohol consumption beyond an already established drinking pattern f. Consuming alcohol heavily in risky situations, such as before driving g. Getting drunk regularly or more frequently than in the past h. Drinking in the morning

Dietary Supplements

1. All government guidance systems encourage people to meet their nutritional needs with food rather than with vitamin and mineral supplements. 2. Although dietary supplement are sold over the counter, this doesn't necessarily mean that they are safe, especially when they are consumed over a long period of time. a. Some vitamins and minerals are dangerous when taken in excess. Talk to a doctor or dietitian before taking any high-dosage supplement.

Protecting Yourself against Foodborne Illness

1. Although the effects of foodborne illnesses are not usually serious, some groups, especially children, the elderly, and pregnant women, are at high risk of severe complications. 2. Most cases are caused by pathogens—disease-carrying microorganisms. The food is contaminated by improper handling, and pathogens can grow if food is prepared or stored improperly. a. According to the CDC, eight known pathogens contribute to the vast majority of foodborne illnesses: i. Salmonella—most often found in eggs, on vegetables, and on poultry ii. Norovirus—most often found on salad ingredients and shellfish iii. Campylobacter jejuni—most often found in meat and poultry iv. Toxoplasma—most often found in meat v. Escherichia coli (E. coli) O157:H7—most often found in meat and water vi. Listeria monocytogenes—most often found in lunch meats, sausages, and hot dogs vii. Clostridium perfringens—most often found in meat and gravy viii.Staphylococcus aureus—most often resulting from improper hand washing leading to food contamination b. Salmonella is the leading cause of foodborne hospitalizations. 3. Most cases trace back to poor food handling in the home or in restaurants. a. Food safety experts encourage the use of four basic food safety principles: i. Clean hands, food contact surfaces, and vegetables and fruits. ii. Separate raw, cooked, and read-to-eat foods while shopping, storing, and preparing foods. iii. Cook foods to a safe temperature. iv. Chill (refrigerate) perishable foods promptly. b. In 2011 the Food Safety and Modernization Act (FSMA) was signed into law to reform the food safety system in the U.S. and further protect the U.S. food supply.

Selecting Instructors, Equipment, and Facilities

1. An exercise class is a good place to get help and advice about exercise. Make sure your instructor or trainer has proper qualifications. 2. Many websites provide fitness programs, including ongoing support and feedback via email. Many charge a fee, so it is important to review the sites, decide which ones seem most appropriate, and if possible go through a free trial period before subscribing. a. Remember to consider the reliability of the information. 3. Good equipment will enhance your enjoyment and decrease your risk of injury. a. Investigate equipment and try it out to see if you will use it regularly. b. Footwear is an important piece of equipment for almost any activity. 4. If you are interested in joining a fitness center, choose one that has the right programs and equipment available at the times you will use them.

The Immediate Effects of Smoking

1. Beginning smokers often have symptoms of mild nicotine poisoning: a. Dizziness b. Faintness c. Rapid pulse d. Cold, clammy skin e. Nausea f. Vomiting g. Diarrhea 2. Depending on the dosage, nicotine can either excite or tranquilize the nervous system. 3. Nicotine's other immediate effects include these: a. Stimulation of the cerebral cortex and the adrenal glands, which release adrenalin b. Inhibition of urine formation c. Constriction of blood vessels, increased pulse rate, and elevated blood pressure i. Requires the heart to work harder to deliver the same amount of oxygen to tissues d. Depression of hunger contractions and dulling of taste buds

Alcohol Intake and Blood Alcohol Concentration

1. Blood alcohol concentration (BAC) is the ratio of alcohol in a person's blood by weight. 2. BAC is determined by the amount of alcohol consumed in a given amount of time and by individual factors. a. Body weight: A smaller person develops a higher BAC than a larger person after drinking the same amount of alcohol. A smaller person has less overall body tissue into which alcohol can be distributed. b. Percentage of body fat: A person with a higher percentage of body fat will usually develop a higher BAC than a more muscular person of the same weight. i. Alcohol does not concentrate as much in fatty tissue as in muscle and most other tissues, in part because fat has fewer blood vessels. c. Sex: Women metabolize less alcohol in the stomach than men do because the stomach enzyme that breaks down alcohol before it enters the bloodstream is four times more active in men than women. This means that more unmetabolized alcohol is released in the bloodstream in women. i. Hormonal fluctuations also may affect the rate of alcohol metabolism, making a woman more susceptible to high BAC at certain times during her menstrual cycle. 3. BAC also depends on the balance between rate of alcohol absorption and rate of alcohol metabolism. a. A 150-pound man with normal liver function metabolizes 0.3 ounces of alcohol per hour, the equivalent of about half a 12-ounce bottle of beer or a 5-ounce glass of wine. b. Metabolic rate is largely determined by genetics and drinking behavior. i. Chronic drinking activates an enzyme in the liver, so people who drink frequently metabolize alcohol at a more rapid rate than nondrinkers. c. It cannot be affected by exercising, breathing deeply, eating, drinking coffee, taking other drugs, or sleeping. 4. If a person absorbs less alcohol per hour than he or she can metabolize, BAC remains low. a. Drinking alcohol this way means large amounts can be consumed over a long period of time without a person's becoming noticeably intoxicated, although this behavior is a danger to health in the long term. b. Absorbing alcohol more quickly than it can be metabolized leads to intoxication.

Body Composition

1. Body composition refers to the proportion of fat and fat-free mass (muscle, bone, and water) in the body. 2. Healthy body composition comprises a high proportion of fat-free mass and an acceptably low level of body fat. 3. Body fat can be lost through diet and exercise; muscle mass can be increased through weight training.

Cardiorespiratory Endurance

1. Cardiorespiratory endurance is the ability to perform prolonged, large-muscle, dynamic exercise at moderate to high intensity. 2. Low levels of cardiorespiratory endurance are linked with heart disease, diabetes, colon cancer, stroke, depression, anxiety, and premature death from all causes. 3. Regular cardiorespiratory endurance training conditions the heart and related physical functions, prompting many improvements: a. The heart pumps more blood per heartbeat. b. Resting heart rate slows and blood pressure decreases. c. Blood volume increases. d. Blood supply to the tissues improves. e. The body can cool itself better. f. Metabolic health improves, which helps the body process fuel and regulate cell function. 4. A healthy heart can better withstand the strains of daily life, the stress of emergencies, and the wear and tear of time. 5. You can develop cardiorespiratory endurance through activities that involve continuous, rhythmic movements of large muscle groups—such as by walking.

Examples of Addictive Behaviors

1. Compulsive Gambling 2. Video Game Disorder 3. Compulsive Exercising 4. Work Addiction 5. Sex Addiction 6. Compulsive Buying or Shopping 7. Internet Addiction

Dietary Reference Intakes (DRIs)

1. DRIs include a set of four reference values used as standards for both recommended intakes and maximum safe intakes. DRIs are frequently reviewed and updated. a. DRIs consider prevention of nutrient deficiencies, as well as the role of nutrients in promoting optimal health and preventing chronic diseases such as cancer, osteoporosis, and heart disease. b. Recommended intake of a nutrient is expressed as a Recommended Daily Allowance (RDA) or Adequate Intake (AI). An AI is set when there is insufficient information to set an RDA value. c. Estimated Average Requirement (EAR) is used primarily in nutrition policy and research and is the average daily nutrient intake level estimated to meet requirement of half the health individuals in a given gender and life stage. d. The Tolerable Upper Intake Level (UL) sets the maximum daily intake by a healthy person that is unlikely to cause health problems. Due to lack of data, ULs have not been set for all nutrients. e. There is no established benefit from consuming nutrients at levels above the RDA or AI. 2. The Food and Drug Administration Daily Values set standards for fat, cholesterol, carbohydrate, dietary fiber, and selected vitamins and minerals. The values represent intake levels for a 2000-calorie diet.

Fiber—A Closer Look

1. Dietary fiber is the nondigestible carbohydrates that are present naturally in grains, fruits, legumes, and vegetables. Even though dietary fiber is not digested, it is necessary for good health. a. Facilitates elimination

Drug-Related Factors

1. Different drugs and different dosages produce different effects, caused by one or more of five different drug factors: a. The pharmacological properties of a drug are its overall effects on body chemistry, behavior, and psychology. i. These properties include the amount of a drug required to exert various effects and the time course of the effects. ii. Other characteristics include a drug's chemical composition. b. The dose-response function is the relationship between the amount of drug taken and the intensity and type of effect. Some drugs plateau in this function, so taking more may not increase the effect. c. The time-action function is the relationship between time elapsed since the drug was taken and the intensity of the effect. i. Effects are generally greatest when its concentrations in body tissues are changing fastest, especially if they are increasing. d. A person's drug-use history influences the effects of, and response to, a drug, meaning that users may have to refrain from using a drug for a while before the same dosage will exert its original effects. e. The method of drug use directly affects the strength of the response.

Changes in Brain Chemistry

1. Drug use changes brain chemistry in fairly predictable ways, but the noticeable effects may vary depending on how fast the drug reaches the brain. a. The more quickly a drug reaches the brain, the more likely the user is to become dependent. 2. When a psychoactive drug reaches the brain, it affects neurotransmitters by increasing or decreasing their concentration and actions. a. Cocaine affects dopamine, a neurotransmitter thought to play a key role in the process of reinforcement. 3. The duration of a drug's effect depends on many factors. 4. As drugs circulate through the body they are metabolized by the liver and excreted by the kidneys in urine

Drug Testing

1. Drug use in the workplace creates problems for individuals, and it affects productivity and safety. a. The economic burden of lost productivity resulting from premature death, illness, and disability is estimated at $114 billion for drug abuse and $179 billion for heavy alcohol use. 2. Drug testing by employers has become workplace policy in many industries. a. Most drug testing involves a urine test. b. Tests for alcohol involve a blood or breath test.

Drinking and Driving

1. Drunk driving is a serious health and safety problem in the United States. 2. In 2016, 10,497 Americans were killed in accidents involving alcohol-impaired drivers, close to one-third of all traffic fatalities for the year. 3. The National Highway Transportation Safety Administration (NHTSA) estimates that someone is killed in an alcohol-related crash every 50 minutes. 4. Any amount of alcohol impairs the ability to drive safely. 5. The dose-response function is the relationship between the amount of alcohol or drug consumed and the type and intensity of the resulting effect. Higher doses are associated with a much greater probability of crashes. 6. Driving while intoxicated has serious legal consequences. 7. If you are away from your home and drinking, find an alternative means of transportation or follow the practice of having a designated driver. 8. Drivers should remain alert to signs that another driver is impaired and know how to drive defensively. a. Wide, abrupt, and illegal turns b. Straddling the center line or lane marker c. Driving against traffic d. Driving on the shoulder e. Weaving, swerving, or nearly striking objects or other vehicles f. Following too closely g. Erratic speed h. Driving with the headlights off at night i. Driving with the windows down in very cold weather

Minerals—Inorganic Micronutrients

1. Minerals are inorganic elements required in small amounts. a. Help regulate body functions b. Aid in the growth and maintenance of body tissues c. Help in energy release 2. There are about 17 essential minerals. a. Major minerals that the body needs in amounts of 100 milligrams or more per day include calcium, phosphorus, magnesium, sodium, potassium, and chloride. b. Essential trace minerals include copper, fluoride, iodide, iron, selenium, and zinc. c. Minerals most commonly lacking in our diets are iron, calcium, potassium, and magnesium. i. Iron-deficiency anemia is a problem in some age groups and particularly among menstruating women and women who have had multiple pregnancies. ii. Osteoporosis results from poor calcium intake.

Common Alcoholic Beverages

1. Ethyl alcohol is the common psychoactive ingredient in all alcoholic beverages. a. Other types of alcohol, including methanol (wood alcohol) and isopropyl alcohol (rubbing alcohol) are highly toxic and can cause blindness and other serious problems, even in small amounts. 2. There are several basic types of alcoholic beverages. a. Beer, brewed from a mixture of grains, contains 3-6% alcohol. b. Ales and malt liquors are similar to beer but contain more alcohol at 6-8%. c. Wines are made by fermenting the juices of grapes or other fruits, with alcohol concentrations varying from 9% to 14%. i. Fortified wines (sherry, port, Madeira) contain about 20% alcohol. d. Hard liquor, made by distilling brewed or fermented grains, usually contains 35% to 50% alcohol but can be much stronger. 3. Alcohol concentration is indicated by proof value, which is twice the percentage concentration (a 100-proof beverage contains 50% alcohol). 4. "Standard Drinks" versus Actual Servings a. A standard drink means the beverage typically contains about 0.6 ounce of alcohol. b. A typical serving of most alcoholic beverages is larger than a single standard drink. 5. Caloric Content a. Alcohol provides 7 calories per gram, and the alcohol in one drink supplies about 100 to 120 calories. i. The "light" in light beer refers to calories; a light beer typically has close to the same alcohol content as a regular beer and about 100 calories.

Improved Psychological and Emotional Wellness

1. Exercise has social, psychological, and emotional benefits, including the following: a. Reduced anxiety and depression b. Improved sleep c. Reduced stress d. Enhanced self-esteem, self-confidence, and self-efficacy e. Enhanced creativity and intellectual functioning f. Increased opportunities for social interaction

Fats—Essential in Small Amounts

1. Fats, or lipids, are the most concentrated source of energy; they represent stored energy and provide insulation and support for body organs. a. Fats provide 9 calories of energy per gram. b. Fats help absorb fat-soluble vitamins and fuel the body during rest and light activity. 2. Two fats, linoleic acid and alpha-linolenic acid, are essential to regulating such body functions as blood pressure and contribute to healthy pregnancy.

Flexibility

1. Flexibility is the ability to move joints through their full range of motion. 2. Inactivity causes joints to become stiffer, leading to unnatural body postures. 3. Stretching exercises can help ensure a normal range of motion for all major joints

Flexibility Exercises

1. Flexibility or stretching exercises are needed to maintain the normal range of motion for the body's major joints. a. A good stretching program should include exercises for all the major muscle groups and joints of the body.

Food Allergies and Food Intolerances

1. Food allergies or food intolerance can cause adverse reactions in some people, and symptoms can range from annoying to life threatening. 2. A true food allergy is a reaction of the body's immune system to a food ingredient, usually a protein. a. The immune reaction can cause hives, cramps, diarrhea, asthma, or swelling of the lips and tongue. b. Anaphylaxis, the most severe response, carries with it a potentially life-threatening drop in blood pressure. c. Eight foods account for more than 90% of food allergies in the U.S.: cow's milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish. i. Food labels are now required to state the presence of these most common allergens. 3. Food allergies often are confused with food intolerance. In food intolerance, the problem lies with metabolism of the food rather than with the immune system. a. Typically the body cannot adequately digest a food or food component or reacts with a particular compound in food, as in lactose intolerance. b. Lactose intolerance is a fairly common food intolerance. c. Almost 1% of Americans have an intolerance to gluten; and another 6% is believed to have gluten sensitivity. d. Through trial and error, most people with food intolerances can adjust their intake of the trigger food to an appropriate level.

Food Biotechnology

1. Food irradiation is the treatment of foods to kill potentially harmful pathogens, including bacteria, parasites, insects, and fungi that cause foodborne illness. a. Even though food irradiation has been endorsed by many agencies, there are few irradiated foods on the market due to consumer resistance and skepticism. 2. In genetic engineering, genes in a plant, animal, or microorganism are added, rearranged, or replaced to change its characteristics, resulting in a genetically modified organism (GMO). a. Supporters cite improved yields, increased disease resistance, better nutritional content, lower prices, and less use of pesticides. b. Opponents cite unexpected effects such as increased levels of toxins or allergens, permanent changes to the gene pool, reduced biodiversity, and pesticide-resistant insects.

Reading Food Labels

1. Food labels can help consumers make intelligent choices about foods. a. All processed foods regulated by the FDA or USDA include standardized nutrition information on their labels. b. Every food label shows serving sizes and the amount of fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugars, and protein in each serving

Genetic Factors

1. Genetic characteristics play an important role in some aspects of tobacco use. a. They may be more important than social and environmental factors in smoking initiation and the development of nicotine dependence.

Improved Body Composition

1. Healthy body composition means that the body has a high proportion of fat-free mass and a relatively small proportion of fat. Too much fat, particularly abdominal fat, is linked to a variety of health problems. 2. Exercise improves body composition by increasing calorie expenditure, slightly raising the metabolic rate. a. Greater muscle mass also increases metabolic rate.

Regulation of Tobacco

1. In 2009, Congress gave the FDA broad regulatory powers over the production, marketing, and sale of cigarettes. a. The agency can dictate how much nicotine is included in tobacco products and can enforce new and stricter rules on marketing. b. They can also strengthen health warnings and put greater limits on advertising. c. In March 2018, the FDA began the first steps toward a new regulatory effort to decrease the level of nicotine in tobacco products in order to make them less addictive.

The Allure of Drugs

1. Young people may be drawn to drugs by the allure of the exciting and illegal. a. They are curious, rebellious, or vulnerable to peer pressure. b. They imitate adult models. 2. Most people try drugs to experiment but do not continue use. 3. Many users are motivated by a desire to escape boredom, anxiety, depression, feelings of worthlessness, or other symptoms of psychological problems. They use drugs as a way to cope.

Increasing Physical Activity and Exercise

1. In 2011, the American College of Sports Medicine released its exercise guidelines for healthy adults. a. For substantial health benefits, adults should do at least 150 minutes a week of moderate-intensity aerobic physical activity, or 75 minutes a week of vigorous-intensity aerobic physical activity. b. For more extensive health benefits, adults should increase their aerobic physical activity to 300 minutes a week of moderate-intensity activity, or 150 minutes a week of vigorous-intensity activity. c. Adults should perform muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on two or more days a week. d. Everyone should avoid inactivity. 2. These levels of physical activity lower the risk of high blood pressure, stroke, heart disease, type 2 diabetes, colon cancer, osteoporosis, and reducing feelings of depression and anxiety. 3. Physical Activity Guidelines for Americans defines moderate-intensity physical activity as activity that causes a noticeable increase in heart rate, such as brisk walking. Vigorous-intensity physical activity is activity that causes rapid breathing and a substantial increase in heart rate, such as jogging. 4. The daily total of physical activity can be accumulated in bouts of 10 or more minutes.

Calorie Labeling: Restaurants and Vending Machines

1. In 2014 the FDA began requiring calorie information be provided on restaurant menus and vending machines as part of the 2010 Affordable Care Act. 2. As of May 2018, calorie information is required on menus and menu boards in chain restaurants and similar retail food establishments

Binge Drinking

1. In 2015, 38.4% of Americans age 18-25 reported that they engaged in binge drinking in the past month. 2. Most binge drinkers are not alcohol dependent. 3. Among Americans under 21 years old, most drinking occurs in the form of bingeing, and over 90% of the alcohol they drink is consumed while binge drinking 4. Over half the alcohol consumed by adults in the U.S. is downed during binge drinking. 5. Binge drinking has enormous health risks and dangers. 6. Binge drinking caused more than half of the 90,000 deaths and three-fourths of the estimated economic cost of excessive drinking—$249 billion—in 2010.

Why Start in the First Place?

1. In the United States, nearly 90% of all adult smokers started smoking before age 18. a. The average age of starting smokers is 15. 2. Young people start smoking for a wide variety of reasons. 3. Rationalizing the Dangers a. Choosing to use tobacco means denying the health risks and the pain, disability, emotional trauma, family stress, and financial expense involved in tobacco-related diseases like cancer and emphysema. b. The sense of invincibility characteristic of adolescents and young adults contributes to the decision to use tobacco. c. Many teenagers believe they can stop smoking when they choose to; however, nicotine addiction can start within a few days of smoking and after just a few cigarettes. 4. Emulating Smoking in the Media a. Advertising and other media portrayals are very influential in young people's decision to use tobacco. Fifty percent of young people surveyed began smoking after watching repeated favorable portrayals of smoking in movies. b. In general, smoking in films and television does not reflect actual patterns of use in the United States.

Drugs, Society, and Families

1. Insurance covered $2.3 billion in addiction and overdose services in 2016. Insured payments and out of pocket costs are not included in this figure. 2. The relationship between drugs and crime is complex. People accused of crimes related to drug possession, sale, or use have flooded the criminal justice system. Violence and use of guns are more prevalent in areas with heavy drug trafficking. 3. The health care issues include emergency department admissions and death. There isn't enough space in treatment facilities to help the millions of Americans who need immediate treatment. 4. Drug abuse affects not only drug users but also their families, especially children.

Action at Many Levels

1. Local laws and ordinances have been passed to discourage smoking in public places. 2. An assessment made in 2017 found that nearly 81% of Americans live in municipalities that restrict or ban smoking in public buildings, workplaces, restaurants, and bars. Hundreds of colleges and universities now have totally smoke-free campuses or prohibit smoking in residential buildings. 3. Smoking restrictions are encouraging users to quit. 4. State legislatures have passed many tough anti-tobacco laws, including bans on smoking in indoor workplaces, restaurants, and bars. 5. As of 2018, comprehensive smoke-free air laws were in effect in 28 states, the District of Columbia, the U.S. Virgin Islands, and Puerto Rico. 6. California has one of the most aggressive tobacco control programs, combining taxes on cigarettes, graphic advertisements, and bans on smoking; and the state now has the second-lowest rate of smoking among U.S. states.

Eating and Drinking for Exercise

1. Maintain a well-balanced diet that contains adequate but not excessive calories. 2. Drinking enough water is essential. a. Drinking fluids before and during exercise is important to prevent dehydration and improve performance. b. A rule of thumb is to drink at least 16 ounces of fluid 2-4 hours before exercise and then drink enough during exercise to match fluid loss in sweat. c. For workouts lasting less than 60 to 90 minutes, cool water is an appropriate fluid replacement. d. For longer workouts, a sports drink that contains water and small amounts of electrolytes (sodium, potassium, and magnesium) and simple carbohydrates is recommended.

Other Substances in Food

1. Many substances in food are not essential nutrients but may affect health. 2. Antioxidants a. Free radicals, substances that damage cells and mutate genes, have been implicated in aging, cancer, and cardiovascular and other degenerative diseases. b. Some antioxidants prevent or reduce the formation of free radicals; others remove free radicals from the body. Antioxidants can repair some types of free radical damage. c. Fruits and vegetables, such as vitamins C and E and selenium, are good sources of antioxidants. 3. Phytochemicals a. Antioxidants are a particular type of phytochemical, a substance found in plant foods that may help prevent chronic disease. i. Cruciferous vegetables, such as broccoli and cauliflower, contain sulforaphane which may render some carcinogenic compounds harmless. ii. Allyl sulfides, found in garlic and onions, may boost immune cell function. iii. Carotenoids found in green vegetables may preserve eyesight with age.

More Efficient Metabolism and Improved Cell Health

1. Metabolism, the process that converts food to energy and builds tissue, becomes more efficient through regular exercise. 2. Exercise may also protect cells from damage from free radicals, which are destructive chemicals produced during normal metabolism, and from inflammation caused by high blood pressure or cholesterol, nicotine, and overeating. 3. Training activates antioxidants that prevent free-radical damage and keep the body's cells healthy.

Muscular Strength and Endurance

1. Muscular strength is the amount of force a muscle can produce with a single maximum effort. a. Muscles are important to help keep the skeleton in alignment, providing the support for good posture. b. Greater muscle mass makes possible a higher rate of metabolism and faster energy use, which help maintain a healthy body weight. c. Maintaining strength and muscle mass is vital for healthy aging. d. Strength training also has been shown to benefit cardiovascular health. i. It helps to reduce the risk of osteoporosis. 2. Muscular endurance is the ability to resist fatigue and sustain a given level of muscle tension. a. Both everyday life and most leisure and fitness activities are enhanced by good muscle endurance. b. One develops muscular endurance by stressing muscles with a greater load (weight) than they usually carry

Absorption

1. Once in the bloodstream, alcohol produces feelings of intoxication. The rate of absorption is affected by a variety of factors. a. Carbonation and artificial sweeteners increase the rate of absorption. b. The presence of food in the stomach slows the rate of absorption. c. The drinking of highly concentrated alcoholic beverages also slows the rate of absorption. 2. When a person ingests alcohol: a. About 20% of alcohol is rapidly absorbed from the stomach into the bloodstream. b. About 75% is absorbed through the upper part of the small intestine. c. The remaining alcohol enters the bloodstream along the gastrointestinal tract.

Training in Specific Skills

1. One can gain training in specific skills only by practicing those skills. Acquiring competence in an activity leads to a sense of mastery and satisfaction. 2. Lessons from a qualified teacher allow a person to learn the basic movements from someone who has mastered the skill. 3. Additional instruction also can help people refine skills they may have been performing for years.

Guidelines for Fish Consumption

1. Overall fish and shellfish are healthy sources of protein, omega-3 fats, and other nutrients. Mercury contamination, however, is a concern, especially in predator fish. 2. According to the FDA, women who are pregnant or may become pregnant and nursing mothers should follow these guidelines: a. Do not eat shark, swordfish, king mackerel, marlin, orange roughy, bigeye tuna, or tilefish (from the Gulf of Mexico). b. Eat 2-3 servings (8-12 ounces) a week of a variety of fish and shellfish that is lower in mercury, such as shrimp, canned light tuna, salmon, pollock, and catfish. Limit consumption of albacore tuna to 6 ounces per week. c. Check advisories about the safety of recreationally caught fish from local lakes, rivers, and coastal areas.

Organic Foods

1. People concerned about pesticides and other contaminants may buy food that is organic. 2. To be certified organic by the USDA, foods must meet strict production, processing, handling, and labeling criteria. a. "100% organic": all organic ingredients b. "Organic": at least 95% organic ingredients c. "Made with organic ingredients": at least 70% organic ingredients 3. If buying organic, experts advise that consumers should spend their money on fruits and vegetables with the highest level of pesticide residue when grown conventionally—the "dirty dozen": apples, bell peppers, celery, cherries, imported grapes, nectarines, peaches, pears, potatoes, red raspberries, spinach, and strawberries. 4. Whether organic foods are better for your health or not, organic farming is better for the environment.

Physical Factors

1. Physical factors include these: a. Body mass b. General health c. Genetic factors d. Concurrent use of other chemicals e. Pregnancy 2. Any use of drugs during pregnancy carries a risk of adverse effect on the fetus.

Possible Health Benefits of Alcohol?

1. Previous studies showed light to moderate drinking may improve heart health. 2. Newer studies have cast doubt on such benefits. a. For people over 55, studies that controlled for heart health also found no protective effects of alcohol.

Proteins—The Basis of Body Structure

1. Proteins form muscles and bones as well as parts of blood, enzymes, hormones, and cell membranes. 2. Amino Acids a. Amino acids are the building blocks of proteins. b. Twenty common amino acids are found in food proteins. i. Nine amino acids are essential. ii. As long as foods supply certain nutrients, the body can produce the other 11 amino acids. 3. Complete and Incomplete Proteins a. Protein sources are considered "complete" if they supply all essential amino acids in adequate amounts and "incomplete" if they do not. b. Most animal proteins are complete; most plant proteins, such as legumes and nuts, are incomplete. c. Certain combinations of vegetable proteins generally make up for the missing amino acids in the other protein. 4. Recommended Protein Intake a. Adequate daily intake of protein for adults is 0.8 gram per kilogram of body weight. b. Most American diets contain more protein than is needed. i. The body converts excess protein into fat. c. The Acceptable Macronutrient Distribution Range (AMDR) for protein intake is 10% to 35% of total daily calorie intake, depending on the individual's age.

Improved Cardiorespiratory Functioning

1. Regular endurance exercise improves the functioning of the heart and the ability of the cardiorespiratory system to carry oxygen to body tissues. 2. Other benefits of exercise: a. Healthy arteries b. Improved sexual functioning and general vitality.

Psychological Factors

1. Responses can be affected by user expectations. 2. Psychological and social factors are especially important when small doses are given. 3. The placebo effect occurs when a person responds to an inert substance as if it were an active drug.

Skill-Related Components of Fitness

1. Skill-related fitness improves the ability to perform a particular sport or activity. 2. Components of skill-related fitness include speed, power, agility, balance, coordination, and reaction time

Social and Psychological Factors

1. Social and psychological factors combine with physiological addiction to maintain the tobacco habit. 2. Tobacco use is often associated with other habits—working, drinking, and talking. 3. These activities continue to trigger the urge to smoke; they are called secondary reinforcers. a. They act together with physiological addiction to keep the user dependent on tobacco

Social Factors

1. Social factors include the setting—that is, the physical and social environment surrounding the drug use. 2. Use at home might have effects different from use at a party or in a laboratory setting. 3. The setting and the user's expectations can have greater effects than the drug itself.

Managing Your Fitness Program

1. Starting Slowly, Getting in Shape Gradually a. Divide your program into three phases: initial stage, improvement stage, and maintenance stage. 2. Exercising Consistently a. Exercising consistently is the key to stay injury free. b. Use a workout journal. 3. Assessing Your Fitness a. A person's ultimate level of fitness depends on his or her individual goals, program, and natural ability. 4. Preventing and Managing Athletic Injuries a. Athletic injuries should be treated promptly. i. Consult a physician about head and eye injuries, ligament injuries, broken bones, and internal disorders like chest pain, fainting, and intolerance to heat—as well as for apparently minor injuries that do not heal. ii. For minor cuts and scrapes, stop the bleeding and clean with soap and water. iii. Soft-tissue injuries should be treated with the R-I-C-E principle: rest, ice, compression, and elevation. iv. After swelling from an injury subsides, in about 36 to 48 hours, apply heat to relieve pain, relax muscles, and reduce stiffness. b. Guidelines for preventing injuries: i. Stay in condition. ii. Warm up before exercise. iii. Use proper body mechanics when moving or executing sports skills. iv. Don't exercise when ill or overtrained. v. Use the proper equipment. vi. Don't return to your normal exercise program until the injury has healed. c. Use special caution in heat or humidity. 5. Staying with Your Program a. To maintain fitness level, one should exercise regularly at the intensity used to achieve the fitness level (a consistent intensity, 3-5 days a week). b. Adapt your training to changes in your environment or schedule. c. With cross-training, you can practice alternate activities, thereby preventing boredom and increasing motivation.

Helping Someone with an Alcohol Problem

1. Strategies for helping a friend or relative with an alcohol problem include these: a. Making sure you do not become an enabler or codependent by making excuses for the abuser b. Honest labeling by making explicit statements—"I think you have a problem with alcohol" c. Encouraging the use of available resources for treatment and going with him or her to the appointment

Diagnosing Substance Misuse and Addiction

1. Substance misuse is use of a substance that is not consistent with medical or legal guidelines. a. Addiction is a psychological or physical dependence on a substance or behavior that has undesirable, negative consequences. 2. The severity of a substance use disorder is determined by the number of criteria from the American Psychological Association's DSM-5 that the person meets. a. Two or three criteria indicate a mild disorder. b. Four to five criteria point to a moderate disorder. c. Six or more criteria are evidence of a severe disorder. 3. The DSM-5 criteria are grouped into four categories: a. Impaired control b. Social problems c. Risky use d. Drug effects, including tolerance and withdrawal 4. The latest version of the DSM dropped the past distinction between dependence and abuse in diagnosing drug-related disorders.

Legalizing Drugs

1. Supporters of some form of drug legalization or decriminalization argue that legalization would eliminate much of the crime associated with drug use. 2. Opponents argue that legalization would foster greater drug misuse and dependence.

DASH Eating Plan

1. The Dietary Approaches to Stop Hypertension (DASH) eating plan was developed to help people control high blood pressure. a. It is tailored with special attention to sodium, potassium, and other nutrients of concern.

Environmental Tobacco Smoke

1. The EPA has designated environmental tobacco smoke (ETS), more commonly called secondhand smoke, as a Class A carcinogen. 2. The U.S. Surgeon General has concluded that for some people there is no safe level of exposure to ETS; even brief exposure can cause serious harm. 3. Mainstream smoke refers to smoke exhaled by smokers. 4. Sidestream, or secondhand, smoke is the smoke that enters the atmosphere from the burning end of a cigarette, cigar, or pipe. Because it is unfiltered, it has, compared with mainstream (exhaled) smoke: a. Twice the tar and nicotine b. Three times the benzo(a)pyrene c. Almost three times the carbon monoxide d. Three times the ammonia 5. Thirdhand Smoke a. Thirdhand smoke is the toxic residues and chemicals that linger on indoor surfaces, curtains, and furniture, and in dust. b. These residues and chemicals can form toxic mixes and harmful compounds that remain at high levels for some time. c. Young children who crawl and put their hands on such substances are at particularly high risk of negative health effects. 6. ETS Effects a. Nonsmokers subjected to ETS develop cough, headaches, nasal discomfort, and eye irritation. Allergies can be exacerbated. b. ETS causes an estimated 7300 lung cancer deaths and about 34,000 deaths from heart disease each year in people who do not smoke. It also contributes to atherosclerosis, aggravates asthma, and increases the risk for breast and cervical cancers. c. Scientists have been able to measure changes that contribute to lung tissue damage and potential tumor promotion in the bloodstreams of healthy test subjects after three hours in a smoky room. i. After just 30 minutes, the function in the coronary arteries is reduced to the same level as that of smokers. 7. Infants, Children, and ETS a. Infants exposed to the smoke from more than 21 cigarettes a day are more than 23 times more likely to die of SIDS. b. ETS triggers bronchitis, pneumonia, and other respiratory infections in infants and toddlers up to age 18 months. c. ETS is a risk factor for asthma and aggravates symptoms for those who already have it. d. ETS is also linked to reduced lung function and middle-ear infections. e. Children and teens exposed to ETS score lower on tests of reading and reasoning. f. Later in life, people exposed to ETS as children are at increased risk for lung cancer, emphysema, and chronic bronchitis.

Immediate Effects

1. The amount of alcohol in the blood is the primary factor for determining the effects of alcohol. 2. Low Concentrations of Alcohol a. With BAC of 0.03% to 0.05%, light-headedness, relaxation, and release of inhibitions can occur. b. At this level, alcohol acts as a stimulant because it depresses inhibitory centers in the brain. 3. Higher Concentrations of Alcohol a. Pleasant effects are replaced by more negative ones: reduced motor coordination, verbal performance, and intellectual functions. b. At levels of 0.1%, major reductions in most sensory and motor functioning occur, people become sleepy, and the senses become less acute. c. At 0.2%, most drinkers are totally unable to function, physically or psychologically. d. Coma generally occurs with levels of 0.35%, and any higher level can be fatal. 4. Alcohol Hangover a. Hangover is probably caused by a combination of toxic products of alcohol breakdown, dehydration, and hormonal effects. i. During a hangover, heart rate and blood pressure increase, making some people more vulnerable to heart attack. b. Brain waves slow for up to 16 hours after BAC returns to 0.0%. 5. Alcohol Poisoning a. Drinking large amounts of alcohol over a short period of time can raise BAC to a lethal range. b. Fatal alcohol poisoning may result from either central nervous system (CNS) and respiratory depression or by inhaling fluid or vomit into the lungs. c. A drinker who loses consciousness can still experience a rising BAC because the body continues to absorb alcohol. 6. Using Alcohol with Other Drugs a. One of the leading causes of drug-related deaths is the practice of combining alcohol and other legal and illegal drugs, particularly other drugs that cause CNS depression. i. The combination can lead to coma, respiratory depression, and death. Examples of include barbiturates, narcotics, Valium-like drugs, and antihistamines. ii. Illegal drugs such as cocaine and heroin are very dangerous in combination with alcohol. b. Caffeinated alcoholic beverages are a growing concern because of their popularity with underage drinkers; and the combined effect with alcohol can be dangerous. 7. Alcohol-Related Injuries and Violence a. Alcohol contributes to or is involved in many homicides, suicides, automobile crashes, and other traumatic incidents. i. Through homicide, suicide, automobile crashes, and other incidents, alcohol is linked to about 90,000 American deaths each year. ii. Alcohol use more than triples the risk of fatal injuries during leisure activities and more than 50% of fatal falls and serious burns happen to people who have been drinking. 8. Alcohol and Aggression a. Alcohol contributes to over 40% of all murders, assaults, and rapes. i. Some people become violent under the influence of alcohol. b. The effect of alcohol on people who are predisposed to aggressive and impulsive behavior is doubly risky. i. In some cases an underlying psychiatric condition, antisocial personality disorder, worsens under alcohol's influence. c. Alcohol can also negatively affect home life in the form of domestic violence and marital discord. 9. Alcohol and Sexual Decision Making a. Alcohol consumption affects a person's ability to make wise decisions about sexual activity. i. Unplanned and unprotected sex become more likely. ii. Heavy drinkers are more likely to have multiple sex partners and to engage in high-risk sexual behavior. iii. Binge drinking is a pattern of rapid, periodic drinking.

Additives in Food

1. The most widely used food additives are sugar, salt, and corn syrup. 2. The purposes of additives: a. Maintain or improve nutritional quality b. Maintain freshness on shelf or in refrigerator c. Help in processing or preparation d. Alter taste or appearance 3. Health concerns have appeared over certain additives. a. Nitrates or nitrites used in processed meats are associated with cancer-causing agents in the stomach. b. BHA and BHT maintain food freshness. They may be linked to increased risk of certain cancers. c. Sulfites, which keep vegetables from turning brown, can cause severe reactions in some people. d. Monosodium glutamate (MSG), a flavor enhancer, may cause increased blood pressure and sweating in some people.

Benefits of Quitting

1. The younger people are when they stop smoking, the more pronounced the health benefits. 2. It's never too late to quit. Regardless of age, people who quit smoking live longer than those who continue to smoke.

Individual Action

1. There are many ways individuals can support tobacco prevention: a. Complain when a smoker violates a no-smoking designation. b. Ask restaurants and shops to adopt a nonsmoking policy. c. Report illegal tobacco sales to youth. d. Learn more about addiction and tobacco cessation. e. Vote for candidates who support anti-tobacco measures.

Dietary Guidelines for Americans

1. To provide general guidance for choosing a healthy diet, the USDA and the Department of Health and Human Services jointly issue Dietary Guidelines for Americans every five years. a. These guidelines are intended for healthy children age 2 years and older and adults of all ages. 2. The main objective of the 2015-2020 report is to encourage healthy eating patterns and regular physical activity in the American population. a. It points out the large discrepancy between recommendations and the actual American diet. 3. Following these guidelines promotes health and reduces risk of diseases such as heart disease, cancer, diabetes, stroke, osteoporosis, and obesity

USDA's MyPlate

1. To put the Dietary Guidelines into practice, USDA issued the food guidance system known as MyPlate that provides a simple graphic showing how to use the five food groups to build a healthy plate at each meal. 2. MyPlate encourages customization and personalization. It is available in Spanish and makes special recommendations for certain populations.

Tobacco Smoke: A Toxic Mix

1. Tobacco smoke contains thousands of damaging chemical substances, hundreds of which are known to be harmful to humans. 2. Smoke from an unfiltered cigarette contains 5 billion particles per cubic millimeter, 50,000 times more than in an equal amount of polluted urban air. 3. When condensed, these particles form a sticky mass called cigarette tar. 4. Carcinogens and Poisons a. At least 69 chemicals in tobacco smoke are linked to the development of cancer. i. Carcinogens directly cause cancer. ii. Cocarcinogens combine with other chemicals to stimulate the growth of certain cancers. b. Other compounds are not carcinogenic but damage the lining of the respiratory tract or reduce the lungs' capacity to fight off infection. c. Tobacco also contains poisonous substances, including arsenic and hydrogen cyanide; nicotine itself is a poison. d. Smokers also inhale carbon monoxide in concentrations 400 times stronger than levels considered safe in industrial workplaces. e. Smokers often are short of breath after exertion, because carbon monoxide displaces oxygen in red blood cells. f. Carbon monoxide also impairs visual acuity, especially at night.

Reducing Sedentary Time

1. Too much time sitting is detrimental to health regardless of whether physical activity goals are met. 2. Sedentary time is associated with markers of poor metabolic functioning. a. One study found that sitting for more than 30 or 60 minutes at a time resulted in significantly elevated glucose and insulin levels. b. Sedentary time also affects blood fats and markers for inflammation. 3. The average American adult spends more than half her or his waking day in sedentary activities; but frequent breaks, such as 2 minutes every 20 or 30 minutes, protect against some of the impacts.

Preventing Drug Misuse

1. Traditional government programs aimed at stopping the drug problem focused on stopping the production, importation, and distribution of illegal drugs. 2. A new national drug policy announced in 2010 focuses on stopping the demand for drugs. 3. Strategies for reducing the drug problem in the future include these: a. Development of persuasive antidrug programs b. Indirect approaches to building young people's self-esteem, improving academic skills, and increasing recreational opportunities c. Direct approaches like providing information about the adverse effects of drugs and teaching young people strategies to resist peer pressure 4. Prevention efforts need to focus on the motivations people have for using and misusing, and on approaching different groups with different techniques.

Additional Health, Cosmetic, and Economic Concerns

1. Ulcers a. Smoking also increases the risk of gastrointestinal reflux, which causes heartburn and can, if severe, raise the risk of esophageal cancer. 2. Thinning of the brain's cortex 3. Erectile dysfunction 4. Reproductive health problems 5. Dental diseases 6. Diminished physical senses 7. Injuries 8. Cosmetic concerns a. Premature skin wrinkling, premature baldness, stained teeth, discolored fingers, and a persistent tobacco odor in clothes and hair 9. Economic costs a. A pack-a-day habit could cost more than $3600 per year for cigarettes alone. b. In January 2018, the average per-pack cost of cigarettes was $6.32. 10. Cumulative Effects a. There are two general types of cumulative effects of cigarette smoking: i. Reduced life expectancy: A male who starts to smoke before age 15 and continues to smoke is only half as likely to live to age 75 as a male who never smoked. Females have similar risks. ii. Diminished quality of life: Smokers spend one-third more time away from their jobs because of illness than nonsmokers. Smokers become disabled at younger ages. 11. Gender Differences in Health Hazards a. Overall tobacco-related illnesses are the same for men and women, but sex appears to make a difference in some diseases. i. Women are more at risk for smoking-related blood clots and strokes. ii. Among those with the same smoking history, the odds of developing one of the three major types of cancer are 1.2 to 1.7 time higher in women than in men. iv. Women smokers have risks associated with reproduction and reproductive organs, including issues with menstrual bleeding, difficult pregnancies and stillbirth, and increased risk for cervical cancer.

The Vegetarian Alternative

1. Vegetarians severely restrict or totally eliminate foods of animal origin from their diet. 2. They may have different reasons: a. They believe foods of plant origin are healthier, are more natural, and take less energy to produce. b. Vegetarianism is more compatible with their religious, ethical, environmental, or financial considerations.

Vitamins—Organic Micronutrients

1. Vitamins are organic substances required in small amounts to regulate various processes within living cells. 2. Thirteen vitamins are essential to health. Four are fat-soluble (A, D, E, and K), and nine are water-soluble (C and the B-complex vitamins: thiamin, riboflavin, niacin, B-6, folate, vitamin B-12, biotin, and pantothenic acid).

Water—Vital but Underappreciated

1. Water is the major component in food and in the human body. 2. The body is 50% to 60% water; the need for water is greater than the need for any other nutrient. 3. Water is distributed throughout the body in lean tissues, other tissues, and body fluids. 4. Water is necessary for digestion and absorption; it is the medium in which chemical reactions take place. Water also helps regulate body temperature. 5. Foods and fluids consumed provide 80% to 90% of daily intake; the rest is generated through metabolism. 6. Water is lost through urine, feces, and sweat and through evaporation from the lungs. 7. Most people can maintain a healthy water balance by consuming beverages at meals and drinking fluids in response to thirst. 8. To maintain hydration, all fluids, including those containing caffeine, can count toward your total fluid intake. Under these guidelines, men need 3.7 total liters, with 3.0 liters (13 cups) coming from beverages. Women need 2.7 liters, with 2.2 liters (9 cups) coming from beverages.

Choosing Exercises

A complete weight-training program—one that works all the major muscle groups— will usually employ 8 to 10 different exercises

Risks Associated with Drug Misuse

A. In 2014, over 400,000 emergency room visits related to drug misuse or abuse were reported, though the actual number could be as high as 1.3 million. The following are serious concerns as well: 1. Intoxication—People under the influence of drugs are more likely to be injured from a variety of causes and to be involved in incidents of aggression and violence. 2. Unexpected side effects—Psychoactive drugs have many physical and psychological side effects. a. Side effects can range from nausea and constipation to paranoia, depression, heart failure, and the risk of fatal overdose. 3. Unknown drug constituents—As there is no quality control in the illegal drug market, the composition, dosage, and toxicity of street drugs is highly variable. 4. Infection and injection drug use—Many injection drug users share or reuse needles, syringes, and other injection equipment, which can easily become contaminated with the user's blood. a. Blood can carry the HIV virus and the hepatitis C virus. b. Syringe exchange programs (SEPs)—in which injection drug users turn in a used syringe and get back a new one free—have been advocated to help slow the spread of HIV and reduce rates and cost of other health problems associated with injection drug use. 5. Legal consequences—Since psychoactive drugs are illegal, using them can result in large fines and/or imprisonment.

Why People Use Tobacco

A. Nicotine Addiction 1. People continue to use tobacco because they are addicted to nicotine, a powerful psychoactive drug that reaches the brain via the bloodstream seconds after it is inhaled or absorbed through the membranes of the mouth and nose (spit tobacco). 2. Many researchers consider nicotine the most physically addictive of the psychoactive drugs. 3. Nicotine acts on the brain much like cocaine and heroin do; it releases chemical messengers in the brain—epinephrine, norepinephrine, and dopamine. a. Nicotine modulates everyday emotions rather than causing a high. b. At low doses, it acts as a stimulant. In some instances, nicotine acts as a mild sedative. 4. Use of any tobacco product can lead to addiction and the appearance of the symptoms of substance dependence—loss of control, pharmacological tolerance, and withdrawal symptoms.

Components of an Active Lifestyle

A. Physical activity remains low for all Americans. 1. Physical activity is any body movement carried out by the skeletal muscles that requires energy. 2. Exercise refers to a subset of physical activity—planned, structured, repetitive movement of the body intended specifically to improve or maintain physical fitness. 3. Moderate-intensity physical activity is essential to health and confers wide-ranging health benefits.

What Is Physical Fitness?

A. Physical fitness is a set of physical attributes that allow the body to respond or adapt to the demands and stress of physical effort. B. Health-related fitness includes the following components: 1. Cardiorespiratory endurance 2. Muscular strength 3. Muscular endurance 4. Flexibility 5. Body composition

Who Uses Tobacco?

A. Rates of smoking vary based on gender, age, ethnicity, and education level. 1. In 2015, 15.5% of Americans aged 18 and older were cigarette smokers. 2. More men than women smoke cigarettes. 3. Adults with twelfth-grade education or less are much more likely to smoke cigarettes than those with a college degree. 4. The number of people in the U.S. who smoke has been decreasing overall.

Components of a Healthy Diet

A. The body requires proteins, fats, carbohydrates, vitamins, minerals, and water; about 45 essential nutrients must be obtained from food. 1. The body needs some essential nutrients in relatively large amounts. These macronutrients include proteins, fats, carbohydrates, vitamins, minerals, and water. 2. The body needs micronutrients, such as vitamins and minerals, in much smaller amounts. B. Most nutrients become available to the body through the process of digestion, in which food is broken down and processed for use for normal body functions. C. The amount of energy in food is expressed in kilocalories (kcal). 1. 1 kilocalorie represents the amount of heat needed to raise the temperature of 1 liter of water 1 degree Celsius. a. An average person requires about 2000 kilocalories per day. b. The difference between energy and calories is that energy is the capacity to do work and calories are used to measure energy. 2. Of the six classes of essential nutrients, fat supplies the most energy per gram (9 calories) followed by protein and carbohydrate (4 calories per gram). a. Alcohol, though not an essential component of our diet, also supplies energy, providing 7 calories per gram. b. It is important to consume calories wisely, concentrating on nutrient-dense foods

Excessive Use of Alcohol

A. The DSM-5 uses the term alcohol use disorder and diagnoses alcohol use on a continuum of mild, moderate, severe, and extreme. B. If a person meets two of the criteria from the DSM-5, he or she has at least a mild disorder; more than four indicate alcoholism or a severe alcohol use disorder. C. Questions used to determine a person's place on the disorder spectrum: 1. Do you often consume alcohol in large amounts over a long period? 2. Do you find that your efforts to control your alcohol use are unsuccessful? 3. Do you spend excessive time using alcohol or recovering from its effects? 4. Do you have a strong desire or craving to use alcohol? 5. Does your persistent alcohol use cause a failure to fulfill obligations at work, school, or home? 6. Do you continue using alcohol despite recurrent social or interpersonal problems caused by its effects? 7. Have you reduced important social or recreational activities because of your alcohol use? 8. Do you persist in using alcohol in situations that are physically risky? 9. Do you continue using alcohol despite knowing that it can cause or worsen a recurrent physical or psychological problem? 10. Do you have a need for increased amounts of alcohol to achieve a desired effect (increased tolerance)? 11. Do you experience symptoms of withdrawal, such as sweating, increased pulse rate, hand tremor, insomnia, nausea, and anxiety?

Designing Your Exercise Program

A. The best exercise program promotes health and is fun. B. The physical activity pyramid can be used to meet goals. 1. A sedentary person should start at the bottom of the pyramid and gradually increase the amount of moderate-intensity activity in daily life. 2. Moving up to the next two levels—parts of a formal exercise program—can produce greater benefits. 3. New research shows that high-intensity interval training—repetitions of high-intensity exercise followed by rest—builds fitness rapidly in less time than traditional aerobic training.

African Americans

Alcohol abuse is a serious problem for African Americans, who experience higher rates of alcohol-related medical problems, crimes, and unintentional injuries. This is in spite of the fact that, as a group, they use less alcohol than most other groups.

Alcohol and the Body

Alcohol affects different people in different ways

Carbohydrates—An Important Source of Energy

Carbohydrates supply energy to the brain, nervous system, and blood, as well as provide fuel for high-intensity exercise.

College Students

College students may eat foods that are convenient but not necessarily high in nutrients and low in fat

Nutritional Guidelines: Planning Your Diet

Dietary Reference Intakes (DRIs), the Dietary Guidelines for Americans, and the USDA MyPlate food guidance system are tools to help people design healthy diets and prevent diet-related chronic illness.

Risk Factors for Drug Misuse and Addiction

Drug users come from all income and educational levels, all races and ethnic groups, and all age groups, but addicts do tend to share certain characteristics.

Why People Use and Misuse Drugs

Drugs have been used to alter consciousness since prehistory. 1. Plants were often used for religious, medicinal, and personal reasons. 2. Many drugs have addictive properties and alter brain chemistry.

Frequency

For general fitness, the American College of Sports Medicine recommends a frequency of at least 2 nonconsecutive days per week. This allows muscles a day for rest between workouts to avoid soreness and injury

Volume

For weight training, the volume of a specific exercise during a workout would be the amount of weight lifted multiplied by the number of reps and sets

Choosing Equipment

Equipment for a weight-training program may include weight machines or free weights.

Type 2 Diabetes

Exercise prevents the development of type 2 diabetes; and for those who already have diabetes, exercise is an important part of treatment

Cardiorespiratory Endurance Exercise

Exercises that condition your heart and lungs and improve your metabolism should play a central role in your fitness program.

Improved Wellness for Life

Exercising regularly may be the single most important thing a person can do to improve his or her quality of life in the future.

Recommended Fiber Intake

Experts recommend a daily fiber intake of 38 grams for adult men and 25 grams for adult women

Solid Fats and Added Sugars

If you consistently choose nutrient-dense foods that are fat-free or low-fat and contain no added sugars, a small amount of additional calories can be consumed in the form of solid fats and added sugars

Prevention of Injuries and Low-Back Pain

Increased muscle strength protects against injury by helping people maintain good posture and appropriate body mechanics. It also helps prevent low-back pain.

Improved Immune Function

Moderate exercise appears to boost immune function and protect from disease, while excessive training may depress the immune system.

Dietary Challenges for Various Population Groups

The Dietary Guidelines for Americans and MyPlate can help anyone create a healthy diet. Some populations face special challenges.

People with Special Health Concerns

People with conditions such as diabetes and high blood pressure may need a special diet

Putting It All Together

Put the basic components of fitness training together in a program that works for you.

Disease Prevention and Management

Regular exercise reduces the risk of many chronic, disabling diseases

Smoking and Pregnancy

Smoking during pregnancy presents more dangers for both the mother and the fetus, including miscarriage, ectopic pregnancy, premature birth, lower birth weight, and long-term impairments in physical growth and intellectual development

The Long-Term Effects of Smoking

Smoking has dangerous long-term effects that are probably related to the total amount of tobacco smoke inhaled.

Alcohol's Immediate and Long-Term Effects

The effects of alcohol on health depend on the individual, the circumstances, and the amount of alcohol consumed.

Frequency

Three to five times weekly is the optimal frequency for endurance training

Building Healthy Eating Patterns

a. A healthy eating pattern is one that meets nutrient needs while not exceeding calorie requirements and while staying within limits for dietary components that are typically overconsumed. b. The Dietary Guidelines highlight three healthy eating patterns: i. Healthy U.S.-Style Pattern ii. Healthy Vegetarian Pattern iii. Healthy Mediterranean-Style Pattern c. All three patterns emphasize whole fruits, vegetables, whole grains, beans and peas, fat-free and low-fat milk and milk products, and healthy oils. i. They include less red meat and more seafood than the typical American diet. d. A fundamental principle of all healthy dietary patterns is that people should eat nutrient-dense foods and should strive to get their nutrients from foods rather than supplements. e. The Dietary Guidelines also make specific recommendations for dietary components of particular public health concern. i. Consume less than 10% of calories per day from added sugars. ii. Consume less than 10% of calories per day from saturated fats. iii. Consume less than 2300 mg per day of sodium. iv. If you consume alcohol, do so in moderation—up to 1 drink per day for women and 2 drinks per day for men—and only if you are of legal drinking age. f. All Americans should also strive to meet federal physical activity guidelines and maintain a healthy body weight.

Cardiovascular Disease

a. A sedentary lifestyle is one of six major risk factors for cardiovascular disease (CVD), including heart attack and stroke. b. Exercise affects the risk factors for CVD and interferes with the disease process itself.

Time (Duration)

a. A total time of 20 to 60 minutes is recommended. i. A single session or multiple sessions of 10 minutes minimum is acceptable. b. The amount of time spent training depends on intensity. i. Twenty minutes of high intensity or 40 to 60 minutes of moderate intensity is sufficient.

Causes of Alcohol Use Disorder

a. A variety of factors are involved in the cause of alcoholism. i. Some studies suggest that as much as 50-60% of a person's risk for alcoholism is determined by genetic factors. ii. Other factors include personality disorders; having grown up in a violent or otherwise troubled household; and imitation of parents and peers. b. Those beginning excessive drinking in their teens are especially prone to binge drinking and alcoholism later in life.

Menthol Cigarettes

a. About 70% of African Americans smokers smoke menthol cigarettes, as compared to 30% of European Americans. i. Studies have found that African Americans absorb more nicotine than other groups and metabolize it more slowly. ii. African Americans also have lower success rates at quitting iii. The anesthetizing effect of menthol may allow smokers to inhale more deeply and hold smoke in the lungs longer, which may be responsible for the differences.

Added Sugars

a. Added sugars refers to white sugar, brown sugar, high-fructose corn syrup, and other sweeteners added to most processed foods. i. These foods are generally high in calories and low in essential nutrients and fiber. ii. High intake of added sugars is associated with dental cavities, excess weight, and increased risk of type 2 diabetes. b. Added sugars currently contribute about 250-300 calories in the typical daily American diet. c. The sugars in your diet should come mainly from whole fruits and from low-fat milk and other dairy products.

Additives

a. Additives are used to manipulate the taste and effect of tobacco products and account for roughly 10%, by weight, of a cigarette. b. Additives include: i. Sugars ii. Other flavorings like theobromine and glycyrrhizin that act as bronchodilators iii. Ammonia, which boosts the amount of nicotine delivered by cigarettes iv. Potassium citrate, aluminum, and clay—additives intended to make sidestream smoke less obvious and objectionable c. Anyone who inhales a cigarette is ingesting more than 7000 chemicals

American Indians and Alaska Natives

a. Alcohol abuse is a very serious problem among American Indians and Alaska natives. b. Treatment programs may be more effective if they incorporate tribal values.

Social and Psychological Effects

a. Alcohol causes more serious social and psychological problems than all other forms of drug abuse combined. b. For every person who is an alcoholic, at least three or four other people are directly affected. c. Alcoholics are likely to suffer other mental disorders in addition to their substance dependence. Many alcoholics also have other substance misuse problems.

Brain Damage

a. Alcoholics can experience brain shrinkage. b. Cognitive impairments occur in about half of the alcoholics in the U.S. i. Memory loss, dementia, and compromised problem-solving and reasoning abilities

Sources of Fiber

a. All plant foods contain some dietary fiber. i. Fruits, legumes, oats, and barley all contain the fiber that helps lower blood glucose and cholesterol levels. ii. Wheat, other grains and cereals, and vegetables are good sources cellulose and other fiber that helps prevent constipation. iii. Psyllium improves intestinal health and helps control glucose and cholesterol levels.

Recommended Carbohydrate Intake

a. Americans consume 200 to 300 grams of carbohydrates daily, well above the 130 grams needed to meet dietary needs. b. The AMDR for carbohydrate is 45% to 65% of total daily calories. i. 225-335 for someone who consumes 2000 calories a day ii. Focus should be on consuming a diet rich in complex carbohydrates, especially whole grains c. Athletes can benefit from high carbohydrate diets but must be cautious not to overconsume.

Asian Americans

a. Asian Americans tend to have lower-than-average rates of alcohol abuse. b. Acculturation may weaken taboos that contribute to the lower rate. c. A genetically based and physiological aversion to alcohol remains a deterrent to misuse.

Athletes

a. Athletes need to meet their increased energy requirements and to drink enough fluids to remain fully hydrated. b. Endurance athletes may benefit from increasing the number of complex carbohydrates in their diets.

Mortality

a. Average life expectancy among people with alcohol use disorder is about 15 years less than those who do not have the disorder. b. About half the deaths caused by alcohol are due to chronic conditions such as cirrhosis and cancer; the other half are due to acute conditions or events such as car crashes, falls, and suicide.

Pregnant and Breastfeeding Women

a. Before conception, nutrition counseling is advised. b. During pregnancy and while breastfeeding women have special nutritional needs and are often advised to take a nutrient supplement.

Vitamin Deficiencies

a. Characteristic symptoms of a deficiency can develop if your diet lacks a particular vitamin. i. Scurvy is caused by long-term lack of vitamin C. ii. Rickets occurs in children without sufficient vitamin D. iii. Blindness may be caused by vitamin A deficiency. iv. Anemia can develop in those whose diet lacks vitamin B-12, folate, or B-6. v. Low intake of folate and vitamins B-6 and B-12 has been linked to increased heart disease risk. b. Vitamin-deficiency diseases are rare in the United States, because vitamins are readily available from our food supply

Chronic Obstructive Pulmonary Disease

a. Chronic obstructive pulmonary disease (COPD) includes emphysema and chronic bronchitis, the most common of these diseases. COPD was the fourth leading cause of death in the United States in 2016. b. Smoking is also the primary cause of emphysema, a disease that impairs the lungs' ability to obtain oxygen and remove carbon dioxide by destroying the elasticity of the air sacs. i. Those with emphysema must constantly gasp for air and feel they are drowning. Their hearts must pump harder and may become enlarged. c. Chronic bronchitis is a persistent, recurrent inflammation of the bronchial tubes that leads to excess secretion of mucus and chronic cough. Smokers with chronic bronchitis face greater risk of lung cancer. d. Smokers who do not have chronic disease symptoms may still have respiratory system damage. i. Cilia lining the bronchial tubes no longer function to move mucus up to the mouth, so their protective qualities are destroyed. ii. Smoking makes macrophages, white blood cells that remove foreign particles, less effective.

Lung Cancer and Other Cancers

a. Cigarette smoking is the primary cause of lung cancer. Those who smoke two or more packs of cigarettes a day have lung cancer death rates 12-25 times greater than those of nonsmokers. i. The risk increases proportionate to the number of cigarettes smoked daily, the number of years a person has smoked, and the age at which the person started to smoke. ii. The risk of lung cancer drops dramatically for those who have quit smoking for a year or longer. b. Smoking is also linked to cancers of the mouth, trachea, pharynx, esophagus, larynx, pancreas, bladder, kidney, breast, cervix, stomach, liver, colon, and skin.

Refined versus Whole Grains

a. Complex carbohydrates can be divided into separate categories: i. Refined (or processed) carbohydrates ii. Unrefined carbohydrates (whole grains) b. Before they are processed, all grains are whole grains consisting of the following: i. Germ (inner layer) ii. Endosperm (middle layer) iii. Bran (outer layer) c. During processing, the germ and bran are often removed, leaving the starchy endosperm. i. The refinement of whole grains transforms whole-wheat flower into white flour, brown rice into white rice, etc. d. Refined carbohydrates retain the calories of their unrefined counterparts but tend to be much lower in fiber, vitamins, minerals, and other beneficial compounds. i. Many refined grain products are enriched and fortified with vitamins and minerals, but often the nutrients lost in processing are not replaced. e. Unrefined carbohydrates take longer to digest, which tends to make people feel full sooner and for a longer time. They keep blood sugar and insulin levels low and are high in dietary fiber. i. Consumption of whole grains has been linked to a reduced risk of heart disease, diabetes, and cancer, and plays an important role in gastrointestinal health and body weight management.

Core Training

a. Core muscles stabilize the spine and help transfer force between upper and lower body. i. Core muscles include muscles in the abdomen, pelvic floor, sides of the trunk, back, buttocks, hips, and pelvis. b. Strong core muscles make movements more forceful and help prevent back pain. i. When core muscles are weak, the nervous system steps in and uses other muscles. ii. Spinal stability and stiffness are more important for health and performance than core movement strength. c. The best exercises for low-back health are whole-body exercises that force the core muscles to stabilize the spine in many different directions

Cardiovascular Disease

a. Coronary heart disease (CHD) is the most widespread single cause of death for smokers. i. CHD is often the result of atherosclerosis, in which fatty deposits called plaques form on the inner walls of the arteries, causing them to narrow and stiffen. (1) Smoking and exposure to environmental tobacco smoke (ETS) accelerate the rate of plaque accumulation in the coronary arteries. ii. Smokers may then experience the crushing chest pain known as angina pectoris. If arteries are completely occluded, heart muscle may die, causing a myocardial infarction (heart attack). iii. Smokers have a death rate from CHD that is 70% higher than that of nonsmokers. b. Other cardiovascular diseases linked to smoking include these: i. Stroke ii. Aortic aneurysm iii. Pulmonary heart disease

Dairy: Move to Low-Fat and Fat-Free Dairy

a. Dairy includes milk and milk products, such as yogurt and cheeses that retain their calcium, as well as calcium-fortified soy milk. b. High in protein, carbohydrate, calcium, potassium, riboflavin, and vitamin D c. 3 cups of milk or the equivalent daily d. Serving size—1 cup equivalent i. 1 cup milk or yogurt ii. 1/2 cup ricotta cheese iii. 1 1/2 oz. natural cheese iv. 2 oz. processed cheese

Physical Activity

a. Dietary Guidelines and MyPlate strongly encourage physical activity. i. MyPlate recommends 2 1/2 hours of moderate physical activity or 1 1/4 hours of vigorous physical activity a week

Latinos

a. Drinking patterns among Latinos vary significantly, depending on their specific cultural background and length of time they have lived in the United States. b. Considering the family as a unit is important in treatment; family solidarity and support are important aspects of Latino culture.

The Cardiovascular System

a. Effects on the cardiovascular system depend on the amount of alcohol consumed. b. Moderate doses may reduce the risk of heart disease. c. Higher doses can: i. Elevate blood pressure ii. Weaken the heart muscle (cardiac myopathy) iii. Cause abnormal heart rhythms (after binge drinking), a syndrome called "holiday heart"

The Digestive System

a. Even in the short term, alcohol can alter liver function. i. Heavy alcohol consumption leads to the development of "fatty liver." ii. If drinking continues, an inflamed liver can occur, resulting in alcoholic hepatitis. iii. Both fatty liver and alcoholic hepatitis are potentially reversible if a person stops drinking. iv Continued use of alcohol leads to liver cell damage and eventual destruction. Destroyed cells are replaced by fibrous scar tissue, a condition called cirrhosis. b. Alcohol can also inflame the pancreas, causing pancreatitis, and can irritate the stomach lining.

Osteoporosis

a. Exercise is important for strong bones. b. Protection against osteoporosis comes from weight-bearing exercise, which builds bone during your childhood, teens, and twenties. c. Strength training and impact exercises, such as jumping rope, can increase bone density throughout life

Making Shifts to Align with Healthy Eating Patterns

a. For most Americans, achieving a healthy eating pattern will require changes to their current food and beverage choices. b. Some changes can be minor and accomplished with simple substitutions; others may require greater determination. c. People have many options for adopting eating patterns that meet their nutrient needs; stay within calorie limits; accommodate cultural, ethnic, traditional, and personal preferences; and take into account food cost and availability.

Intensity, Time, Volume, and Progression

a. For static stretches, hold to point of mild discomfort for 10-30 seconds, rest for 30-60 seconds, and then repeat, trying to stretch a bit farther. i. Older adults might benefit from holding a stretch for 30-60 seconds. b. Increase intensity gradually over time. i. Improved flexibility may take many months to develop

Fruits: Focus on Whole Fruits

a. Fruits are rich in carbohydrates, dietary fiber, and many vitamins (especially vitamin C). b. 2 cups of fruits daily i. Choose whole fruits over fruit juices. c. Serving size—1 cup equivalent i. 1 cup fresh, canned, or frozen fruit ii. 1 cup 100% fruit juice iii. 1 small whole fruit iv. 1/2 cup dried fruit

Harm Reduction Strategies

a. Harm reduction strategies attempt to minimize the negative effects of the drug use and abuse. b. Examples include these: i. Use of designated drivers to reduce alcohol-related motor vehicle crashes ii. Drug substitution programs like methadone clinics iii. Syringe exchange programs used to reduce HIV and hepatitis C transmission iv. Safe injection facilities v. Easy-to-use forms of naloxone, a drug that rapidly reverses opioid overdose vi. Free testing of street drugs for purity and potency

Hydrogenation and Trans Fats

a. Hydrogenation turns unsaturated fatty acids into more-solid fats to extend shelf life and prevent separation of fatty oil. These solid fats are highly saturated. b. Hydrogenation also changes some unsaturated fatty acids to trans fatty acids. It is done to transform liquid oil into margarine or vegetable shortening. i. Trans fats have been associated with an increase in low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) and a lowering of high-density lipoprotein (HDL) cholesterol ("good" cholesterol).

Cancer

a. In 2000, the U.S. Department of Health and Human Services added alcoholic beverages to its list of known carcinogens. b. Chronic alcohol consumption increases the risk of cancers of the mouth, throat, larynx, and esophagus. i. Five or six daily drinks, combined with smoking, increases the risk of these cancers by a factor of 50 or more. c. Alcohol is largely responsible for colorectal cancer and the most common form of liver cancer. d. Alcohol increases the risk of breast cancer. i. A study published in 2015 shows that drinking even one drink per day increases the risk of breast cancer. e. In all alcohol-related cancers, genetics and other biological factors play an important role.

Glycemic Index

a. Insulin and glucose levels rise and fall after a meal or snack containing any type of carbohydrate. b. Some foods cause a quick and dramatic rise in glucose and insulin levels; others have slower, more moderate effect. c. A food that has a strong effect on blood glucose levels is said to have a high glycemic index, which indicates the type of carbohydrate in that food. i. Although whole grains, high-fiber foods, and high-fat foods generally tend to have a low glycemic index, patterns are less clear for other types of foods and do not follow an easy distinction such as that of simple versus complex carbs

Intensity

a. Intensity of training is the crucial factor in attaining a significant training effect— that is, increasing the body's cardiorespiratory capacity. b. A primary purpose of endurance exercise is increasing maximal oxygen consumption (V̇ O2max)—the maximum ability of the cells to use oxygen. c. It is intensity of training that determines improvement in V̇ O2max. i. Beneficial effects occur at rates lower than the maximum rate with much less chance of injury. ii. Your target heart rate zone is the range of rates at which you should exercise to obtain cardiorespiratory benefits. d. Heart rate monitors are useful if close tracking of heart rate is important in your program. e. Scientists also use METs to measure the capacity to increase metabolism (energy usage level) above rest. i. Activities that increase metabolism by 6-8 METs are classified as moderate-intensity exercises and are suitable for most people

Factors Associated with Trying Drugs

a. Male—Males are twice as likely as females to abuse illicit drugs. b. Troubled childhood—Teens are more likely to try drugs if they have had behavioral issues in childhood, have suffered sexual or physical abuse, used tobacco at a young age, or suffer from certain mental or emotional problems. c. Thrill-seeker—A sense of invincibility is a factor in drug experimentation. d. Dysfunctional family—Chaotic home life or parental abuse increases the risk of drug use. e. Peer group that accepts drug use—Young people who are uninterested in school and earn poor grades are more likely to try drugs. f. Being poor—Young people who live in disadvantaged areas are more likely to be around drugs at a young age. g. Girl dating an older boy—Adolescent girls who date boys 2 or more years older than themselves are more likely to use drugs.

Codependency

a. Many treatment programs offer counseling for people close to drug abusers. These individuals can develop behaviors, known as codependency, that help or enable the drug abuser to remain drug dependent. b. Codependent people often engage in behaviors that remove or soften the effects of the drug use on the user—so-called enabling behaviors.

Medication-Assisted Treatment

a. Medication-assisted treatment involves using medications to reduce the craving for the abused drug or to block or oppose its effect. b. The best-known medication for drug abuse is methadone, which is a synthetic drug substituted for a more damaging one, such as heroin. i. Methadone reduces the craving for heroin. Although methadone also is addictive, it allows the addict to function normally in daily activities. c. The drug buprenorphine is approved for treatment of opioid addiction. Other drugs are being researched. d. Relapse rates for medication-assisted treatment are high but decrease when psychological and social services are provided concomitantly

First Steps 1. Medical Clearance

a. Men over age 40 and women over age 50 should get a medical examination. b. Certain medical conditions may require a modified exercise program. i. Physical checkup, including an electrocardiogram (ECG or EKG)

Men

a. More likely to drink, misuse, and develop an alcohol misuse disorder b. Usually start drinking early in life and are identified as alcoholics by their thirties and forties

Treatment

a. Most alcoholics require a treatment program, although approximately one-third stop drinking on their own or reduce their drinking enough to eliminate problems. b. No single treatment works for everyone. c. Because many alcoholics have patterns that fluctuate, their alcoholism is probably a response to environmental factors such as stress and may be helped by treatment. d. There are many different types of treatment programs: i. Alcoholics Anonymous (AA) uses a 12-step program that requires recognition of a "powerlessness over alcohol" and the need for help from a "higher power." (1) The alcoholic may rely on a sponsor for support and crisis intervention. ii. Alternatives to AA may avoid any emphasis on a "higher power." (1) Rational Recovery (2) Women for Sobriety iii. Moderation Management encourages people to manage their drinking behavior by limiting intake or abstaining. iv. Al-Anon and Alateen are companion programs for friends and families of alcoholics to help them explore how they enabled the alcoholic to drink and to learn how to change codependent behavior. v. Employee assistance and school-based programs can deal directly with school and work issues that might be sources of stress for the abuser. (1) They focus on effective coping responses for internal and external stressors. vi. There are medical treatments for alcoholism. They work best in combination with counseling or other nonpharmacological programs: (1) Disulfiram, which causes people to become violently ill when they drink (2) Naltrexone, which reduces the pleasant effects of alcohol and usually does not make the user ill; an injectable monthly form is available (3) Acamprosate helps people maintain alcohol abstinence after they have stopped drinking. It appears to work on the brain pathways related to alcohol abuse. (4) Antidepressants and antianxiety medications can improve mental health and drinking behavior in people who abuse alcohol and are depressed or anxious. Valium may be used during withdrawal to ease the symptoms.

Types and Sources of Fats

a. Most of the fats in food are similar in composition, including a glycerol molecule plus three fatty acids. The resulting structure is called a triglyceride. i. Within a triglyceride, different fatty acid structures result in different types of fats. A fat may be: (1) Unsaturated or saturated (2) Monounsaturated (3) Polyunsaturated b. The essential fatty acids linoleic and alpha-linolenic acids are both polyunsaturated. c. Different types of fatty acids have different characteristics and different effects on health. i. Liquid oils tend to be unsaturated, and solid fats are mostly saturated. ii. Saturated fats are usually solid at room temperature. Leading sources of saturated fat are red meats (hamburger, steak, roasts), whole milk, cheese, and hot dogs or luncheon meats. d. Most monounsaturated and polyunsaturated fatty acids are liquid at room temperature. Olive, canola, safflower, and peanut oils contain mostly monounsaturated fatty acids; corn, soybean, and cottonseed oils contain mostly polyunsaturated fatty acids.

A Food Plan for Vegetarians

a. MyPlate can be adapted for use by vegetarians with only a few key modifications: i. For the meat and bean group, focus on nonmeat choices of dry beans, nuts, seeds, eggs, and soy foods like tofu and tempeh. ii. Vegans and other vegetarians who do not consume any dairy products must find other rich sources of calcium. iii. A wide variety of plant proteins will supply all of the essential amino acids and all needed nutrients, except vitamin B-12 and possibly calcium, iron, zinc, and vitamin D

Vegetables: Vary Your Veggies

a. Naturally low in calories and fat, vegetables contain carbohydrates, dietary fiber, carotenoids, vitamin C, folate, potassium and other nutrients. b. 2 1/2 cups of vegetables a day c. Serving size—1 cup equivalent i. 1 cup cooked or raw vegetables ii. 2 cups raw leafy salad greens iii. 1 cup vegetable juice d. It is important to eat a variety to obtain maximum nutrition. Eat vegetables from several subgroups each day. i. Dark green vegetables ii. Red and orange vegetables iii. Beans and peas iv. Starchy vegetables v. Other vegetables

. A Caution about Supplements

a. Nutritional supplements and drugs will not change a weak, untrained person into a strong, fit person. b. The long-term effects of many supplements have not been studied

Older Adults

a. Older adults require fewer calories because of their reduced activity but may absorb nutrients less efficiently. Nutrient needs do not change much, so nutrient-dense foods are needed to meet this group's nutritional requirements. b. Foods fortified with vitamin B-12 or B-12 supplements are recommended for people over age 50, along with antioxidant consumption, eating high-fiber foods, and getting adequate fluids.

Types of Strength Training Exercises

a. One can maintain muscle strength by performing common exercises, such as curl-ups and push-ups, several times a week; exercises that involve all the various muscle groups should be performed. b. Increasing muscle strength and endurance requires doing resistance exercise, which is exerting force against a significant resistance (weights, exercise machines, or one's own body weight). c. Isometric (static) exercises apply force without movement; they tone and strengthen muscles. For maximum strength gains, hold for 6 seconds maximum; do 5 to 10 repetitions. d. Isotonic (dynamic) exercises apply force with movement in weight-training. Exercises include using barbells, dumbbells, weight machines, and body weight, as in push-ups or curl-ups.

Supporting Healthy Eating Patterns

a. People are more likely to shift their eating patterns toward the guidelines if we make a collaborative effort. b. The Dietary Guidelines' Social-Ecological Model (SEM) is a theoretical framework for understanding the factors that influence health and wellness: i. Individual factors ii. Environmental settings iii. Sectors of influence, such as government, education, media, and so on iv. Social and cultural norms

Factors Associated with Not Using Drugs

a. Positive self-esteem b. Assertive, independent thinkers who are uninfluenced by peer pressure c. Self-control d. Social competence e. Optimism f. Academic achievement g. Religiosity h. Open communication with and support from parents

Progression

a. Progression depends on your goals, fitness, health, age, and adaptation to training. i. Most benefits occur at moderate training intensities for about 150 minutes per week. ii. Genetics, motivation, age, fitness level, health, and level of skill/training will all affect one's progression level.

Cancer

a. Research has shown a relationship between increased physical activity and a reduced risk of cancer. i. Analysis of data from studies of 1.44 million subjects concludes that higher levels of leisure-time physical activity are associated with lower risks for 13 of 26 types of cancer. ii. There is evidence that exercise reduces the risk of colon cancer and perhaps prostate cancer, and cancer of the breast and reproductive organs in women. iii. Physical activity during high school and college years may be particularly important for preventing breast cancer later in life.

Selecting Activities

a. Selecting the proper activities is essential for a successful fitness program. b. A person who has been inactive should begin with moderate physical activity. As fitness level increases, more activity can be added to the program. c. Activities should fit a person's interests, personality, and lifestyle. d. Accessibility, expense, and time are important factors. An activity that is inconvenient to do or requires time to master might lead a novice to lose interest.

Groups and Peer Counseling

a. Self-help groups like Alcoholics Anonymous and Narcotics Anonymous help people acknowledge that they have a problem over which they have no control. b. Peer counseling programs are another approach that are available at some colleges

Simple and Complex Carbohydrates

a. Simple carbohydrates add sweetness to foods and include single sugar molecules (monosaccharides) and double sugar molecules (disaccharides). i. Monosaccharides include: (1) Glucose—most common sugar used by animals and plants for energy (2) Fructose—a very sweet sugar found in fruits (3) Galactose—the sugar found in milk ii. Disaccharides are pairs of single sugars. (1) Sucrose or table sugar (fructose + glucose) (2) Maltose or malt sugar (glucose + glucose) (3) Lactose or milk sugar (galactose + glucose) b. Complex carbohydrates include starches and most types of dietary fiber. c. Digestion breaks down carbohydrates into simple sugar molecules, like glucose, for absorption. i. Once glucose is in the bloodstream the pancreas releases the hormone insulin, which allows cells to take up glucose and use it for energy. ii. The liver and muscles take up glucose to provide carbohydrate storage in the form of a starch called glycogen. d. Problems controlling blood glucose levels can lead to diabetes mellitus.

"Reduced Harm" Cigarettes

a. Some smokers attempt to cut down the amount of harmful chemicals they inhale by switching to low-tar, low-nicotine, or filtered cigarettes. i. However, smokers often compensate by smoking more cigarettes or inhaling more deeply, thereby offsetting any benefits of the lowered amount of chemicals. ii. These types of cigarettes do not reduce the risk of smoking-related illness. iii. In 2010, federal regulations were enacted that make it illegal to describe tobacco products as "light," "mild," or "low," which were terms that were effective at making consumers believe these products were safer.

Vitamin Excesses

a. Some vitamins can be harmful if taken in excess. b. It is best to obtain vitamins from food rather than relying on supplements

Functions of Vitamins

a. Some vitamins help chemical reactions take place. b. Vitamins unleash energy stored in carbohydrates, proteins, and fats. c. Vitamins are critical in producing red blood cells and in maintaining the nervous, skeletal, and immune systems. d. Some vitamins act as antioxidants, which help preserve healthy cells in the body.

Frequency

a. Stretching exercises should be performed at least 2 to 3 days per week (5-7 is optimal). b. If they are performed after exercise, as part of a cool-down, more flexibility may develop because the muscles will be warmer and can be stretched farther.

General Recommendations

a. The Dietary Guidelines offer five overarching recommendations: i. Follow a healthy eating pattern across the lifespan. ii. Focus on variety, nutrient density, and amount. iii. Limit calories from added sugars and saturated fats and reduce sodium intake. iv. Shift to healthier food and beverage choices. v. Support healthy eating patterns for all.

Reading Supplement Labels

a. The Food and Drug Administration (FDA) does not authorize or test dietary supplements; supplements are not required to demonstrate safety or effectiveness. b. Appropriate dosage guidelines for some supplements have been well established; however, many dosages are unknown. c. Ingredients in supplements may interact with other substances in a dangerous way. d. Herbs also may be contaminated or misidentified.

Intensity and Time

a. The amount of weight (resistance) is the intensity; the number of repetitions of each exercise is equivalent to time. b. To improve fitness, one must do enough repetitions of each exercise to temporarily fatigue the worked muscles. i. In general, a heavy weight and as few as 1 to 5 repetitions builds strength; a lighter weight with 10 to 25 repetitions builds endurance. ii. It is best to start with a weight you can lift for 8 to 12 repetitions and add weight gradually over a period of weeks. iii. For developing strength and endurance for general fitness, a single set of each exercise is sufficient. iv. Make sure to warm up and cool down before and after every weight training session.

Type

a. The best exercises to develop cardiorespiratory endurance stress a large portion of the body's muscle mass for a prolonged period of time. i. They include walking, jogging, running, swimming, bicycling, and aerobic dancing. ii. Competitive sports that require high intensity, such as racquetball, tennis, basketball, and soccer, are good if the skill level and intensity are sufficient to provide a vigorous workout.

Loss of Control

a. The relapse rate for those who try to quit smoking is high. About 68% of smokers say they want to quit completely, and each year about 55% of smokers try to quit. b. Nicotine addiction leads to a rigid cycle of need and gratification; on average, users can go no more than 40 minutes between doses.

Volume of Activity

a. There are multiple ways to estimate exercise volume for cardiorespiratory endurance. The following are roughly equivalent: i. 150 minutes per week of moderate-intensity activity ii. Calories: 1000 calories per week in moderate-intensity exercise iii. MET-minutes: 500 to 1000 MET-min per week iv. Steps: 5400 to 7900 steps or more per day

Grains: Make Half Your Grains Whole Grains

a. These are usually low in fat and rich in complex carbohydrates, dietary fiber, vitamins, and minerals. Choose foods made with little fat and added sugars. b. Six ounce-equivalents each day—with half from whole grains c. Serving size—1 ounce-equivalent i. 1 slice of bread ii. 1 small muffin (2 1/2-inch diameter) iii. 1 cup of ready-to-eat cereal flakes iv. 1/2 cup cooked cereal, rice, grains, pasta v. 1 6-inch tortilla

Oils

a. These should be oils and fats that are liquid at room temperature. i. Come mostly from plant and fish sources b. Oils are major sources of vitamin E and unsaturated fatty acids, including essential fatty acids, but are not a food group. c. 6 teaspoons (27g) per day d. Serving size—1 teaspoon equivalent i. 1 teaspoon of vegetable oil or soft margarine ii. 1 tablespoon mayonnaise-type salad dressing e. Foods that are mostly oils include nuts, olives, avocados, and some fish.

Protein Foods: Vary Your Protein Routine

a. This group includes meat, poultry, fish, dried beans and peas, eggs, nuts, seeds, and processed soy foods. b. Provide protein, niacin, iron, vitamin B-6, zinc, and thiamin i. Animal foods contain B-12. c. 5 1/2 ounce-equivalents daily i. Choose a variety of protein foods and watch serving sizes carefully. ii. Choose at least one serving of plan proteins. iii. Choose at least 8 ounces of cooked seafood a week. d. Serving size—1 ounce equivalent i. 1 ounce cooked lean meat, poultry, fish ii. 1/4 cup cooked dry beans or tofu iii. 1 egg iv. 1 tablespoon peanut butter v. 1/2 ounce nuts or seeds

Sex Differences in Muscular Strength

a. Three factors help explain the strength disparity between men and women: i. Testosterone levels, which promote the growth of muscle tissue, are 6-10 times higher in males. ii. Men's greater skeletal size gives them more leverage. iii. The speed of nervous system control of muscles is faster in men, which gives them more power. b. Most women will not develop large muscles from strength training. c. Losing muscle over time is a greater health concern for women.

Proper Stretching Technique

a. Timing determines the best stretching technique. i. Static stretching, which involves extending to a certain position and holding it, may be done before and after a workout. ii. Dynamic stretching, which actively moves through the joints' ranges of motion, should be done before a workout. b. Ballistic stretching ("bouncing") is dangerous and counterproductive. c. The safest and best technique for increasing flexibility may be active static stretching with a passive assist.

Recommended Fat Intake

a. To meet the body's demand for essential fats: i. Men need 17 grams of linoleic acid and 1.6 grams of alpha linolenic acid per day. ii. Women need 12 grams of linoleic acid and 1.1 grams of alpha-linolenic acid per day. b. Most Americans consume enough essential fats; limiting unhealthy fats is a much greater health concern. c. The AMDR for total fat intake is 20% to 35% of total calories. i. Omega-6 fatty acids (5-10% of total calories) ii. Omega-3 fatty acids (0.6-1.2% of total calories) d. It is important to evaluate fat content, but more important to look at it in the context of one's overall diet. e. The latest federal guidelines place greater emphasis on choosing healthy unsaturated fats in place of saturated and trans fats.

Basic Principles of Physical Training

a. To put together an effective exercise program, a person should understand the basic principles of physical training. b. Specificity i. To develop a fitness component, a person must perform exercises that are specifically designed for that component. This is the principle of specificity. ii. For example, weight training develops muscular strength but does little in developing flexibility. iii. A well-rounded exercise program includes exercises geared to each component of fitness, to different parts of the body, and to specific activities or sports. c. Progressive Overload i. When the amount of exercise, also called overload, is progressively increased, the body adapts by improving its functioning, and fitness improves. ii. The amount of overload needed to maintain or improve a person's level of fitness is determined in four dimensions, which are represented by the acronym FITT-VP: Frequency, Intensity, Time, Type, Volume, and Progression. d. Rest and Recuperation i. Adequate rest is an important to training. Overtraining leads to injury, illness, and excessive fatigue. e. Reversibility i. The principle of reversibility comes into play when the body adjusts to lower levels of physical activity in the same way it adjusts to higher levels. ii. When you stop exercising, you can lose up to 50% of fitness improvements within two months. f. Individual Differences i. There are genetic limits to a person's ability to improve his or her fitness. ii. There are large individual differences between people and their ability to improve fitness, achieve a desirable body composition, and perform and learn sports skills.

Progression

a. Training intensity is the most important factor for improving strength and power. b. After achieving your goal, maintain strength by training one to three times per week.

Treatment Centers

a. Treatment centers offer short-term and long-term services, including hospitalization, detoxification, counseling, and other mental health services. b. One type is the therapeutic community, which is a residential program administered by ex-addicts who use confrontation, strict discipline, and peer pressure to resocialize the addict with a different set of values. c. Halfway houses offer a transition from residential programs to independent living.

Types of Vegetarian Diets

a. Vegans eat only plant food. b. Lacto-vegetarians eat plant foods and dairy products. c. Lacto-ovo-vegetarians eat plant foods, dairy products, and eggs. d. Others can be categorized as partial vegetarians, semi-vegetarians, or pesco-vegetarians (those who include fish and other seafood). e. Health professionals now recommend plant-based diets as a primary method in the prevention and treatment of chronic diseases.

Sources of Vitamins

a. Vitamins are found in fruits, vegetables, and grains and are added to some processed foods. b. A few vitamins are made in certain parts of the body. i. Skin makes vitamin D when exposed to sunlight. ii. Intestinal bacteria make vitamin K.

The Warm-Up and Cool-Down

a. Warming up improves performance and reduces the chance of injury. i. Warm up with low-intensity movements similar to those in the activity—for example, a slow jog before moving into faster running. b. Cooling down restores the body's circulation to its normal resting condition. Continuing to exercise at a low level after completing an activity helps regulate the return of blood to the heart.

Health Effects

a. With tolerance, the effects of continued use of alcohol are diminished. i. Heavy users may need to consume about 50% more than originally need to experience the same degree of intoxication. b. In withdrawal, symptoms emerge as the alcoholic stops or reduces consumption: shakiness, rapid pulse and breathing, insomnia, anxiety, and gastrointestinal upset. i. More severe withdrawal symptoms occur in 5% of alcoholics. These include: (1) Seizures ("rum fits") (2) Confusion and hallucinations (3) In a very few cases, delirium tremens (DTs) occurs, with severe disorientation, confusion, seizures, and hallucinations. c. Alcoholics face all the physical problems associated with excessive use of alcohol. d. Some damage is compounded by nutritional deficiencies that often accompany alcoholism. e. Memory defects and profound memory gaps ("blackouts") may be filled by conscious or unconscious lying.

Women

a. Women become intoxicated at lower doses of alcohol and tend to experience physical effects of chronic drinking sooner than men. b. Women tend to become alcoholics at later ages and with fewer years of drinking. c. Women are more likely to develop medical complications from alcohol.

People Who Benefit from Supplements

a. Women of child bearing age should get 400 micrograms a day of folic acid. b. People over age 50 should get adequate B-12. c. People who smoke should get 35 mg more vitamin C per day than the RDA. d. Consider whether you already eat a fortified breakfast cereal every day before making decisions about supplements

Energy Intake and Portion Sizes

a. Your food group goals should be based on an appropriate level of energy intake. When your weight is stable, your current energy intake is in balance with calories expended. b. To lose weight, most people need to reduce the number of calories they consume and increase physical activity. c. Most people underestimate the number of calories they consume and the size of their portions.