20 years younger look younger, feel younger, be younger!

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Page 1: 20 Years Younger Look Younger, Feel Younger, Be Younger!
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Begin ReadingTable of ContentsCopyright Page

In accordance with the U.S. Copyright Act of1976, the scanning, uploading, and electronicsharing of any part of this book without the

permission of the publisher constitute unlawfulpiracy and theft of the author’s intellectual

property. If you would like to use material fromthe book (other than for review purposes), prior

written permission must be obtained bycontacting the publisher at

[email protected]. Thank you for your

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support of the author’s rights.

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Reverse the effects of agingwith the 20 Years Younger

program

It’s never been simpler to look, feel, andbe 20 years younger.

Did you know that exercise helps keepcognitive skills sharp and lack of sleepmakes you more prone to obesity? Theseare just two examples of how improvingone body system can jump-start changesin another.

Bob Greene’s cutting-edge program is

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built around four essential pillars:

Exercise: Fight muscle and bone loss,strengthen the core, and stay agile with acombination of strength training andaerobics.Nutrition: A complete nutrition plandesigned to promote longevity, includingdelicious recipes, menus, and advice onsupplements.Skin care: The three-step skin-careprogram will battle wrinkles and otherage-related damage and restore the glowto your skin.Sleep: Get a better night’s sleep withthis eleven-point plan; enjoy moreenergy, reduce your risk of disease, andmore.

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The science of aging has shown thatincorporating these four pillars into yourlife can change your physiology,allowing you to significantly slow downage-related decline and function.Experience amazing changes to yourbody, mind, and spirit, and learn what itfeels like to be 20 years younger!

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Introduction

A NUMBER OF YEARS AGO, I spent part ofthe spring cycling my way across thecountry, riding from Long Beach,California, to New York City. It wassomething I had always wanted to do,and the opportunity presented itselfwhen I was booked on a multicity tour topromote a book I’d written. I knew thatthe 3,600-mile trip would be grueling,but I thought it would actually be lessstressful than racing from one airport to

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another, which is how a typical booktour unfolds. To prepare, I trained hardso that I’d be able to hit my target ofriding about one hundred miles a day. Iplanned to sleep in a different townevery night and visit bookstores, malls,and fitness centers in more than thirtycities along the way.

I wasn’t far into the trip when I beganto feel dramatic changes taking place. Bythe time I hit Arizona, I had a mental andemotional clarity that I’d never beforeexperienced. At times, I’d be riding foreight hours or more with nothing but thesound of my own breathing and the beatof my heart in my ears. As I lookedaround me, colors seemed brighter, theworld smelled fresher, sounds seemed

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sharper, the things I touched seemedmore textured. All my senses wereamplified. And nothing rattled me—not adog giving chase, rain on my back, atreacherous ascent. As my legs cycledrhythmically, the pedestrian concerns ofthe everyday slipped away and I’d findmy thinking stripped down to theessentials. I contemplated the sceneryand I contemplated my life. What wasimportant to me? What did I want out oflife? While I was on that trip it allbecame so much clearer.

As I edged toward Chicago I becameaware that I was also going throughextraordinary physical changes. I’d beenhailed on at the Grand Canyon and twice

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climbed more than 11,000 feet in thestill snowy Rockies, and I feltinvincible, virtually bulletproof. Everynight I slept like a rock. In my earlyforties at the time, I thought I was prettyfit going into the ride, but that extremephysical challenge left me much strongerthan I’d ever been in my life, even in mytwenties.

While I knew riding cross-countrywould be a challenge and that I’d comeoff the bike fitter than when I started, Ihadn’t realized how much the trip wouldtransform me both physically andemotionally. I was particularly amazedat how clearheaded I felt. I was able tolook at my life and see exactly where Iwanted to go. By the time I reached the

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East Coast, I was operating on allcylinders and had regained (and evensignificantly surpassed) the strength,power, energy, lucidity, and drive of myearlier years.

Graduate students in exercisephysiology learn about the anti-agingbenefits of physical activity, and I wasno exception. In fact, I’d had a longtimeinterest in the science of aging and theprevention of age-related decline. Butonce my cross-country trip allowed meto see the possibilities for myself, Ibecame passionate about the subject. Itwasn’t long after I completed that cross-country tour that I started exploring ideasfor this book.

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It’s not practical for most people toget on a bike and ride for a month (it’snot something I could easily fit into mylife anymore either), but I wondered ifthere were adjustments you could maketo your everyday life that would have asimilar de-aging, life-enhancing effect. Iknew that a good fitness plan could go along way toward turning back the clock,but what else was possible? To find out,I spent the next few years talking toexperts in other fields, learning about thelatest advances in anti-aging science anddetermining what aspects of thatresearch could be translated into aworkable plan for daily life.

After a time, it became evident that

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there are four main fronts on which youcan vigorously fight back against theeffects of aging: exercise, nutrition, skincare, and restorative sleep. Addressingany one of these areas with an eyetoward shaving off the years can have atremendous payoff, but it pales incomparison to the combined impact ofall four—especially when you alsocontrol the stress in your life andpractice positive thinking, two otheraspects that can significantly slow theaging process. A well-roundedcomprehensive approach can not onlyhelp you look and feel younger, but canactually make your body reverse course,even at the cellular level. At this pointthere’s little doubt: Good anti-aging

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strategies can both extend your life andsubstantially raise the quality of it.

By calling this book 20 YearsYounger I’m making what some mightthink is an exaggerated claim. But mostpeople these days are living lives thatpredispose them to early aging. If yougrab ahold of your health and activelypursue greater well-being, I don’t thinkit’s extravagant to say that you candramatically turn things around. It’scommonly accepted that the bodyundergoes certain changes with age, andto some extent those changes areinevitable. Even works of art maintainedunder pristine light and temperatureconditions eventually begin to wither.

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What is less known, though, is that thelife you lead and the decisions you makeevery day are largely responsible forhow quickly, profoundly, and noticeablyyou age. In fact, much of what we thinkof as aging—wrinkles, weight gain,memory loss, lack of energy, certaintypes of illnesses—is not primarilyattributable to the passage of time.Rather, it’s a direct result of sedentaryliving, poor diet, lack of sleep,insufficient (or nonexistent) skin care,too much stress, and even a defeatistattitude. It stands to reason, then, that ifyou reverse those habits—if you getmoving, eat longevity-promoting foods,sleep soundly and adequately, protectand nourish your skin, and improve your

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outlook on the world—the signs of agingwill reverse themselves, too.

Some people have gotten the messagethat the life you lead can indeed turnback the clock. But I feel others havemisinterpreted the message to mean thatthey should zealously pursue anyprogram that promises everlasting youth.Extreme exercise regimens, severelyrestrictive diets, unproven hormonaltherapies, cosmetic surgery makeovers—they may all seem like quick andeffective ways to return the body to itsyouthful self, but more often than notthey’re counterproductive. What we’reoffering you in this book instead arenatural, research-based strategies for

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getting your body (and mind) in top formand even lowering your physiologicalage. The goal isn’t to help you turnyourself back into a teenager but ratherto help you lead your longest, fullest,and healthiest life. Stay strong,energetic, mentally sharp, and confident,and your age will not define—ordebilitate—you. Instead it will beincidental; something noted on yourdriver’s license but not indicative ofyour health or capabilities.

I’m in my fifties now and I’ve alwaysprided myself in trying to live a healthylife. Some of those habits, as it turns out,

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have helped me when it comes to aging.I’ve been extremely conscientious aboutexercise, of course, and I’d give myselfa pretty good grade in healthy eating,getting enough sleep, and controllingstress, too. The one area where I wishI’d been more diligent is in caring formy skin. It’s long been my Achilles’heel.

Like so many people, I grew upbefore the widespread use of sunscreen.Nobody had heard of SPF back then, andwhile we knew that getting sunburn hurt,we hadn’t been clued in to the dangers ofsun exposure. I’ve always had rather fairskin, and when a friend of mine in myelementary school suggested I get a tan, Ibegan to feel self-conscious about how

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pale I was—an insecurity that lingeredwell into early adulthood. I never wasthat successful at getting a tan (I alwaysburned instead), but that doesn’t mean Ididn’t try.

A number of years ago Oprah and Iwere training for a race when, probablyannoyed at me for urging her to “pushharder,” she turned to me and said, “I’venever met anyone so together. Is thereanything you struggle with?” “Well, Idon’t tan very well,” I replied, giving anhonest answer. Oprah burst out laughing.I know she thought I was kidding, but Iwas genuinely insecure about my fairskin!

As I gathered information for this

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book and went looking for an expert tocontribute a chapter on skin care, Ithought I might be able to use myself as aguinea pig. By now I was regrettingevery unprotected minute I’d spent in thesun, and I needed some help inrejuvenating my skin. My plan was tointerview several top-echelondermatologists, try their products andadvice, and see how well they—and I—fared.

By the time I met Harold A. Lancer,MD, I’d already talked to a few differentdoctors and tried their plans, but withless than stellar results. When I went into see Dr. Lancer, both his knowledgeand his demeanor immediatelyimpressed me. During my appointment,

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he had me take off my shirt so he couldassess the skin below my chin, and thenhe proceeded to call in his staff ofassistants and nurses. There I was, witha group of women looking at me as if Iwere in a petri dish, when Dr. Lancersaid, “Look at him. He has the body ofsomeone decades younger.” Just when Iwas starting to feel a little puffed up, headded, “His skin, though—that’s justabout right for his age.” He started topoint out all my sun damage and agespots. I was hoping for a better report,but given that I have the kind of skin thatwrinkles if you glare at it too long, Iwasn’t surprised. And Dr. Lancer, asyou’ll see when you read his chapter,

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tells it like it is.What I like most about Dr. Lancer’s

approach (and I think you will, too) isthat he has shown you can get your skinto behave younger—not just lookyounger—with three skin care steps. Tohis mind, all the popular cosmeticprocedures, from lasers and fillers toneurotoxins, are really beautifiers of thelast resort. He sees the trend starting tomove from these more invasiveinterventions and toward a more cost-effective, natural, do-it-yourselfapproach to skin maintenance. I can sayfrom personal experience that it reallyworks.

I thought I’d done a fairly good jobprotecting my sleep, but it wasn’t until I

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invested in a great mattress—a Tempur-Pedic—that I started to realize I coulddo other things to maximize the qualityof my sleep. Shortly after that, I metRonald L. Kotler, MD, when weappeared on Good Morning America onthe same day. I watched his segment onsleep and admired his approach togetting a good night’s slumber. In hischapter, Dr. Kotler, who is also thecoauthor, with Maryann Karinch, of 365Ways to Get a Good Night’s Sleep,explains how sleep changes as you getolder and how you can offset thosechanges. It turns out that adequate sleepnot only affects the way you look andfeel but is also connected to lowering

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the risk of many life-shortening diseases.I like to keep my website updated

with the latest information about health,exercise, skin care, and nutrition,including dietary supplements. But I’dbeen feeling frustrated by the quality ofthe supplements on the market as well asthe information supporting them. Theyalways seemed to have too much of onething and too little of something else. Iwas so disappointed by what I found outthere that I developed my own line,called Bestlife vitamins (available atwww.20yearsyounger.com). That’s howI met Diane L. McKay, PhD, to whom Iturned for advice on both the efficacyand safety of supplements. Dr. McKayhas done extensive research on vitamin

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and mineral supplementation, is up onthe latest studies, and brings a bit ofsanity to a topic that can be confusingand somewhat controversial. Hercontributions to the book have beeninvaluable. In chapter 3, Dr. McKayhelps separate the supplements that havetrue anti-aging and overall healthbenefits from the ones that are a waste ofmoney, and she provides a guide tosafely adding supplements to your diet.

Someone once asked Woody Allen howhe felt about the aging process, andAllen answered, “Well, I’m against it.” Ilaughed when I read that and thought to

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myself, Me too! But the truth is, I’m notreally against aging. I’m simply for agingwell. Accepting that you’re growingolder is not the same thing as accepting alife that’s limited by age-relatedmaladies or where you don’t look or feelyour best. Age, as they say, really is justa number. It’s how well you’re able tolive your life that counts. Anothershowbiz guy, the comedian GeorgeBurns, once said, “You can’t help gettingolder, but you don’t have to get old.”And Burns knew what he was talkingabout. He lived a vigorous life until theage of one hundred.

I’d like to live to one hundred, too, aslong as I could still live a high-qualitylife at that advanced age. I’m sure most

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people would, but as the father of twoyoung children, I have a particularreason for wanting to live long and havethe strength and vitality to enjoy myfamily for many years to come. I camelate to fatherhood—I was almost fiftywhen we had our first child—and it’sgiven me incredible incentive to stay asenergetic, healthy, and youthful as I can.If I’ve learned anything during the timeI’ve spent exploring the aging process,it’s that motivation is key, just as it is forachieving anything worthwhile. Youcan’t be complacent if you want to agegracefully. It takes some discipline andhard work to slow down aging—if itwere easy everyone would look and feel

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twenty years younger. When you commityourself to all the elements of this plan—staying fit, eating right, caring for yourskin, sticking to good sleep habits—you’re distinguishing yourself from thecrowd. And you’ll be richly rewardedfor your efforts. Examine your currentlifestyle, readjust your schedule, directyour passion and drive toward adoptinga new, healthier anti-aging lifestyle, and—trust me—you’ll get amazing results.

I’d like to thank all of the 20 YearsYounger sponsors for being innovativewith their products. Their support andcreativity have enabled millions of

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Americans to live healthier—and better—lives.

BestLife FoodsBestLife Vitamins & SupplementsFlatout FlatbreadMichael’s FoodsOctane FitnessOmronSmart Balance FoodsSunlightenTempur-Pedic mattresses and pillows

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PART I

THE ART AND SCIENCE OF AGING

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CHAPTER 1

The Science of Aging

The longer I live, the more beautifullife becomes.

—Frank Lloyd Wright

EVERYONE HAS A NOTION of what it meansto age. Whether it’s a snapshot in yourhead of how your parents have sloweddown or lines you see on your own face,for many people it has something to dowith decline. Things not being the waythey used to be. Everything less than

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before.A lot of people feel that aging is

about loss. And in some ways it is.“Aging is a wide range of physiologicalchanges that make us more susceptible todeath, limit our normal functions, andrender us more susceptible to disease,”says João Pedro de Magalhães, PhD, aresearcher on the biology and genetics ofaging and a lecturer at the University ofLiverpool in England. I would add thatthe physiological changes that take placeas we age can also render us moresusceptible to psychological downturns.It’s not uncommon for people to loseenthusiasm as they get older,disheartened by their physicaldeterioration and inability to live the

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way they used to.Do we have to age? It’s the $6

million question and it’s one thatresearchers the world over are donatinga lot of time and money to answering.Some scientists are even hoping to findthe answer to the inevitable nextquestion: Do we have to die? I don’tthink we’re all that much closer toimmortality than Ponce de León waswhen he went searching for the fountainof youth way back in 1513. However,we do have a much greaterunderstanding of the aging process now.And we are living longer: Over the lastone hundred and fifty years, the averagelife span has climbed from about age

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forty-five to closer to age eighty.Living longer is important, but the

ultimate goal is to live longer and livewell into your later years. And throughthe science of aging we now know thatit’s very possible. In fact, it’s becomeclearer that not all the effects of agingwe’ve come to expect are inevitable,and that by making certain lifestylechoices you can dramatically slow thoseeffects down—and maybe, in somecases, even eradicate them. We all age—that is an undeniable fact—but yourlikelihood of aging poorly increases ifyou decide to simply sit back and leavewell enough alone. To the contrary, takeaction and you’ll retain your vitality, agegracefully, and, yes, have a longer,

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better life.Each of the subsequent chapters in

this book asks you to make certainlifestyle changes toward that goal. Thereasons behind those changes will beclearer if you know a little bit about thetheories of why we age and thephysiological consequences of growingolder.

THEORIES ON WHY WEAGE

Scientists have long debated a centralquestion about aging: Why? Why do weage? Many of them, both past and

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present, fall into the evolutionary camp.In the late 1800s, a German by the nameof August Weismann was one of the firstto promote an evolutionary theory. Hebelieved that we’re programmed to ageand die in order to make room for theyounger generation, continuing theevolution and betterment of the species.You might call it planned obsolescence.

Over time, the evolutionary theory ofaging has, well, evolved and othertheories have risen to the fore. One,called the mutation accumulation theory,is based on the idea that undesirablegenes that cause the death of children getweeded out; they’re not passed on to thenext generation. But undesirable genesthat don’t cause death until late in life

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get passed on from generation togeneration because the people who havethose genes have children before theirdeath. Over successive generations,those genes have accumulated,predisposing people to contract diseasesas they grow old, then die.

Another well-known evolutionarytheory is called the antagonisticpleiotropy theory. Its central idea is thatsome genes may be beneficial to us inour early lives but detrimental to us aswe grow older. For instance, genes thatincrease a woman’s ability to reproducemay also ultimately lead to menopauseand all the health hazards (among them,bone loss and an increased risk of heart

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disease) that go with it. According to theantagonistic pleiotropy theory, evolutionmay select for genes that favor youthbecause the chances that humans andother organisms will survive accidents,predators, and disease to live long livesare slim (or at least were before modernmedicine).

The other major theories on why weage have less to do with evolution andmore to do with the cumulative effects ofdamage to the body. Over the years,injury from simple wear and tear, sundamage, a poor diet, smoking, pollution,even the body’s own metabolicprocesses, add up to promote aging andeventual death. One of the mostprominent of these theories focuses on

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oxidative stress. Oxidative stress refersto the injury done to DNA, cells, andtissues in the body by free radicals,molecules with unpaired electrons thatare produced when the body metabolizesoxygen. Free radicals also becomepresent in the body through all theinjurious means I just mentioned (poordiet, etc.). In their incomplete state, freeradicals become thieves, stealingelectrons from other molecules andwreaking havoc along the way. Thedamage they leave in their wake is oftencompared to the rusting of metal. Thebody has the ability to absorb freeradicals and repair the damage they do,but its defense system tends to weaken

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over time, leaving it vulnerable todisease.

Like all theories about the cause ofaging, the oxidative stress theory is justthat, theory. We don’t know for sure ifunbound free radicals are the main causeof aging; however, we do know that freeradicals cause harm and that oxidativedamage can certainly age your body,decrease your quality of life, and evenshorten your life span. Morespecifically, by damaging a cell’s DNA,oxidative stress can be the first step totransforming a healthy cell into a cancercell (cancer also has other causes, suchas inherited genetic mutations). Freeradicals influence LDL (bad) cholesterolas well, making it even more prone to

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sticking to the walls of arteries andincreasing the risk of heart disease,stroke, erectile dysfunction, and otherconditions.

Many of the strategies you’ll readabout in this book are aimed atpreventing and repairing free radicaldamage. I’ll be recommending manyfoods that contain antioxidants such asvitamin E, vitamin C, and certainphytonutrients that disarm and disablefree radicals. These dietary watchdogsalso boost the body’s own free radicaldefense system. Likewise, the exerciseprogram will help turn up your body’sown free radical–fighting capabilities. Alot of Dr. Lancer’s skin care

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recommendations also focus onquenching free radicals that degradecollagen and elastin, the proteins thatgive skin its structure and bounce.

In addition to free radicals,inflammation has been implicated inaging because of the role it plays in somany age-related diseases. (They’reactually related—free radicals can causeinflammation.) Short-lived inflammationis a good thing; it’s the body’s defenseagainst a flu virus, bacteria, a wound, achemical irritant, and other kinds oftrauma. Inflammation occurs when,triggered by damage, immune cells rushinto the injured area, releasingcompounds that destroy bacteria orpromote wound healing. When the

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condition resolves, the immune responsegoes away. At least, most of the time.Sometimes, for a number of reasons,inflammation persists. That’s calledchronic inflammation, and it’s beenlinked to everything from cancer andheart disease to diabetes, dementia, andeven wrinkles. While it’s far fromcertain that inflammation is the majorculprit in aging, anything you can do toreduce inflammation—such as exerciseregularly—will reduce the cumulativeeffects of aging.

The Aging Brain

Using MRI and other imaging

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technologies, researchers havelearned that your brain starts to getsmaller as you get older. “The volumeof the frontal cortex, which isresponsible for reasoning, problem-solving, and strategic tasks, getssmaller, and white matter gets moreporous; it’s not as tightly woven as itwas,” explains Denise Park, PhD,director of the Center for VitalLongevity in Dallas. These changesmay explain why most peopleexperience subtle declines in the rateat which they process newinformation, the amount of informationthey can process at a time, and theability to remember new informationlong-term.

Memory of the past can also beaffected. “As you age, it gets harder toput tags on individual memories, whichallows them to be distinctive andeasier to retrieve later on,” says TomHess, PhD, professor in the department

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of Lifespan Developmental Psychologyat North Carolina State University inRaleigh. This change in memoryfunctioning appears to be due to age-related loss of neurons in thehippocampus, the area of the brainpartially responsible for establishingnew specific memories.

With age, protein deposits maystart to form in the brain. The brainnaturally produces a type of plaquecalled amyloid, which normallydegrades and is eliminated by thebody. Researchers have noticed abuildup of this protein during autopsieson people who had Alzheimer’sdisease. Up until very recently, itwasn’t possible to look at plaque inhealthy people, but Park and her teamhave been able to inject a radio tracersubstance into the brain, then useimaging techniques to see whetherhealthy volunteers have a buildup of

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amyloid. They’ve found that between25 and 35 percent of healthy adults startto have amyloid buildup in their fortiesand fifties. Park notes that the plaqueis associated with some cognitivedecline but that it’s uncertain whetherit’s an early sign or stage ofAlzheimer’s disease. “Lots of peoplefunctioning at a high level have thisplaque that’s associated withAlzheimer’s,” she says.

Growing older isn’t all bad newsfor the brain. Every time you learnsomething new, new wiring gets laiddown. The result: more processingpower. You can also fight the aging ofthe brain. Read how exercise helpshere, and turn to here for brain-boosting tips.

In the evolutionary theory of aging,genes determine aging and, ultimately,

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death. In the damage theory of aging,factors such as unhealthy food, stress,and even the body’s own metabolicprocesses are the primary agents.However, many people, including me,believe that aging is a combination ofboth. All the recommendations in thisbook, in fact, are predicated on the ideathat you are working both with your owngenetic predispositions and with thethings in life that you can control, suchas what you eat and how much youexercise. Aging without question has itsfoundations in genetically determinedmechanisms. “But,” points out JoãoPedro de Magalhães, “genetics can bemodulated by environmental factors.”

I’ll give you a good example. One of

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the markers of aging that you’ll behearing a lot more about in this book aretelomeres. Telomeres are the tail ends ofchromosomes, the structures that carrygenes. Every time a cell divides, thetelomeres stabilize the cell’schromosomes, but in the process theybecome shorter. When telomeresbecome too short, the cell can no longerdivide and it dies. This is believed tolead to various aspects of aging,including diminished muscle strength,wrinkles, and lowered immunity. Howmuch telomere length really affectslongevity—if at all—is still unknown,but many prominent researchers believeit’s an important cog in the wheel of life.

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In 2008, researchers at King’sCollege in London looked at the lengthof the telomeres in the white blood cellsof twins. Some of the participants werevery active, while their twin siblingswere quite a bit less active. The resultsof the study showed that, across theboard, telomere length was related toactivity: the more active the person, thelonger the telomeres. When very activeexercisers were compared directly totheir less active twins, they had telomerelengths that looked to be about four yearsyounger. Here was a case wheregenetics were the same, but the cellswere influenced by differing externalfactors, in this instance, exercise.

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MAJOR AGINGACCELERATORS

Obesity

Being overweight predisposes the bodyto heart disease, but that’s only one waythat obesity can affect longevity andaccelerate aging. New research suggeststhat it also makes cells older on amolecular level. For instance, some ofthe same researchers that looked attelomere length in active and sedentarytwins also looked at telomere length inobese women. What they found was thatobese women had shorter telomeres thanlean women. If you translated the

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telomere length into years, the obesewomen’s cells were nine years olderthan the lean women’s. Excess body fatis also thought to cause oxidative stressand is known to promote inflammation ofthe kind that’s been linked to age-relateddiseases.

Inflammation caused by excessivebody fat may also be related to theshrinking of the brain. Gary Wenk, PhD,a professor of psychology, neuroscience,and molecular virology, immunology,and medical genetics at the Ohio StateUniversity and Medical Center, hasshown that proteins that are a by-productof inflammation can cause regions of thebrain responsible for memory andlearning new things to become smaller.

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Other studies have shown that olderpeople who are obese have lessercognitive and memory capabilities andare at an increased risk for Alzheimer’sdisease.

Another way that obesity affectsaging is by contributing to insulinresistance. Insulin is the hormonecharged with ushering the sugar fromyour blood into cells throughout yourbody. When you aren’t producing enoughinsulin, or your cells become resistant toinsulin’s actions, blood sugar rises.People with type 1 diabetes produce noinsulin. People with type 2—the kindthat is often caused by too much body fatand constitutes about 90 to 95 percent of

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diabetes cases—are insulin resistant.That is, their bodies don’t respondproperly to normal amounts of insulin sothat sugar doesn’t get adequatelytransported from the blood to the cells.People with type 2 diabetes may eveneventually stop producing normalamounts of insulin, which can make thesituation worse.

Insulin resistance can shorten yourlife span and hasten aging in a number ofways: it encourages inflammation,quashes sirtuin activity (sirtuins areenzymes that delay cell death), shortenstelomeres, and raises levels ofcompounds called AGEs—advancedglycation end products—that wreakhavoc in the body (see here). Besides

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obesity (and particularly anoverabundance of intra-abdominal fat—stored fat that surrounds the organs), adiet high in sweets, sodas and othersugary drinks, white bread, white rice,and other processed grains seems topromote insulin resistance. There’s ahereditary factor to insulin resistance aswell—your genes may make you moresusceptible. But you might be able tostave it off for longer, and if you get it,regulate your blood sugar better, withthe type of diet you’ll find in chapter 3.

Smoking

While the link between excessive bodyweight and aging is disheartening given

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the rates of obesity in this country, it’ssomewhat more surprising than what haslong been known as the number onecause of preventable death: smoking.Besides its deleterious effect on lifespan, smoking promotes aging in justabout every way imaginable. It’s known,for instance, that smoking creates freeradicals and that it’s associated with thedevelopment of many age-relateddiseases, including some that you mightnot even think would be related:osteoporosis, diabetes, and the eyedisease macular degeneration. In theobesity study I mentioned earlier, theyalso looked at the effect of smoking ontelomeres and found that it shortenedtelomere length by a full 18 percent.

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It’s been known for some time thatsmoking is linked to dementia, andrecently researchers at KaiserPermanente in Oakland found that it’salso associated with an increased risk ofAlzheimer’s disease. Compared tononsmokers, people who smoked twopacks a day in midlife increased theirrisk of Alzheimer’s by 157 percent.

Dr. Lancer will talk more about theeffects of smoking on the skin in chapter4. However, suffice it to say that there’ssuch a thing as “smoker’s face,”characterized by deep lines around themouth and eyes and a grayish tint to theskin. Nicotine contracts the bloodvessels, decreasing blood flow to the

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skin and all the other major organs in thebody.

There are a few other reasons whyit’s to your advantage to quit smoking.One is that it makes it difficult toexercise at the pace you need to getsizable anti-aging benefits. The other isthat smoking can interfere with sleep. Tosee just how much, researchers at theJohns Hopkins University School ofMedicine hooked up forty smokers andforty nonsmokers to monitoring machinesand looked at their brain waves as theyslept. The smokers spent a lot less timein deep sleep, the most rejuvenating kindof slumber, and a lot more time in thelighter stages of sleep, when it’s easy tobe awakened—possibly in part because

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they were going through nicotinewithdrawal while they slept. Thesmokers also reported feeling lessrefreshed in the morning. (You’ll learnmore about the importance of a goodnight’s sleep in chapter 5.) Smoking iscertainly one of the worst things you cando to yourself—it’s like lying on a traintrack when you know that the train iscoming. Quitting, on the other hand, isperhaps the single best thing you can dofor yourself.

Stress

Work, finances, kids’ schedules,relationship problems, sick parents, yourown health issues—there are so many

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sources of stress in our modern dailylives. When you experience stress, yourbody releases powerful chemicals andhormones, including one called cortisol,that prepare your body to fight or flee aperceived threat or danger—the “fight orflight” response. “That response createsa biochemical soup that changes thechemistry of our blood,” explains ElissaEpel, PhD, associate professor in thedepartment of psychiatry at theUniversity of California, San Francisco.

The fight or flight response isbeneficial in the short run; it helps usdeal with a variety of dangeroussituations. After the threat has beenresolved, hormones level off and yourbody goes back to baseline. But if these

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high levels of stress chemicals persist—as they often do when someone is livinga high-pressure life—they can beharmful. Instead of protecting the body,they can cause damage to molecules andtissues and lead to a weakened immunesystem, acne, and other problems,including increased intra-abdominal fat,the kind that puts the body at risk forstroke, heart disease, and high bloodpressure. The stress response alsotriggers higher levels of damaging freeradicals, inflammation, and, in somecases, even spikes in insulin and glucoselevels that make the body seemprediabetic. And all of these, notsurprisingly, can speed up the aging

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process.Prolonged stress can also be

extremely harmful to the brain. Studieshave shown that persistent stress cancause depression and anxiety. It can killbrain cells and damage thehippocampus, the area in charge ofmemory and learning (research suggestsstress actually shrinks this portion of thebrain). When damaged, the hippocampuscannot create new memories or accessstored ones as efficiently. And becausethe hippocampus is part of the systemthat signals the body to stop producingcortisol, levels of the stress hormone canremain out of control and continue toharm the body.

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Getting a Handle onStress

In this day and age, it’s the rareperson who doesn’t feel stressed insome way. Rarer still is the personwho is managing it well. I say“managing” it because it’s really notpossible to entirely eliminate stressfrom your life. But if you organize yourlife more efficiently and have a fewgo-to ways to relax, you cansignificantly lower the wear and tearstress has on your body. Here are afew suggestions for living a lower-stress life.

List the major sources of stress inyour life to identify the bigcategories.

Keep a journal for two weeks to

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identify the more specific triggers.Write down all the situations thatmake you feel anxious or tense, aswell as how you handled (or didn’thandle) them. At the end of twoweeks, read through your journal.What stressful events can youavoid? Which relationships aremaking you feel stressed out? Canyou improve them, or possiblyconsider ending them? If you’reconstantly pressed for time with aday that’s way too full, what in yourschedule could you possiblyeliminate?

Make sure you are following all thehealthy recommendations in thisbook. Eating healthfully, exercisingregularly, and getting enough sleepcan go a long way toward helpingyou cope with stress.

Have a collection of “emergency

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stress stoppers” in your arsenal. TheAmerican Heart Associationrecommends these seven ways tocalm down.

1. Count to ten before you speak.2. Take three to five deep breaths.3. Walk away from the stressful

situation and say you’ll handle itlater.

4. Go for a walk.5. Don’t be afraid to say “I’m sorry”

if you make a mistake.6. Break down big problems into

smaller parts. For example,answer one email or phone callper day instead of dealing witheverything at once.

7. Drive in the slow lane or avoidbusy roads to help you stay calmwhile driving.

Make time for daily relaxation. It’simportant to determine what helpsslow your mind and body down.

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Maybe it’s meditation, yoga, orworking out in the gym. It could bereading, sitting down with a cup oftea, listening to music. Find whathelps you de-stress and practice it atleast once a day.

Get help if you need it. And I’m notjust talking about seeing a therapist,although seeing a therapist can behelpful if you feel that your life isout of control. Consider enrolling ina stress management program at alocal hospital, medical center, orcommunity clinic. Someone like aprofessional organizer or life coachmight be able to help you manageyour life more efficiently. If you’refeeling overwhelmed, talk to yourfamily, friends, colleagues, boss, oreven your company’sadministration. They may be able tohelp you scale back if you’ve takenon too many responsibilities.

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The effects of prolonged stress caneven be seen on a cellular level. Epel’sresearch has shown that people withhigh stress levels have shortertelomeres, which we know is indicativeof whole-body aging. (See here for adescription of one study involvingstress, telomeres, and exercise).

Managing current sources of stress isa must, but it’s also important to realizethat the stress experienced in the pastcan play a role in your present-day well-being, too. Research shows that stressfulor traumatic life events that youexperienced as a child—for instance,losing a parent—can have a powerful

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and lasting effect. “Really stressfulevents from childhood can add a coupleyears to a person’s subjective age; theycan make people feel older,” saysMarkus Schafer, a sociology researcherat Purdue University. “On the other hand,when people feel in control of their livesand things are going smoothly, they’rebetter able to maintain a sense ofyouthfulness.”

Whether it’s stress from the past orstress in the present that you’re battling,it may make it more difficult to fight thephysical decline that comes with aging.With my own clients, I’ve seen thoseoverly affected by stress becomeoverwhelmed and have a hard timeliving up to their eating and exercise

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goals. When you’re stressed out, a comfycouch and a carton of ice cream becomea lot more appealing than getting on atreadmill or having a healthy meal—although both of the latter (especiallyexercise) are good antidotes for stress.Stress also has a tremendous effect onattitude. It can make you feel negativeabout yourself and your life; it’s hard toappreciate all the good things you havewhen you’re overburdened, tense, andpressured. Stress can simply sap all thejoy and happiness right out of you.

AGING’S EFFECTS ON THEBODY

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There are essentially two ways that weage. The first is called primary aging.“That happens at the cellular level andincludes attacks on our cells by freeradicals, DNA damage, and the wearand tear on cells, tissues and organsfrom constant ongoing chemical andother reactions that constitutemetabolism,” explains DonaldWilliamson, PhD, an anti-agingresearcher and the John StaufferMcIlhenny Professor in Nutrition atPennington Biomedical Research Centerin Louisiana. “Secondary aging isdeveloping a disease such as cancer,atherosclerosis, or diabetes, which canshorten the life span.”

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Some aspects of aging are obvious.It’s apparent, for instance, that the skinchanges. Layers within and beneath theskin become thinner, helping to causesagging and wrinkles—the skin, in asense, folds in on itself. The skin alsobecomes less elastic and drier. It growsto be less sensitive to touch, too, andbecomes less adept at regulating thebody’s temperature. Hair loses pigment(the reason we become gray) and hairvolume is lost in both men and women.

Body shape can change, too. Mostpeople gain fat, and in many women, fatstorage shifts from the hips and thighs tothe abdomen. This deep intra-abdominalfat is one of the reasons that the risk of

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heart disease and diabetes in womendramatically increases after menopause.

One of the more noticeable signs thatsomeone is growing older is the suddenappearance of reading glasses on his orher face. As the lens of the eye becomesless flexible, it makes it harder to focuson objects in the near distance. Vision indim light also diminishes, and cataracts—clouded lenses—can start forming asearly as age forty.

There are also many changes that youcan’t see, and these changes have animpact on secondary aging. For instance,the thymus, a gland central to the immunesystem, shrinks, and many of the immunecells decrease in their ability to battlebacteria, viruses, and even cancer cells.

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The heart muscle degenerates slightlyand the valves inside the heart becomethicker and stiffer. Arteries are morelikely to get clogged with plaque, andblood pressure may increase. Thefunction of most organs declines as well,and cells become less able to divide andreproduce. Some hormone levels risewhile others drop, changing thecharacteristics of many physiologicalprocesses such as metabolism andinsulin sensitivity. Our sleeparchitecture—the different stages ofsleep—shifts so that we spend less timein deep, refreshing sleep and more timein the lighter phases from which we’remore easily awakened.

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Significant changes in the muscles,bones, and joints start to occur as well.Muscle fibers shrink and the repair ofmuscle tissue slows, lowering strength,decreasing the rate at which calories areburned, and making the body moresusceptible to obesity. The jointsbecome stiffer and bone mass is lost,increasing the risk of osteoporosis. Thevertebrae can also become morecompressed, the reason why manypeople lose height as they grow older.

THE LIGHT AT THE END OFTHE TUNNEL

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Just reading all of the above, I know, cancause you some despair. No one likes tothink of their body (and especially theirmind) deteriorating. But there’s room foroptimism, because you can really make adifference in the rate at which you ageand how susceptible you become to age-related diseases. Everything I describeabove can happen, but it doesn’t haveto: How you live can have a significantimpact on how your body ages. In thefollowing chapters, you’ll learn abouthow exercise, good nutrition, skin care,and healthy sleep habits actually changeyour physiology. Your body will growchronologically older; there is nothingyou can do about that. But you can get

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physiologically younger. Successfulaging isn’t an oxymoron. By adhering tothe advice in this book, you cansubstantially lower your likelihood ofdisease, look and feel younger, and staystrong, vital, sharp, active, and happy.Work at it and you can even turn backthe clock twenty years or more—noexaggeration.

Keep Your Health inCheck

One of the most important things youcan do to fight age-related maladies isto watch for any symptoms of disease.Catching conditions early is key tomaking a good recovery. Visit your

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doctor regularly, talk to him or herabout any tests that have no setrecommendations, and make sure thatyou are scheduled for the tests thatyou should have at regular intervals.Here are some guidelines adaptedfrom recommendations from the U.S.Department of Health and HumanServices and the American HeartAssociation. Vaccinations are also veryimportant. Check the Centers forDisease Control and Preventionwebsite (cdc.gov) to see the currentrecommended vaccinations for yourage group.

Screening Tests Ages 26–39

Ages 40–49

Ages50–64

Full check-up,includingweight andheight

Discuss with your physician.

Thyroid (TSH)test

Discuss with your physician.

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Blood pressuretest

At least every 2 years.

Cholesterol testEvery 5 years; more frequently if yourcholesterol is over 200 or you are a manover 45 or a woman over 50.

Bone densityscreen

Discuss with yourphysician.

Diabetes: Bloodglucose or A1ctest

Discusswith yourphysician.

Start atage 45,thenevery 3years.

Every 3 years.

Chlamydia test Get this test if you have new ormultiple partners.

Sexually Both partners should get tested for STIs,

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transmittedinfection (STI)tests

including HIV, before initiating sexualintercourse.

Colorectalhealth (use 1 ofthese 3methods): Fecaloccult bloodtest

Yearly.

Flexiblesigmoidoscopy(with fecaloccult bloodtest)

Every 5years.

Colonoscopy Every 10years.

Every2–4

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Comprehensiveeye exam

Discusswith yourphysician.

Get abaselineexam atage 40,thenevery2–4years oras yourdoctoradvises.

yearsuntilage 55,thenevery1–3yearsuntilage 65,or asyourdoctoradvises.

Hearing test

Startingat age 18,thenevery 10years.

Every 10years. Every 3 years.

Mole exam Monthly mole self-exam; by a physicianas part of a routine full checkup.

For WomenOnly:

Mammogram Every 1–2 years. Discuss withyour physician.

Clinical breast At least

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exam every 3years.

Yearly.

Pap test

Every 2years.Women30 andolder,every 3years.

Every 3 years.

Pelvic exam Yearly.

For Men Only:

Digital rectalexam

Discuss with your physician.

Prostate-specific antigentest (PSA)

Discuss with your physician.

Testicular exam Discuss with your physician.

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CHAPTER 2

The Ultimate Anti-Aging Weapon:Exercise

A FEW YEARS AGO I was waiting to boarda plane when I noticed the man standingnext to me, a guy who appeared to be inhis late sixties, wearing a really coolpair of glasses. I complimented him onthe glasses, and just as he was telling me

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they were a gift from his daughter, Iglanced down at his boarding pass andsaw the name “LaLanne.” I immediatelythought back to how, growing up, I hadwatched my mom exercise along to JackLaLanne’s TV show. I’m surprised Ididn’t recognize him right away, butonce I realized who he was I knew thathe couldn’t be in his sixties. When I gothome I looked it up and confirmed it:Jack LaLanne was in his early nineties.

As a champion of combiningcardiovascular exercise and strengthtraining for good health and fitness,LaLanne was way ahead of his time.And it obviously paid off. The man I metthat day in the airport not only lookedway younger than his years, but he was

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strong and healthy and had a youthfulway about him. If there ever was anadvertisement for the anti-aging benefitsof exercise, I was looking at it rightthere. When it comes to reversing theaging process, nothing touches exercise.

If you think about it, it makescomplete sense. Aging, as I described inthe previous chapter, is in part definedby the loss and breakdown of tissueswithin the body. Physical activity, to thecontrary, builds up tissues within thebody. That’s obvious when you look atthe musculature of devoted exercisers,but exercise also builds up tissue andenhances cellular activity in ways thatyou can’t even see. For instance, think

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about what exercise does for the body interms of disease prevention. Studiesshow that the risk of obesity, heartdisease, hypertension, stroke, diabetes,cancer, and just about every othercondition that leads to disability and/orearly death goes up with age. But peoplewho exercise regularly defy thosestatistics. They stay leaner and havemore robust cardiovascular systems,better insulin sensitivity, and strongerimmune systems. Daily physical activitysends a message to your brain and yourbody to stay young and vibrant, and as aresult exercisers typically live not onlylonger but higher-quality lives.

By “higher quality” I mean thatexercisers don’t suffer the same physical

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and psychological decline that sedentarypeople usually do—a decline that oftenbegins as early as age twenty-five. Whenpeople don’t exercise, they experienceboth muscle and bone loss, settingthemselves up for weakness and the riskof injury in their older years. Exercisers,on the other hand, maintain strongmuscles and bones, allowing them tocontinue leading active, on-the-go lives.Research also suggests that olderexercisers have sharper memories andcognitive skills, and that they’re moreoptimistic and satisfied with life.Because exercise helps ease depressionand anxiety, people who exerciseregularly tend to be calmer, too. That

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alone is useful in the fight against aging,since we know that stress contributes tothe deterioration of the body. Recently, astudy at the University of California, SanFrancisco, found that women with a lotof stress in their lives who werephysically active had longer telomeresthan stressed women who weresedentary. (Longer telomeres, as youmight remember from chapter 1, are amark of younger, healthier cells.)Exercise, we now know, has benefitsright down to the cellular level.

It even affects how other peopleperceive you. When English researchersquizzed people on their perceptions ofsixty-five-year-old exercisers versusnon-exercisers of the same age, they

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judged the exercisers to be friendlier,more hardworking, kinder, happier,more sociable, and better-looking thanthe non-exercisers. And here’s thekicker: The people making the judgmentswere basing their perceptions on awritten statement that mentioned whoexercised and who did not but includedvery little physical description; they hadnever even seen the sixty-five-year-olds.

A FOUNDATION FORLIVING LIFE TO THEFULLEST

A friend of mine loves to tell the story of

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her grandfather, a man who was activeall his life and regularly played softballuntil he was ninety-three. One night, hergrandfather was visiting the family whena knock sounded on the door. It was thenext-door neighbor, who’d seen aprowler on the side of my friend’sfamily’s house. My friend’s grandfather,in his early eighties at the time, ran to theside of the house, shouted out at theprowler—a young man—then took offrunning after him down the alley. A fewblocks later her grandfather caught theman (he let him go with a warning), andhis feat went down in family history.

Hopefully, you’ll never have todemonstrate your physical proficiency insuch a dramatic way, but I tell the story

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to remind you that the benefits of beingphysically fit go well beyond obtaining alean, toned, and younger-looking body.The most important thing exercise doesfor you is keep you living an active andindependent life. Being able to walkquickly when you’re late and climb thestairs of a stadium at a ball game withoutyour heart racing. Having the strength topull your luggage off the baggagecarousel at the airport and the agility toset up a tent. Possessing the stamina tohike the Grand Canyon and the power tocycle through vineyards. Having theflexibility to swing a tennis racquet andthe energy to swim in the ocean andwalk on the sand. Even if these types of

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things are no problem for you now, theyvery well could be if you don’t takepreventive measures.

As I frequently say, we were meantto move. And yet, as a society, webarely do. We text, we email, we pushremote control and elevator buttons, westep onto escalators, we put dishes in thedishwasher, we drive, and we sit, sit,sit. According to an American CancerSociety study, women who areotherwise inactive and sit six hours aday increase their likelihood of earlydeath by 98 percent compared to womenwho are very active and sit less thanthree hours per day. That’s astounding!We’ve become very apathetic aboutmoving our bodies and we’re paying the

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price in runaway rates of obesity anddiabetes.

The Aging Brain onExercise

Arthur F. Kramer is what you might callthe sage of the aging brain andexercise. The director of the BeckmanInstitute of Advanced Science andprofessor in the Department ofPsychology and Neuroscience at theUniversity of Illinois at Urbana, he hasled numerous studies looking at whathappens to the brains of older peoplewhen they exercise. His work makes astrong case for working out to staymentally sharp as well as for pickingup exercise no matter what your age.“We know from our studies that you

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can take older people who are almostprofessional couch potatoes and havethem start exercising late in life andget pretty dramatic benefits,” saysKramer. “Studies also show thatexercise improves cognitive function inpeople with Parkinson’s disease,multiple sclerosis, and Alzheimer’s.”

In Kramer and his colleagues’ mostrecent study, they invited sixty-five ofthose professional couch potatoes,ages fifty-nine to eighty, to join awalking group for a year. At the end ofthe year, the researchers looked at thewalkers’ brains with high-resolutionimaging and found that they hadincreased brain connectivity andimproved scores on cognitive tests.Connectivity, which means thatdifferent parts of the brain are actingin sync, typically declines with age, andso does cognition. By contrast, a controlgroup in Kramer’s study that did onlystretching exercises had no

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improvement in either cognition orconnectivity.

Other work coauthored by Kramerhas found that older people whostarted with fifteen minutes of walkingand built up to forty-five minutesshowed increases in brain volume inareas that usually show significantage-related deterioration. Thevolunteers in that study ranged in agefrom sixty through seventy-nine.“There may be a point of no returnwhen you’re too old for exercise toimprove your brain function,” saysKramer. “But so far we haven’t foundit.”

For every step forward we’ve takenin technology, we’ve taken a step backin regard to our health. But there’s aremedy for that: a solid, well-rounded

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exercise program that compensates forthe loss of activity in the way we liveour lives today. That’s a gooddescription of the anti-aging fitness planwaiting for you at the end of this chapter.It’s designed expressly tocounterbalance the way modern lifefacilitates and even accelerates the agingprocess. You may be surprised at howmuch exercise I’m going to ask you todo; I’m probably going to tell you tomove more than you initially want to.But engaging in structured exerciseevery day is how you fight back againstaging. You can’t just go for a quick walkaround the block on your lunch hour andexpect to get all the anti-aging benefits Imentioned. It takes more time and more

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energy—it takes a solid investment inyourself—but it’s well worth it. Therewards are life-changing, and if youdevelop a strong exercise habit, they’llstay with you for a lifetime.

It’s no accident that the exercisechapter is here in the front of this book.A comprehensive exercise regimen isthe foundation of any anti-aging program;its contributions to overall youthfulnessand well-being are unparalleled. Notonly is regular physical activitytransformative on its own, but it alsoacts as a gateway to improvement in allthe other areas we touch on in this book.People who are physically active tend toeat more healthfully. They have good

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circulation so their skin gets the oxygenand nutrients it needs to look—and act—younger. Exercisers sleep better, too,staying longer in the more rejuvenatingstage of slumber. They also typicallycope better with stress and often have amore positive outlook on life. Exercisedirectly or indirectly relates toeverything else you can do to turn backthe clock.

HOW EXERCISE SLOWSTHE AGING PROCESS

If you’ve been physically active all yourlife, you’re probably already

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“physiologically” younger than yourchronological age. But if you’re a lapsedexerciser or really haven’t ever donemuch physical activity at all, you canstill make significant headway in thefight against aging. Though I wouldn’t goas far as to say that exercise is thefountain of youth, evidence suggests that,in many ways, it’s the closest thingwe’ve got. Here are some reasons why:

Exercise prevents the deterioration ofmuscle and bone. By some calculations,most women begin losing about 1percent of muscle mass per year after theage of forty; men begin losing muscle intheir twenties. That loss of muscle tissue

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also contributes to a big loss in strength:Muscular strength can drop by as muchas 30 to 40 percent by the time you’re inyour eighties. A lot of people areresigned to their musculature growingflabbier and weaker with age; theyfigure it’s a fact of life. But the truth is,it’s not inevitable. The blame for mostmuscle tissue and muscle strength losscan be laid squarely at the feet ofinactivity. I hate to trot out an old cliché,but it’s undeniably true: Use it or lose it.Countless studies have shown that if youstrength train you can regain and/ormaintain muscle volume, endurance, andpower—even if you’re ninety years old.

Beyond the obvious—no one wantsto end up as the older person (or even

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the middle-aged person) who has troublepushing open a door or transporting hisbody around—there are good reasons topreserve muscle. Muscle tissue iscalorie-hungry, meaning that it takes alot of energy to maintain it. The moremuscle you have, the more calories youburn each day, which helps you limitweight gain. One reason that so manypeople end up gaining weight in middleage—and having a higher likelihood ofobesity-related conditions such as heartdisease, high blood pressure, anddiabetes—is because muscle loss hasleft them with a lowered ability to burncalories. When you hold on to muscle,you hold on to your calorie-burning

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power, too.Strength training is the best way to

build and preserve muscle. When youstrength train by doing exercises withdumbbells (my preference for mostpeople), resistance bands, or weightmachines, the load creates microtears inthe muscles, and the body, in repairingthose tears, generates larger, densermuscles. Another thing strength trainingdoes is activate nerves within themuscles that allow them to respond tochallenges more effectively.

Strength training also allows you totake aim at another common age-relatedissue: bone loss. Bone tissue may seemstatic, but in fact your body is constantlybreaking down bone and rebuilding it.

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When you’re young, your body breaksdown and rebuilds bone in equalmeasure, but the balance gradually shiftsas you get older. By the time mostpeople are in their forties and fifties, aconfluence of factors, including, inwomen, loss of estrogen, has createdenough of an imbalance to cause bonethinning. People who have a particularlylarge imbalance of breakdown andbuildup are at risk for the brittle bonedisease osteoporosis. But when youstrength train, your muscles tug on yourbones, triggering the rebuilding processand keeping the bones healthy. Weight-bearing cardiovascular exercise—anything that involves impact, such as

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running, walking, stair stepping, aerobicdance—also helps build bone. It’s worthnoting that when you strength train andchoose a weight-bearing activity as yourcardiovascular exercise, you doubleyour efforts to prevent age-related boneloss.

Exercise keeps age-related diseases atbay and reduces the likelihood ofmiddle-age spread. Cardiovascularexercise (also known as aerobicexercise) has different anti-aging effectsthan strength training, but they are noless amazing. I’ll get to the specificsabout those effects shortly, but first letme explain what it means to improve

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your cardiovascular system, which ismade up of your heart and the network ofblood vessels that course through yourbody. When your cardiovascular systemis fit, it has a heightened ability toprocess oxygen and deliver it to yourworking muscles. That makes movement,especially sustained movement,noticeably easier. Running to catch abus, going up stairs, walking to the store,keeping up with a child, require far lesseffort when you have cardiovascularpower and endurance. A fitcardiovascular system even works moreefficiently when you’re at rest. With allthat energy saved you inevitably feelless fatigued.

Physical activities that accelerate

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your breathing and make your heart workharder for a continuous and extendedperiod of time significantly improveyour cardiovascular system. These typeof workouts all involve repetitivemotion and engage your large musclegroups, but most important they allowyou to sustain movement. Brisk walking,running, swimming, cycling, ellipticaltraining, stair stepping, and aerobicdance all fit the bill. By contrast, anactivity such as tennis, which is great forbalance and hand-eye coordination, isn’tan ideal cardiovascular activity, becauseit typically requires too much startingand stopping. Strength training is anotheractivity that is sometimes thought to have

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aerobic benefits; however, while it’swonderful for muscle strengthening, itdoesn’t challenge the cardiovascularsystem.

Though you’re born with an innateamount of cardiovascular ability (oraerobic capacity, as it’s often called), itcan begin to decline at a relatively earlyage. If you’re very inactive, thedeterioration starts sometime in yourtwenties and then accelerates with eachdecade. But if you engage in consistent,moderate-to-high-level cardiovascularexercise, you can maintain yourcardiovascular ability and even seeimprovement well into your thirties,forties, and beyond. Regularcardiovascular exercise also causes

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other changes in the body thatsignificantly lower the risk of many age-related diseases. For instance, it’s longbeen known that cardiovascular exerciseraises levels of HDL (good) cholesterol,helping to protect against heart disease.It also increases insulin sensitivity,lowering the risk of diabetes, andreduces inflammation, which is linked toa number of life-threatening conditions(see box here).

Like strength training, cardiovascularexercise helps you fight midlife weightgain, too. It’s believed that most adultsgain about ten pounds per decade, butdata collected for the National Runners’Health Study, a project being conducted

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at the U.S. Department of Energy’sLawrence Berkeley National Laboratoryin California, shows that people who areconsistently active put on significantlyfewer pounds than that. And most likelyit’s not just because exercise burnscalories while you’re doing it. When youregularly engage in cardiovascularexercise, you increase the productionand storage of something called aerobicenzymes. These enzymes do a great jobof boosting your metabolism, the rate atwhich you burn calories, as well ashelping the body burn more fat. In largepart due to these enzymes, regularexercisers simply incinerate morecalories twenty-four hours a day. Sincethe metabolism typically slows down

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with age, that’s a boost everyone overthe age of thirty can use.

There’s another way cardiovascularexercise affects body weight. Men areprone to gaining weight in their belliesall through their lives. As women getolder, that tendency increases andasserts itself in them as well. Mostwomen typically gain fat in their arms,legs, and hips until menopause, whenhormone levels shift and they beginstoring what is known as intra-abdominal fat, located deep in theabdominal cavity. This fat puts you atgreater risk for heart disease, stroke, andcancer. Remarkably, cardiovascularexercise seems to target intra-abdominal

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fat. One study found that women on anaerobic exercise program lost 3 to 7percent of their belly fat—without evenchanging their eating habits.

Offsetting the Agingof the Immune

System

Whenever there’s an outbreak of a fluvirus or food poisoning, the elderly areamong those who get hit the hardest.One reason that’s likely is that theimmune system’s ability to fight offinfection tends to decline with age.That said, several studies have foundthat physically active elderly peoplehave greater immune cell function thanelderly people who don’t move

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around much. We also know thatmoderate exercise increases activity ofnatural killer cells (a type of immunecell that can destroy tumor and otherharmful cells) in people of all ages,undoubtedly the reason regularexercisers get fewer colds and flu andmiss significantly fewer days of work.Natural killer cells also appear to helpwipe out cancer cells, another waythey keep you safe.

While it may be too early to saythat exercise stops the natural aging ofthe immune system, researchers atMcMaster University in Ontario,Canada, found that it seems to producechanges in the body that compensatefor age-related reductions inantibodies. One of those changes is alower level of inflammation.Inflammation has an important role inthe body; when triggered by somekind of injury or infection, it helps thebody heal by promoting more immune

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activity in the affected area. Butchronic, low-grade inflammationactually worsens unhealthfulconditions, doing more harm thangood, and it’s been implicated as aculprit in numerous conditions,including heart disease, cancer,Parkinson’s disease, Alzheimer’sdisease, and autoimmune diseasessuch as rheumatoid arthritis and lupus.There is also some evidence to suggestthat chronic inflammation—which canbe a side effect of obesity, amongother things—can lead to DNAmutations and, ultimately, thedevelopment of cancer.

There are a few different waysthat exercise may reduceinflammation. One is by loweringlevels of an inflammatory proteincalled C-reactive protein (CRP). CRPlevels in the body increase with age,one reason we become more prone to

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developing inflammation-relateddiseases as we get older. Exercisereduces the levels of proteins calledpro-inflammatory cytokines andincreases levels of an anti-inflammatory form of cytokines. In aroundabout way, exercise may also ridthe body of inflammation bydecreasing body fat: Body fat actuallyproduces pro-inflammatory cytokinesthat cause inflammation.

Exercise changes the body at thecellular level. Many of the anti-agingbenefits of exercise don’t necessarilyshow up on cholesterol tests or on thescale, but they’re significant nonetheless.One of the most exciting areas of anti-aging research is the attempt to discoverhow exercise affects the life span and

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function of cells. For instance,researchers at the University ofColorado at Boulder recently comparedthe white blood cells of people agedfifty-five to seventy-two who did regularaerobic exercise to those of both theirsedentary peers and younger peopleaged eighteen to thirty-two whoexercised regularly. What they foundwas that the older exercisers had longertelomeres than the older sedentary folks,and their telomeres were notsignificantly different from those ofyounger exercisers. “Two general ‘anti-aging’ strategies would be either todecrease the rate of telomere shortening,or to increase the rate of telomere repairso that they maintain their length,” says

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Thomas LaRocca, a PhD candidate andlead author of the study. “Aerobicexercise may stimulate pathways andenzymes in the body that do both.”

There’s also evidence that regularcardiovascular exercise positivelyaffects mitochondria, little factories inthe cells that manufacture ATP, the mainsource of energy driving just about everybiological process in the body.Mitochondrial function is known todecline with age. However, work byresearchers at the Mayo Clinic Collegeof Medicine has shown that older peoplewho regularly engage in cardiovascularexercise have better mitochondrialfunctioning and capacity than young

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people who don’t exercise.One of the ways that the mitochondria

play a role in aging is by providingenergy to replace damaged proteins,thereby preventing the deterioration ofmany tissues and structures in the body.K. Sreekumaran Nair, MD, PhD, anendocrinologist and an author of theMayo Clinic study, gives this example:“One reason you lose strength with ageis that the proteins that enable themuscles to contract become damaged;it’s not only due to loss of muscletissue,” he says. “With bettermitochondrial function, you cansynthesize new contractile proteins.”Nair and his colleagues also found thatcardiovascular exercise increases the

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expression of SIRT3, which issometimes called the longevity gene.SIRT3 is one of a number of enzymescalled sirtuins that make cells lesssusceptible to an early death. Calorierestriction and the compound resveratrol(which you can read more about inchapter 3) also increase production ofSIRT3.

WHAT IS FITNESS?

I’ve just told you many of the ways thatstrengthening your muscles and trainingyour cardiovascular system can improveand even extend your life. But I don’twant to give you the idea that attaining

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muscular strength or cardiovascularendurance or both is all there is to beingfit. Fitness actually has many qualities,and each of them needs to be addressedby a comprehensive fitness program.

If I asked you to think of someonewho’s the epitome of fitness, you mightvisualize an elite athlete such as amarathon runner. After all, what couldbe more representative of fitness than theability to run twenty-six miles? Butmarathon runners are often like otherexercisers who stick to one sport andthink of themselves as fit yet are wantingin other areas. That marathon runner, forinstance, while definitely possessed ofexcellent cardiovascular fitness, might

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throw her back out bending down to pickup her briefcase. She may lack corestrength and flexibility. Think, too, of theguy at the gym who can bench 350pounds but can’t run up the stairs of thesubway without panting. He has limitedcardiovascular endurance.

Whereas a high level ofcardiovascular fitness and musclestrength will help you reap the anti-agingrewards I’ve talked about, to be truly“fit” you also need to be proficient inways that allow you to function at a highlevel as you go about your daily life.You don’t just want to be good at aparticular type of exercise; you want tobe good at all aspects of fitness,allowing you to be good at life. What’s

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more, you want to be fit in ways thatwill keep you from getting injured sothat you can consistently participate incardiovascular and muscle-strengtheningexercise and at a level that willmaximize all the anti-aging benefits Icited.

Cardiovascular endurance andmuscular strength are critical aspects offitness, but there are six other importantqualities of overall fitness that I haven’tmentioned yet. These qualities also tendto weaken with age if you don’t addressthem. The first is flexibility, the abilityof your muscles to give and allow yourjoints a good range of motion. Flexibilityenables your body to move freely and

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comfortably, but as the muscles shortenand stiffen with age, flexibility wanes,restricting movement. Abdominal andback (“core”) strength is critical too,because it protects your spine from wearand tear and stabilizes the entire bodywhen you lift, push, or pull anything.Core strength also improves yourposture, keeping your body upright so itdoesn’t succumb to hunching fromcomputer use or general fatigue.Strengthening key stabilizing muscles isalso important. When well conditioned,certain muscles protect other areas of thebody. Strengthening the calves, forinstance, helps prevent shin splints;strengthening the muscles around theshoulder girdle helps prevent rotator

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cuff tears.Agility, the ability to quickly change

direction and react to changingcircumstances, is another important areaof fitness, as is balance, being able tocontrol and maintain your body’sposition. Last but not least is hand-eyecoordination, the ability to assess thelocation and/or size of an object andquickly initiate the appropriate muscularresponse in your hands—or even yourfeet or other parts of your body (itshould really be called body-eyecoordination). It helps keep you safe ineveryday ways by, for instance,allowing you to quickly sidestep a rockon the sidewalk and drive a car

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proficiently. It also makes you better atengaging in recreational activities suchas golf, bowling, Frisbee, pool, Ping-Pong, and racquetball (in fact, practicingthese activities helps you maintain hand-eye coordination).

This might sound overwhelming—it’s a lot to cover—but rest assured thatyou don’t need separate workouts to getfit in all of these areas. There’s a lot ofoverlap, and many exercises coverseveral aspects of fitness. Thecomprehensive plan beginning here isgoing to help you cover all your bases ina methodical and economical way. Thinkof it this way: Your goal should be toestablish a basic level of fitness—it’scommonly called functional fitness—that

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includes all the elements I just listed aswell as moderate amounts ofcardiovascular endurance and all-overmuscular strength and endurance.Together these elements will allow youto comfortably walk up stairs, benddown to pick things up, reach for a boxon a high shelf without straining amuscle, be quick and coordinatedenough to catch a dish that’s slipped outof your hands, and rapidly sidestep anobstacle in your path without twisting anankle. They also help you get out and dofun things and perform them at higherlevels: skiing or snowshoeing in themountains, sightseeing in big cities,cycling on a long bike path, hiking in the

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hills, canoeing on a lake. It’s easier andmore enjoyable to do just about anyactivity when you’re in possession ofoverall fitness.

Let’s go back to my initial question,What does it mean to be fit? Being fitmeans all of the areas of your body arefunctioning well; you’ve trained andoptimized all the qualities of fitness.You can tell when someone is fitbecause he or she is able not only to getthrough the day comfortably and safely,but also to participate in many activitiesat a higher level and without injury.

You can attain this baseline level offunctional fitness—and many anti-agingbenefits—by training at Level I in the 20Years Younger exercise plan. The plan

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also allows you to progress and achieveeven greater levels of cardiovascularendurance and muscular strength (whichwill ramp up the anti-aging payoff). Ithink just about everyone who is willingto commit to fitness can rise to Level II.It’s more demanding, but doable—andthe benefits are that much greater. LevelIII is very challenging. I realize that noteveryone is going to be able to fit LevelIII into his or her life; it’s a lot ofexercise. But it’s also the ultimatecomprehensive anti-aging program. Ifinspiration strikes, and I hope that itwill, you will be well rewarded for yourefforts.

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THE 20 YEARS YOUNGERANTI-AGING EXERCISEPLAN

There are three things that make thisexercise plan different from other typesof fitness programs. One is that itemphasizes variety so that you hit all theareas of fitness essential to halting theaging process: flexibility, core strength,stabilization, agility, balance and hand-eye coordination, cardiovascularendurance, and muscle strength. Mostexercise programs tend to have anarrower target. An exercise plan forweight loss, for instance, might have youfocusing primarily on calorie burning—

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but at the expense of other aspects ofyour physiology that are also affected byage. By contrast, this program doesn’thave you chewing up a lot of time tryingto reach a limited goal; instead, it casts awide net that lets you turn back the clockin virtually all areas of fitness relating toaging.

The second important thing about thisplan is that although it requires a fairlysubstantial commitment on your part, I’monly asking you to take on as much asyou can handle at a time. There are threelevels and you can choose just how faryou want to go. If you haven’t beendoing much physical activity lately (orany at all), start at Level I, which

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primarily focuses on functionalconditioning and helping you establish abase of cardiovascular endurance andmuscular strength. In a matter of weeks,you’ll feel stronger and notice that youget through your day with less effort.You should also notice that you’resleeping better and your skin looks morevibrant. Having laid the groundwork atLevel I, you can progress to Level II. (Ifyou’re already a regular exerciser, youcan probably skip the beginning leveland jump right into Level II.) Here Iratchet up the challenge, asking you tospend more time on cardiovascularexercise and muscle strengthening. Thepayoff is considerable: This level ofexercise can bring about substantial

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changes in body fat, the strength of yourmuscles, the fitness of your heart, andyour mood—changes that will not onlybenefit your health but help push backthe clock to a greater degree.

I have had clients who started anexercise program reluctantly, committingto do “something” only because theirdoctor warned them that they had betterget active or face the music. To theirsurprise, many of these initially reluctantexercisers get inspired not only to take itto the next level but, in a manner ofspeaking, to shoot for the stars. They runmarathons, enter triathlons, or simplymake physical activity among theirhighest priorities. This is what I’m

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hoping will happen with you. Once youreap the rewards of Level II, you may beinspired to invest additional time andenergy to move up to Level III. I want tostress that all levels of the plan haveanti-aging benefits, but the advancedlevel does the most to help you maintainmuscle and bone, fight middle-agespread, and lower your risk of disease.It’s the best opportunity you have torecapture (and maybe even improveupon!) your youth.

The third thing that makes thisprogram different is that it includes whatI call lifetime sports and recreationalactivities. Activities such as golf, tennis,and bowling help you stay active duringyour leisure time; most important for our

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anti-aging purposes, many of them alsohelp you work on agility, balance, andhand-eye coordination. Another reason Irecommend them is that many of themare social activities, too, and we knowthat keeping socially active is apowerful predictor of longevity.

Before I give you the specifics of thecomprehensive plan, let’s go over somebasics for each of the components.

Cardiovascular Exercise

Most people find a type ofcardiovascular exercise they like andstick with it, sometimes even doing thesame type of exercise every day. I’mgoing to encourage you to take a

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different approach and choose not onetype of aerobic exercise, but two, eventhree. This is referred to as crosstraining. Each type of exercise worksyour body in a different way, so whenyou expand your repertoire, you expandthe number of muscles trained and thenumber of ways you can fight aging. Inaddition, when your schedule includesvariety, you lower your risk ofdeveloping an overuse injury that willsideline you and keep you from doingany exercise at all. Having more thanone go-to workout also keeps your weekmore interesting.

You can also avoid burnout andmaximize the benefits you get by shakingup your workout routine every six

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months. I’ll give you an example. Sayyou walk on Monday, Tuesday,Wednesday, and Friday and ride yourbike on Thursday and Saturday. After sixmonths you might switch—cycle fourdays a week and walk on two—orreplace cycling with the ellipticaltrainer. Though you need to spendadequate amounts of time establishing abase level of fitness in each type ofactivity, once you have that base (and sixmonths is enough to let you establish it),you can change things around withoutlosing the activity-specific conditioningyou’ve gained.

When deciding which aerobicworkouts to choose, consider that some

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do a better job of improving yourcardiovascular system than others. Ofcourse, I think you should select the onesthat give you the biggest payoffs for youreffort, but it’s also important to choosesomething you like; otherwise, youwon’t stay motivated for long.

Use the roundup here to guide you. Itlists the pros and cons of each workoutand gives my opinion on how effective itis for achieving your aerobic and anti-aging goals.

How long, how often, and how harddo you need to do cardiovascularexercise? On the exercise plan chart I’llgive you a specific number of minutesyou should accomplish each week.Ideally, every workout should be at least

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twenty continuous minutes; however, youcan choose how to break up the rest ofthe minutes. You can also choose whatdays you want to engage incardiovascular exercise, but don’t takeoff two days in a row. To determine theproper intensity of your exercise, I’mgoing to introduce you to the PerceivedExertion Scale here. This tool helps yougauge how exercise feels on a scale of 0to 10 primarily using your breathing as aguide. To get maximum cardiovascularbenefits, you’ll need to work out at a 7or 8 on the scale. Not working hardenough (below level 7 or 8) is thenumber one reason people don’t getresults.

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Another way to measure intensity iswith a heart rate monitor. This device,which resembles a watch, gauges yourheart rate and can help you stay withinyour target heart rate zone. (Omronmakes a line of heart rate monitors.)They can provide some usefulinformation and are an especially goodoption for people with certain conditionswho must monitor their heart rate whileexercising.

If you aren’t very fit, it will take verylittle movement to get your heart andbreathing rates up into the range theyneed to be in. For instance, a slowerwalking speed of 3.5 miles per hour maybe enough to get a beginner up to an 8 on

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the Perceived Exertion Scale, but arelatively fit walker may need to walk ata speed of 5 miles per hour to get intothat range. No one can tell you whatnumbers to punch into the treadmillcontrol panel to get your best workout.Listening to your body will tell you ifyou’re working hard enough.

Counting Steps PerDay

The number of steps you take per day,whether you’re formally going for awalk or just moving around as you doyour daily activities, counts towardimproving your fitness in Level I, butonly Level I. That’s because although ithelps you attain a good functional

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level of fitness, it’s typically notvigorous enough to help you achievehigher levels of fitness. To determineyour steps per day, you’ll need apedometer, a clip-on counting deviceyou can wear all day. (I like the onesfrom Omron.) You can find them atmost sporting goods stores orwww.20YearsYounger.com.

Strength Training

If you haven’t ever lifted weights before,the process can seem daunting. Butstrength training is not difficult tomaster, and it takes very little time tocomplete an entire program when it’sdone properly. Level I starts with sixbasic strength-training exercises; if you

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decide to go all the way up to Level III,there are quite a few more. Most of theexercises call for dumbbells; however,they also can be done on the type ofweight machines you typically find in agym. A few of the exercises in Level IIIare only done on weight machines.

There is always some question as towhether it’s best to use heavy weightsand fewer repetitions (the number oftimes you raise and lower a weight orpush against or pull a weight machine)or lighter weights and more repetitions.For anti-aging purposes in particular, Irecommend relatively heavy weights andfewer reps—eight to ten unlessotherwise noted—which is the best wayto build strength and maintain muscle.

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Lighter weights and more repetitions cando a good job of toning muscles andimproving muscular endurance;however, you’ll already be enhancingboth those qualities with cardiovascularexercise. Repetitions are organized intosets. It’s possible to get some goodbenefits from one set, and it’s a currenttrend to recommend only one. But for themaximum anti-aging payoff, I’d like youto gradually work up to three sets perexercise. In between sets, rest onlyfifteen to thirty seconds (the closer to thelower end of that range you can go, thebetter). Fatigue is what prompts thechanges in your muscles’ anatomy, andtoo much rest lessens the strength-

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building effect. It’s also important tobreathe properly as you strength train.Always breathe out during the exertionphase and in as you’re returning tostarting position. For instance, whenyou’re doing a biceps curl, you breatheout as you curl the weights up towardyour shoulders and in as you lower themback down.

Strength is very individual, so it’snecessary to go through a little trial anderror to determine how many pounds youshould be lifting for each exercise.Here’s the method I like to use. Toselect the proper weight, start with verylight resistance, then go up to the nextweight, then the next, until you find aweight that is heavy enough to make your

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muscles feel fatigued after lifting it eightto ten times. By fatigued I mean that it’sdifficult to accomplish the lastrepetition. (If you feel slightly sore thenext day or two after training, it’s a signthat the weights were right.) If theweights are heavy enough, you may onlybe able to do eight reps during a secondset and even fewer during a third set. Ifyou can easily do ten reps on the thirdset, your weights are probably too light.

As you get stronger, you’ll need toincrease the weight you lift. If itbecomes too easy, then you’re not goingto get all the benefits you could begetting. I also recommend mixing upyour workouts when you can. Strength-

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training exercises can get a little staleafter a while, and your body willrespond better to the challenge if youweave in alternative exercises every sixto eight months. There are, for instance,several different types of bicepsexercises. If you usually do traditionalbiceps curls, you might try somethinglike pull-ups (or modified pull-ups)instead. When I go on vacation, I oftenuse weight machines in the hotel gymthat are different from the ones I use athome. You’ll find alternatives for all ofthe strength-training exercises here.

Stretches and Core Exercises

There are nine stretches and core

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exercises in Level I of the plan, elevenin Level II, and thirteen in Level III.Though that sounds like a lot, theyactually take relatively little time toperform. I recommend that you do themevery day. On days that you’re doingother exercise, the best time to do theseexercises is after your cardiovascular orstrength-training workout. You want tostretch when your muscles are warm andblood flow makes them more elastic;stretching cold muscles can cause injury.If you’re not doing a sweat-inducingworkout that day, at least take a shortwalk or do something to heat up yourbody a bit before you stretch. In mostcases, it’s best to hold a stretch forfifteen to thirty seconds and repeat two

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to three times. Bouncing is a bad idea,and another way to set yourself up forinjury. You don’t have to limit yourstretching to just these few exercises.Gently stretch your body at intervalsthroughout the day (again, make sureyou’re body is warm first), and considertaking yoga or Pilates classes to achieveeven greater strength and flexibility.

Generally fifteen repetitions for eachcore exercise works well. Contrary topopular belief, you don’t need to docrunches all day long to get good results.I’ll have you start with one set of eachexercise then work up to two, then on tothree.

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Lifetime Sports and RecreationalActivities

The reason I refer to these as “lifetime”activities is because you should be ableto do them at any age. They all hit one ormore of three important qualities offitness: agility, balance, and hand-eyecoordination. Get in the habit ofparticipating in them now and you’llalways have a way to stay vibrant andactive. Many of the activities on the listhere are things you can do with family,friends, or a significant other. Use theopportunity to get the people you careabout doing something beneficial fortheir health, too. And reap the anti-agingbenefits of spending time with others

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(read more about social interaction andaging in chapter 6).

In the list I note which of theseactivities help you improve balance andhand-eye coordination in particular. Ifyou choose a recreational activity thatdoesn’t provide very much balanceconditioning, I recommend that you tryperforming your strength-trainingexercises while on a balance apparatussuch as the BOSU ball. Keep in mind,too, that some of the lifetime sports candouble as your cardiovascular exercise.Skiing (cross-country or downhill),kayaking, walking, swimming, skating—anything that allows for sustainedmovement and a high oxygenconsumption will work.

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THE PROGRAM

Level I

CARDIOVASCULAR EXERCISE

Choose activities from the list here.

A minimum of 200 minutes/week—break up as you like; never two days offin a row.

Alternative for beginners: 70,000steps/week—count steps every day (seehere).

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STRENGTH TRAINING

Start with one set; work up to two setsby month two; work up to three sets bymonth three. Eight to ten repetitions perset. Three days/week.

1. Heel Raise

2. Shrug Roll

3. Squat

4. Chest Press

5. Biceps Curl

6. Thumbs Down

STRETCHES

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Perform each stretch two to three timesevery day.

1. Hamstring Stretch

2. Quadriceps Stretch

3. Upper Calf Stretch

4. Lower Calf Stretch

5. Middle and Lower Back Stretch

CORE EXERCISES

Start with one set; work up to two setsby month two. Fifteen repetitions per set.Do every day.

1. Basic Crunch

2. Upper Abdominal Crunch

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3. Twisting Trunk Curl Crunch

4. Alternating Arm and Leg Raise

LIFETIME SPORTS ANDRECREATION

Choose from the list here—a minimumof one time/week.

If you don’t choose an activity thatcovers both balance and hand-eyecoordination, do your strength-trainingexercises on a balancing apparatus.

Level II

CARDIOVASCULAR EXERCISE

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A minimum of 300 minutes/week—break up as you like; never two days offin a row.

STRENGTH TRAINING

Three days/week; three sets; eight to tenrepetitions/set.

1. Heel Raise

2. Shrug Roll

3. Squat

4. Chest Press

5. Biceps Curl

6. Thumbs Down

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7. Lunge

8. One-Arm Row

9. Dumbbell Fly

10. Triceps Extension

11. Shoulder Press

12. External Rotation

STRETCHES

Perform each stretch two to three timesevery day.

1. Hamstring Stretch

2. Quadriceps Stretch

3. Upper Calf Stretch

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4. Lower Calf Stretch

5. Middle and Lower Back Stretch

CORE EXERCISES

Two sets; fifteen repetitions/set. Doevery day.

1. Basic Crunch

2. Upper Abdominal Crunch

3. Twisting Trunk Curl Crunch

4. Alternating Arm and Leg Raise

5. Extended Arm Crunch

6. Vertical Leg Crunch

LIFETIME SPORTS AND

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RECREATION

A minimum of two times/week.

Level III

CARDIOVASCULAR EXERCISE

400 minutes/week—break up as youlike; never two days off in a row.

STRENGTH TRAINING

Three days/week; three sets; eight to tenrepetitions per set. This list is long, so iftime is short you may want to divide itup and do half the exercises one day, the

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other half the next, with one day off. Itwon’t technically be three times a week,but it is still an effective way toaccomplish your goals.

1. Heel Raise

2. Shrug Roll

3. Squat

4. Chest Press

5. Biceps Curl

6. Thumbs Down

7. Lunge

8. One-Arm Row

9. Dumbbell Fly

10. Triceps Extension

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11. Shoulder Press

12. External Rotation

13. Leg Extension

14. Leg Curl

15. Lateral Raise

16. Upright Row

17. Incline Chest Press

18. Frontal Raise

19. Lat Pull-Down

STRETCHES

Perform each stretch two to three timesevery day.

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1. Hamstring Stretch

2. Quadriceps Stretch

3. Upper Calf Stretch

4. Lower Calf Stretch

5. Middle and Lower Back Stretch

CORE EXERCISES

Two sets; fifteen repetitions/set. Doevery day.

1. Basic Crunch

2. Upper Abdominal Crunch

3. Twisting Trunk Curl Crunch

4. Alternating Arm and Leg Raise

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5. Extended Arm Crunch

6. Vertical Leg Crunch

7. Reverse Trunk Curl

8. Incline Sit-Up

LIFETIME SPORTS ANDRECREATION

A minimum of two times/week.

CARDIOVASCULARWORKOUTS

All aerobic workouts are not createdequal; each has its pluses and minuses.

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In the following section, I’ve outlinedthe differences among workouts and whysome of them may work better for youthan others. Rest assured that there issomething for everyone here.

When you start any cardiovascularexercise program, it’s important to checkwith your doctor, especially if you haveany serious medical conditions, such ashigh blood pressure, heart problems,lung disease, diabetes, or an orthopedicproblem. It’s important to make sureyou’re not compromising your health.

Walking. This is my first choice formost people just starting an exerciseprogram. Everyone can do it, and it canbe done almost anywhere. Plus it’s easy

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on the joints and has a low rate of injury.Either outdoor walking or treadmillwalking is acceptable, but be sure not toconfuse walking for cardiovascularfitness with strolling. You have to getyour heart rate up. The only downside towalking is that as you get fitter, itbecomes harder to get continuedimprovements in cardiovascularconditioning and weight loss. You mayneed to add some jogging or mix inanother type of aerobic workout toincrease the difficulty. If you walk on atreadmill, raising the grade significantly,even all the way up to 15 percent, isanother good way to intensify thechallenge.

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Hiking. Whether you can hike oftenenough to meet your cardio requirementswill depend on where you live, but ifyou live in an area where hiking iseasily accessible, take advantage of it.You burn more calories and use yourmuscles in different ways when walkingup and down hills than you do on flatground.

Jogging/Running. It’s hard to beatjogging (slow running) and running forquick results, and if you can, Irecommend that you do it once or twicea week. But it also places a lot of stresson your body. Many runners getsidelined with injuries, especiallyoveruse injuries. If you’re going to

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choose jogging or running, don’t do itmore than three days per week and makesure you mix it up with something thatuses different muscles or is easier on thebody (such as cycling).

Stair Climbing. Stair-stepping machinesprovide a good workout, though they’regetting harder to find in gyms these days,perhaps because many people used themexclusively, didn’t cross train, andended up with overuse injuries. Whenyou use a step machine, the steppersupports some of your weight so you’renot moving all of your body weight,which is key to getting an optimalcardiovascular workout. For an evenbetter aerobic workout, try running or

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walking up real stairs. It can get tedious,but if you’re up for it and don’t haveknee problems, it’s a great way to getaerobically fit. If your neighborhooddoesn’t have any staircases, try thebleachers at a local school stadium.

Cycling. Cycling is fun, and as long asyou challenge yourself, it will give you agood cardiovascular workout. Irecommend that if you choose outdoorcycling as your main cardiovascularexercise, you double the duration of yourworkout. The bike gives your body a lotof assistance, so you need to doubledown to get the same results that youmight get from, say, running or evenbrisk walking. My advice, too, is don’t

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depend solely on the bike. The low-impact nature of the sport means that youdon’t stress the bones enough to preventbone loss, and some studies have shownthat cyclists can be as or even moreprone to bone loss than inactiveindividuals.

Elliptical exercise. I’m a big fan of thistype of exercise because it gets yourheart rate up with minimal impact and itworks both the upper and lower body.While the elliptical trainer gives you agreat cardiovascular workout, it doesn’tfeel punishing, which is why a lot ofpeople who typically don’t likemachines do well with ellipticalexercise. The best elliptical trainers are

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the ones that allow you to use your armsand require you to lift your legs in arunning-type motion. Octane Fitnessmakes a great one(www.octanefitness.com).

Stationary cycling. Just about everygym has a stationary bike and it can giveyou a good aerobic workout—as long asyou pedal vigorously. Many people tendto take it too easy on stationary bikes.Take a page from spinning classes (seebelow) and try pedaling to music, whichmay help you pedal a little faster, and upthe resistance to make the workout morechallenging. Stationary bikes supportyour weight, so you typically don’t getas good a workout as on other types of

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machines, and they don’t provide thekind of impact that keeps bones strong. Ifyou have a back problem, you might try arecumbent stationary bike; however, youcan pedal these without much effort, sobe sure you’re working at a 7 or 8 on thePerceived Exertion Scale (here). For at-home workouts, you can also purchase atrainer apparatus that allows you to turnyour regular bike into a stationary one.

Stationary rowing. A great upper andlower body workout as long as you do itat a vigorous pace, rowing is virtuallynonimpact. There can be a tedium factorwith stationary rowing, but if you’re at agym you can avoid boredom by doingpart of your workout on the rower and

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part on another (or even more than one)machine. For instance, if your workout isforty minutes long, you might do only thefirst ten minutes on the rower.

Cardio class. Fitness instructors arereally getting creative these days so ifyou like moving to music, I urge you tocheck out the schedule at your local gymor exercise studio. Zumba, Afro-Brazilian dance, hip-hop, and cardiofusion are just some of the latest choiceson the aerobic menu. The advantage ofgoing to a fitness center is that you’llfind a variety of classes, but if you takeonly one of them regularly, it maybecome less challenging with time.Many instructors don’t vary their

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routines. In addition, if this is your onlycardio workout, you’re putting yourselfat risk for an overuse injury.

Spinning. These classes are typicallydone to invigorating music so they tendto be very motivating. The music,though, is just part of what makes theclasses fun and encourages you to workhard. The instructor makes a hugedifference, so make sure you find a goodone. The only downside to spinning isthat when a bike supports your weight,you don’t get quite as good a workout aswhen you’re on the ground, and likeregular cycling it doesn’t do much tohelp keep your bones strong. However,you can increase the resistance on

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spinning bikes, which helps compensatefor the difference the bike’s supportmakes, and many spinning instructorshave you stand as you pedal, which putssome beneficial stress on your bones(though not as much as, say, jogging).

Swimming. While swimming works allyour muscles, it lends itself to movingslowly—most people don’t swim fastenough to get the aerobic benefits theyneed. Also, traditionally, vigorouscardiovascular activity reduces yourappetite, probably by heating up yourbody. Swimming doesn’t raise yourbody temperature to the same degree asother types of cardiovascular exercise(the water helps cool you down), so you

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may not get the appetite-reducing benefitof exercise. Worse, swimming canactually stimulate your appetite. If youhave trouble getting your speed up onyour own, consider joining a mastersswimming workout, where you’ll have acoach to put you through the paces.

DVD-led aerobic workouts and WiiFit. Pop in the disk and you’re off; inmost cases you don’t even need a lot ofroom to exercise. The majority of DVDworkouts also include a warm-up andcool-down segment, which is a plus.They’re also great for travel; manyhotels have DVD players in the rooms.My only caveat: be careful that you don’tend up with an overuse injury from

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doing the same thing day after day. ADVD program isn’t going to change, soyou’re going to be working the samemuscles in the same way over and overagain. For best and safest results, haveseveral DVDs in your arsenal andalternate them. If you choose the Wii,make sure that you select a Wii programthat is expressly for cardio.

Jumping rope. This is a veryinexpensive and, if you’re proficient,excellent way to get fit. You can alsotake a jump rope with you wherever yougo. However, it can be pretty tough onthe body and requires the ability to zoneout; otherwise it can get pretty boring.You may want to spend just a few

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minutes jumping rope, then combine itwith another activity for a longer cardioworkout. Note that it’s not a great choicefor beginners. If you do decide to jumprope, be cautious about the surface youjump on. Concrete is too hard on thebody, and asphalt is only slightly better.The best surface is a wood floor oraerobic flooring (a shock-absorbingsurface). You can buy aerobic flooringin small dimensions and use it to jumprope on.

Outdoorrowing/canoeing/kayaking/stand-uppaddling. This is another type ofexercise that’s fantastic if you can do itat a high and continuous level. Stand-up

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paddling in particular is great forbuilding core and overall strength as youbuild aerobic endurance. But you can’tjust go out and paddle around and expectto see cardiovascular improvements.Choose it only if you can turn it into avigorous, sustainable workout. Also beaware that rowing allows you to useyour whole body, whereas canoeing andkayaking are more upper-body workouts.

Ice-skating and in-line skating.Obviously, you need to have a rinknearby to make ice-skating work, andyou also have to skate continuously tomake the workout effective, which cansometimes be hard to do. Yet if you canmanage to hit the right level of exertion

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and you love going to the rink, ice-skating is a very good form of exercise.In-line skating can be a lot moreconvenient than ice-skating and has manyof the same benefits.

Cross-country skiing. This is one of thefew workouts that vigorously challengesboth the upper and lower body. What’smore, it places little stress on themuscles, joints, and ligaments. Ofcourse, you’re beholden to the weather,which can be a drawback. Always havea back-up activity in mind so that you’renot left out in the cold if it doesn’t snow.

Downhill skiing. To make downhillskiing a sustained cardiovascular

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activity (twenty minutes minimum)you’ll have to find some long runs. But ifyou can do it, it’s excellent for aerobictraining and great conditioning for yourlegs.

Horseback riding. Most people don’tthink of horseback riding as an aerobicactivity, but if you do it vigorously itrequires a lot of heart and lung power.

The PerceivedExertion Scale

The optimum level of exertion is a 7 or8. It may take a while for you to workup to this intensity—or to maintain it forany length of time—but it will come. If

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you can’t hit that pace right off the bat,start at a lower level of exertion andtry to exercise at a 7 for a minute ortwo before moving back to your morecomfortable pace. Build on that, addinga minute as you can so that youeventually work up to a wholeworkout at level 7 or 8.

0 This is the way you feel at rest.There is no fatigue, and yourbreathing is not elevated.

1 This is how you’d feel whileworking at your desk or reading.There is no fatigue, and yourbreathing is normal.

2 This is what you’d feel like whenyou’re getting dressed. There islittle or no feeling of fatigue, andyour breathing is still normal.

3 This is how you’d feel whilewalking slowly across the room toturn on the TV. You may feel a little

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fatigued and you may be aware ofyour breathing, but it is still slowand natural. You also might feelthis way in the beginning of anexercise session.

4 This is the way you would feel ifyou were walking slowly outside.There is a slight feeling of fatigueand your breathing is slightlyelevated but comfortable. Youshould experience this levelduring the initial stages of yourwarm-up.

5 This is how you’d feel whilewalking somewhere at a normalpace. You’re aware of yourbreathing, which is now deeper,and there is a slight feeling offatigue. You should experiencethis level at the end of your warm-up.

6 This is how you’d feel if you werehurrying to an appointment for

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which you were late. There is afeeling of fatigue, but you knowyou can maintain this level ofexertion. Your breathing is deep,and you’re aware of it. This is howyou should feel as you transitionfrom warm-up to your regularexercise session.

7 This is how you’d feel if you wereexercising at moderate tomoderately high intensity. There’sa feeling of fatigue, but you’resure you can maintain this level forthe rest of your exercise session.Your breathing is deep, and you’reaware of it. You could carry on aconversation but would probablychoose not to do so. You should tryto maintain this level during yourworkouts.

8 This is how you should feel whenyou’re exercising vigorously atmoderately high intensity. You’re

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feeling fatigued, and if you askedyourself if you could continue forthe remainder of your exercisesession, your answer would bethat you think you could butyou’re not sure. You’re on theedge, but you can maintain thepace, at least for a fairly goodwhile. Your breathing is verydeep, and though you could stillcarry on a conversation, you don’tfeel like it. You should try toexercise at this level only afteryou’re feeling comfortable enoughat level 7. Many people see rapidresults at this level.

9 This is what you’d feel like if youwere exercising very, veryvigorously. You’d definitely feelfatigued, and you probablywouldn’t be able to maintain thishigh-intensity level for very long.Your breathing is very labored,

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and it would be very difficult tocarry on a conversation. If you’redoing interval training, you mayhit this level for short periods oftime, but it’s not a level that youcan or need to stay at for a lengthyduration.

10 This level is all-out exercise, sodifficult that you couldn’t maintainit for very long. Hence, there’s nobenefit to it.

STRENGTH-TRAININGEXERCISES

The majority of these exercises can bedone with dumbbells, but when you getto Level III, some are done on the type of

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weight machines you find in gyms. If youdon’t have access to weight machines,skip those exercises.

1. Heel Raise

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Stretches and strengthens the calves andhelps prevent shin splints.

Stand on a board approximately 2inches thick by 36 inches long, or anyother stable surface raised a fewinches off the ground. (If necessary,you can also do this without a board.)Place the ball of each foot on theraised area, with heels on the floor.Keep feet about 12 inches apart;knees are straight, but not locked.

Inhale and slowly raise heels as highas you can and hold for 1 secondbefore slowly lowering down tostarting position, exhaling as you go.Do 15 times for each set.

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2. Shrug Roll

Helps stabilize the shoulders(deltoids)/rotator cuffs.

Stand up straight, feet a little apart

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and arms at your sides. Inhale, shrugshoulders up toward your ears ashigh as they can go. Pause for asecond in this position, then exhaleand roll shoulders back whilesqueezing your shoulder bladestogether. Pause for a second inmidsqueeze, then drop shouldersback to the starting position. Do 10times for each set.

3. Squat

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Works the upper legs (quadriceps,hamstrings).

Stand with feet slightly wider thanshoulder-width apart, your backstraight, head up, and toes and knees

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pointed slightly out. There should bea slight bend in your knees. Hold adumbbell in each hand, your arms atyour sides and palms facing inward.

Contract your abdominal muscles.Bend your knees, gradually loweringyour body (as if you were going to sitin a chair) until your thighs arealmost parallel with the floor; neverlet them go lower than parallel withthe floor. Pause for a second, thenpush up from your heels andgradually return to starting position.Control your movements throughoutthe exercise, inhaling on the waydown, exhaling on the way up. Do 8to 10 repetitions for each set.

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4. Chest Press

Works the chest and back of upper arms(pectoralis major, pectoralis minor,triceps).

Lie on your back on a bench with yourknees bent and your feet on the floor.Keep your back flat against the

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bench, with little or no arch. Hold adumbbell in each hand slightly abovechest level, elbows bent out to theside and your palms facing awayfrom you.

Contract your abdominal muscles.Gradually raise the dumbbells untilyour arms are fully extended aboveyour chest. Do not hyperextend yourelbows. Pause for a second, thengradually return dumbbells to startingposition. Control your movementsthroughout the exercise, exhalingwhile raising the dumbbells andinhaling on the return. Do 8 to 10repetitions for each set.

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5. Biceps Curl

Works the upper arms (biceps).

Stand with your feet slightly apart andknees slightly bent. Hold a dumbbellin each hand, your arms at your sides,

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palms facing inward.

Contract your abdominals. Curl thedumbbells up to your shoulder whiletwisting your palms so that they arefacing you at top of move. Pause for asecond and then gradually lowerdumbbells to starting position.Control movements throughout theexercise, exhaling while lifting thedumbbells up and inhaling on thereturn. Do 8 to 10 repetitions foreach set.

6. Thumbs Down

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Works the shoulders (deltoids)/rotatorcuffs.

Stand erect with your feet shoulder-width apart. Holding a dumbbell ineach hand in front of your thighs,rotate your arms inward so that your

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thumbs touch your thighs. Keep yourknees slightly bent.

Contract your abdominal muscles.With your arms straight (but nothyperextended) raise both dumbbellsup in front of you to shoulder heightwhile still keeping your thumbs downand arms rotated inward. Pause for asplit second, then return to thestarting position. Control yourmovements throughout the entireexercise, exhaling as you raise thedumbbells and inhaling on the waydown. Do 8 to 10 repetitions for eachset.

7. Lunge

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Works the legs (quadriceps, hamstrings,calves).

Stand with your feet shoulder-widthapart, your back straight, head up,

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and knees slightly bent. Hold adumbbell in each hand, your arms atyour sides and palms facing inward.

Contract your abdominal muscles.Step forward with your right foot andbend both knees so that your frontthigh becomes parallel to the floor.Your front knee should be directlyabove your ankle, never beyond it.Pause for a second and return to thestarting position by pushing off fromyour front foot. Control yourmovement throughout the exercise,inhaling as you step forward,exhaling on the return. Do 8 to 10repetitions, then switch sides. Doanother 8 to 10 repetitions for each

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set.

8. One-Arm Row

Works the back and shoulders(deltoids).

Kneel on a bench with your right arm

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supporting your weight. Hold adumbbell in your left hand with yourarm naturally hanging down, palmfacing in toward your side.

Contract your abdominal muscles.Bend your left elbow and graduallyraise the dumbbell up to about chestheight. Your elbow should be kepthigh and finish above your shoulder.Pause for a split second, then returnto the starting position. Control yourmovements throughout the entireexercise, exhaling as you raise thedumbbell and inhaling as you returnto the starting position. Do 8 to 10repetitions; switch sides. Do another8 to 10 repetitions for each set.

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9. Dumbbell Fly

Works the chest (pectoralis major,pectoralis minor).

Lie on your back on a bench with yourknees bent and your feet flat on thefloor. Keep your back flat against the

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bench, with little or no arch, and yourarms fully extended but nothyperextended above your chest andperpendicular to the floor. Hold adumbbell in each hand, palms facinginward.

Contract your abdominal muscles.Gradually lower dumbbells out to theside, keeping elbows slightly bentthroughout the exercise. Continueuntil upper arms are parallel withfloor. Pause for a second, thengradually return to starting position.Control movements throughout theexercise, exhaling while lowering thedumbbells and inhaling on the return.Do 8 to 10 repetitions for each set.

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10. Triceps Extension

Works the backs of upper arms (triceps).

Stand with your feet slightly apart and

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your knees slightly bent. Raise onedumbbell above your head and claspit with both hands, fingersintertwined. Your arms should befully extended but not hyperextended.

Contract your abdominal muscles.Gradually bend your elbows andlower the dumbbell back behind yourhead and neck. Keep your upper armsin place and continue lowering theweight until your forearms areparallel to floor. Pause for a second,then gradually raise the dumbbell tostarting position. Control movementsthroughout the exercise, inhalingwhile lowering the dumbbell andexhaling while raising it back up. Do

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8 to 10 repetitions for each set.

11. Shoulder Press

Works the shoulders (deltoids).

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Sit upright on a chair or slightlyslanted if using an incline bench, withyour back supported and your feetflat on the floor. Keep your back flatagainst the back of the chair or bench,with little or no arch. Hold adumbbell in each hand slightly aboveshoulder level and with your palmsfacing away from you, elbows out tothe side.

Contract your abdominals. Keepingpalms facing away from you, raisethe dumbbells up and inward until theends of dumbbells are nearlytouching each other and are directlyoverhead. Do not hyperextend yourelbows. Pause for a second, then

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gradually lower the dumbbells tostarting position. Control yourmovements throughout the exercise,exhaling while raising the dumbbellsand inhaling on the return. Do 8 to 10repetitions for each set.

12. External Rotation

Works the shoulders (deltoids)/rotatorcuffs.

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Lie on a mat on your left side withyour left arm bent and your headresting in your hand. Hold adumbbell in your right hand, yourright arm bent at a 90-degree angleand your elbow resting on your side,slightly above your hip. Rest theweight on the floor.

Contract your abdominal muscles.Keeping your elbow resting on yourside, slowly raise the weight up untilit is pointed at the ceiling or as highas your range of motion allows.Pause for a split second at the topbefore gradually lowering thedumbbell. Control your movementsthroughout the entire exercise,

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exhaling as you raise the dumbbelland inhaling on the way down. Do 8to 10 repetitions; switch sides. Doanother 8 to 10 repetitions for eachset.

13. Leg Extension (machine only)

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Works the front of the legs (quadriceps).

Sit on the machine’s seat with yourbody erect and your back firmlyagainst the seat. Adjust the leg arm ofthe machine so that your knees arecentered with the pivot point. The legpad should be adjusted so that it restscomfortably above your feet. Withyour thighs parallel to each other and4 to 5 inches of space between yourknees, legs straight but not locked,point your toes straight up or with aslight pitch forward. Grasp thehandholds firmly and look straightahead.

Contract your abdominal muscles.

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Extend your legs completely withoutlocking your knees. Pause for a splitsecond before returning the weight tothe starting position. Pause for a splitsecond before starting the nextrepetition. Control your movementsthroughout the entire exercise,exhaling as you extend your legs andinhaling as you return to startingposition. Do 8 to 10 repetitions foreach set.

14. Leg Curl (machine only)

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Works the back of the legs (hamstrings).

Sit on the machine’s seat with yourbody erect and your back firmlyagainst the seat. Adjust the leg arm ofthe machine so that your knees arecentered with the pivot point. The legpad should be adjusted so that it restscomfortably on the back of the leg,

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just above the Achilles tendon.Lower the thigh stabilization pad tofit snugly across the thighs. With yourthighs parallel to each other and 4 to5 inches of space between yourknees, legs straight but not locked,point your toes straight up or with aslight pitch forward. Grasp thehandholds firmly and look straightahead.

Contract your abdominal muscles.Bend your knees at a 90-degreeangle. Pause for a split second, thenallow your legs to slowly come backto starting position. Pause for a splitsecond before starting the nextrepetition. Control your movements

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throughout the entire exercise,exhaling as you bend your legs andinhaling as you return to startingposition. Do 8 to 10 repetitions foreach set.

15. Lateral Raise

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Works the shoulders (deltoids)/rotatorcuffs.

Stand erect with your feet shoulderwidth apart, your arms down, and aslight bend in your elbows. Hold adumbbell in each hand, one in front

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of each thigh with your palms facinginward toward each other. Keep yourknees slightly bent.

Contract your abdominal muscles.Raise each dumbbell out to the sidein a semicircular motion until yourarms are parallel with the floor.Pause for a split second beforegradually lowering the dumbbells tothe starting position. Control yourmovements throughout the entireexercise, exhaling as you raise thedumbbells and inhaling as you returnto starting position. Do 8 to 10repetitions for each set.

16. Upright Row

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Works the shoulders (deltoids).

Stand with your feet shoulder-widthapart, your arms straight and yourtorso erect. Using an overhand grip,hold a barbell (preferred for this

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exercise) or dumbbells in your hands,allowing them to rest lightly on yourthighs (if using a barbell, grip the barwith hands 2 to 4 inches apart).

Contract your abdominal muscles.With your elbows pointed outward,gradually pull the weights upwardalong your abdomen and chest untilyour elbows reach shoulder height.Exhale as the weights reach yourshoulders, pause for a split second,and inhale as you gradually lower theweights to starting position. Controlyour movements as you go. Do 8 to10 repetitions for each set.

17. Incline Chest Press (requires

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incline board)

Works the upper chest and back of upperarms (triceps).

Lie with your back flat against an

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incline bench with little or no arch inyour back. Keep your knees bent andfeet flat on the floor. Bend yourelbows and hold a dumbbell in eachhand slightly above chest level,palms facing away from you.

Contract your abdominal muscles.Gradually raise both dumbbells upuntil your arms are fully extendedabove your chest. Do not hyperextendyour elbows. Pause for a splitsecond, then gradually return thedumbbells back to starting position.Control your movements throughoutthe entire exercise, exhaling as youraise the dumbbells and inhaling onthe return. Do 8 to 10 repetitions for

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each set.

18. Frontal Raise

Works the shoulders (deltoids).

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Stand erect with your feet shoulder-width apart. Hold a dumbbell in eachhand with your arms down and yourpalms facing your thighs. Yourclosed fingers should be lightlytouching your thighs. Keep yourknees slightly bent.

Contract your abdominal muscles.Raise both dumbbells up in front ofyou to shoulder height. Pause for asplit second, then return to startingposition. Control your movementsthroughout the entire exercise,exhaling as you raise the dumbbellsand inhaling on the way down. Do 8to 10 repetitions for each set.

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19. Lat Pull-Down (machine only)

Works the upper back and chest(pectoralis major, pectoralis minor).

While seated (or kneeling if the

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station has no seat) at a lat pullstation, grip the bar using anoverhand grip with your hands a fewinches wider than shoulder-widthapart. Your torso should be slightlytilted backward and your armsextended.

Contract your abdominal muscles.Pull the bar straight down in front ofyour face. Pull smoothly, keepingyour elbows out and away from yourbody. Pull the bar past your chin untilit lightly touches your upper chest.Pause for a split second, then returnto the starting position. Control yourmovements throughout the entireexercise, exhaling as the bar

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approaches your chest and inhalingas you release back to startingposition. Do 8 to 10 repetitions foreach set.

To Keep ItInteresting, Exercise

Alternatives

There are many different ways towork the same muscles. Every six toeight months, consider changing up theexercises you do. That will keep yourworkout fresh and challenge yourmuscles in the same but also slightlydifferent ways. Here are alternativesto the strength-training moves listedhere. See my website20YearsYounger.com for more on these

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exercises.

Instead of Heel Raise:

Heel Raise with BandHeel to Toe Rock

Instead of Shrug Roll:

Behind-the-Back Barbell ShrugCalf Raise Shoulder Shrug (machine)Shrug with Band

Instead of Squat:

Leg Press (machine)Swiss Ball No-Weight SquatWall SitOne-Legged Step Down

Instead of Chest Press:

Push-UpChest Press with Resistance BandSeated Chest Press (machine)

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Instead of Biceps Curl:

Biceps Curl with BandsIncline Biceps CurlHammer CurlPull-Ups

Instead of Thumbs Down:

Cross Body with Band

Instead of Lunge:

Multi-Plane LungeWalking Lunge

Instead of One-Arm Row:

Back ExtensionsIncline Bench PullOne-Arm Row with Exercise Band

Instead of Dumbbell Fly

Fly (machine)Disk FlyFly with Exercise Band

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Instead of Triceps Extension:

DipCable Push Down (machine)Plank Up

Instead of External Rotation:

Dumbbell Rotation with ArmAbduction

External Rotation with BandExternal Rotation Double-Handed

Instead of Leg Extension:

Single-Leg Quad RaiseChair Straight-Leg Extension

Instead of Leg Curl:

Hamstring Roll-InButt BlasterBridge

Instead of Lateral Raise:

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Incline Lat Raise on BallBent-Arm Lateral RaiseLateral Raise (machine)

Instead of Upright Row:

Double-Arm High PullProne Incline Shoulder PressUpright Row with Band or Tube

Instead of Incline Chest Press:

Incline Chest Press on BallIncline Chest Press with BandPush-Up on Ball

Instead of Frontal Raise:

Incline Front RaiseFront Raise with Band

Instead of Lat Pull-Down:

Lat Pull-Down with BandCable Straight-Arm Pull-Down

(machine)

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Pull-Up

STRETCHES

1. Hamstring Stretch

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Stand with one foot propped up on astep or on a chair in front of you, legsstraight. Place hands on hips, makingsure you’re stable. Keep the leg thatis lifted straight and slowly bendyour torso toward your toes, keeping

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your back straight until you feel astretch in the back of your legs(hamstrings). Breathe evenly as youstay in the stretch. Hold for 5 seconds(no bouncing) and relax for another 5seconds. Repeat on each leg 3 to 5times.

2. Quadriceps Stretch

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Standing, hold on to the back of achair with your left hand. Bend yourright knee behind you and grab yourright ankle with your right hand.Bring your heel toward your buttocksuntil you feel a little tension in your

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thigh. Keep the knee of the other legslightly bent. Both knees should beparallel. Breathe evenly as you stayin the stretch. Hold for 5 seconds,relax for 5 seconds, and continue thisway for 3 or 4 stretches. Repeat onthe other side.

3. Upper Calf Stretch

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Standing, hold on to the back of achair with your left hand whileplacing the other hand on your righthip. Bend your left leg about 45degrees and bring your right legstraight out behind you about 3 feet

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and place your heel on the floor.Your bent left knee should be rightabove your left foot (not in front ofit). If you don’t feel the stretch inyour right leg, bring the left footforward a little more. Do not archyour back. Breathe evenly as you stayin the stretch. Hold for 5 seconds,relax for 5 seconds, repeat 2 moretimes. Then switch legs and repeat.

4. Lower Calf Stretch

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Standing, hold on to the back of achair with your left hand. Place yourright hand on your hip and slide yourright leg straight out behind you about2 feet, keeping the heel on the ground.Bend both knees and slowly lower

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your hips toward the floor, keepingboth heels on the ground. You shouldfeel gentle tension in the lower calfof your back leg. Breathe evenly asyou stay in the stretch. Hold for 5seconds; relax for 5 seconds; repeat2 more times. Switch sides.

5. Middle and Lower Back Stretch

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Seated on a chair with your kneesapart, hold your arms out in front ofyou and stretch them forward.Keeping them in this position,gradually bend your torso forwardand allow your back to round untilyou feel a gentle tension in yourupper and/or middle back. (At thispoint, your arms may be betweenyour knees, hands touching the floorif possible.) Breathe evenly as youstay in the stretch. Hold the stretchfor 5 seconds, relax for 5 seconds,and repeat 2 more times.

CORE EXERCISES

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1. Basic Crunch

Lie on your back, with knees bent,feet flat on the floor, and heels 12 to15 inches from your buttocks. Placeboth your hands behind your neck.

Let your abs do the work of raisingyour torso straight up to a 30-to-45-degree angle, but don’t curl yourbody or your back up. Point your chinto the ceiling.

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Hold for 1 second, then lower down.Exhale as you rise up; inhale as youlower down. Do 15 times for eachset.

2. Upper Abdominal Crunch

Lie on your back with your elbowsout, hands behind your neck.

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Bend your knees at a 90-degree angleand rest your feet on an exercise ballor chair.

Raise your torso to a 35-to-45-degreeangle and hold for a second.

Return to starting position. Exhale asyou rise up; inhale as you lowerdown. Do 15 times for each set.

3. Twisting Trunk Curl Crunch

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Lie on your back, with knees bent andheels 12 to 15 inches from yourbuttocks. Place both hands behindyour neck.

Place your left ankle over your rightknee so that your legs form a triangle.

Let your abs do the work of raisingyour right shoulder toward your leftknee, 8 to 12 inches off the ground.

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Return to starting position. Exhale asyou rise up; inhale as you lowerdown.

Do 15 on this side, then switch legsand repeat for another 15 for eachset.

4. Alternating Arm and Leg Raise

Lie on your stomach, facedown, armsstretched out in front of you, with

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your head supported by a foldedtowel. (The towel goes under yourarmpits and under your chin.)

Raise your right arm and your left legsimultaneously by contracting yourabdominal and lower back muscles.Keep your shoulders and pelvispressed against the floor and yourarm and leg straight. Your left armand right leg should be on the floor.

Lift to the point at which you feel agentle tension in the lower backmuscles. Pause for a second beforegoing back to starting position.Exhale as you rise up; inhale as youlower down.

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Do 15 times, then repeat on the otherside 15 times for each set.

5. Extended Arm Crunch

Lie face-up on the floor with yourknees bent, feet flat on the floor, andyour heels 12 to 15 inches from yourbuttocks. Place one hand behind your

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neck for support. Extend the otherarm straight out so that it is betweenyour knees.

Contract your abdominal muscles anduse them to raise your torso off thefloor to a 30-to-45-degree angle.Your chin should go straight uptoward the ceiling with no rolling ofyour neck. Pause for a split secondbefore returning to starting position.Exhale as you rise up; inhale as youlower down.

Do 15 for each set.

6. Vertical Leg Crunch

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Lie face-up on the floor with yourlegs straight up, perpendicular to theground, knees bent slightly. Placeyour palms lightly behind your neck.

Contract your abdominal muscles anduse them to raise your torso off thefloor to a 30-to-45-degree angle.

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Your chin should go straight uptoward the ceiling with no rolling ofyour neck. Pause for a split secondbefore returning to starting position.Exhale as you rise up; inhale as youlower down.

Do 15 for each set.

7. The Reverse Trunk Curl

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Lie on your back, with your legsstraight up, perpendicular to theground, knees bent slightly. Placeyour palms facedown and at yoursides.

Keep your back—including yourshoulder blades—as flat as possible

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on the floor. Contract your abdominalmuscles and curl up your pelvis. Thiswill raise your legs up higher towardthe ceiling. Hips should be 3 to 5inches off the floor. Pelvis andbuttocks should be fairly relaxed; it’syour abdominal muscles doing thework. Exhale as you contract yourabs and hold for 1 second. Inhale onthe way down. Do 15 for each set.

8. Incline Sit-Up (requires incline

board)

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Lie face-up on an incline board withyour knees bent, feet hooked underthe board’s leg pads. Place yourhands behind your neck with yourelbows out to the side. Your backshould be flat against the pad of theboard and your feet locked under thefootholds.

Contract your abdominal muscles and

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use them to raise your torso to a 35-to-45-degree angle. Your chin shouldpoint straight up toward the ceiling;don’t let your neck roll as you riseup, and keep your shoulders square.Pause for a second before returningto starting position. Exhale as yourise up; inhale as you lower down.

Do 15 for each set.

Increasing the height of the inclineboard will increase the challenge.Try doing each set on a differentsetting.

LIFETIME SPORTS AND

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RECREATIONAL ACTIVITIES

Some of these sports and activities areespecially good for balance, some areespecially good for hand-eyecoordination, and some are good forboth. A few of them are simply excellentways to get more physical and socialactivity into your life.

Archery*

Badminton*†

Baseball/softball*

Basketball*†

Bike riding†

Bocce*†

BOSU Ball/balance boards†

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Bowling*†

Boxing/punching speed bag*

CanoeingClimbing (rock/wall)*†

Cricket*

Croquet*

Dancing†

Darts*

FishingFootball*

Frisbee*

Gardening/yardworkGolf*†

Gymnastics†

Hockey (roller or ice)*†

Hopscotch†

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Horseback riding†

Horseshoes*

Hunting*

Ice-skating†

In-line skating†

Jacks*

Jump rope†

Karate/martial arts†

KayakingKiteboarding†

Lacrosse/field hockey*

Lawn bowling*

Mountain biking†

Netball*

Paddleboarding†

Pilates†

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Ping-Pong*

Playing catch (with football, baseball)*

Plyometrics†

Polo*

Quoits*

Racquet sports (squash, racquetball,handball)*†

River rafting†

Rugby*

Sailing†

Shuffleboard*

Skiing/snowboarding†

Step aerobics†

Surfing†

SwimmingTai chi†

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Tennis*†

Volleyball*†

Wake boarding†

Walking†

Water aerobicsWater polo*

Water skiing†

Wind surfing†

Wrestling†

Yoga†

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CHAPTER 3

Lifelong, Life-Lengthening Eating

WHEN I WAS ON THE CROSS-COUNTRY BIKERIDE I described earlier in the book andpulled into Chicago, I got to ride rightonto the set of The Oprah Winfrey Showwhile it was in the middle of taping. Ididn’t even get off the bike (a surpriseguest, just passing through!) but stoppedto chat with Oprah. “Wow,” she said, “I

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hear you’re drinking gallons of orangejuice. Is it true you’re eating eight to ninethousand calories a day? That’s mydream.” “I know it is,” I replied, and Icouldn’t resist adding, “but your dreamdoesn’t involve riding a hundred miles aday. That’s your biggest nightmare!”

Who wouldn’t like to eat all that theywanted every day? Maybe not eight tonine thousand calories, but it would benice to eat whatever you felt like withoutany worries about the repercussions.Because of my profession people oftenexpect me to be a perfect eater. I’ll goout with friends or business associatesand besides watching every morsel I putin my mouth, they’ll become very self-conscious about what they’re ordering.

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But not only do I enjoy food, I like to seeother people enjoying food, too.

Once when I was appearing on alocal morning show, I talked with avariety of other interesting guests in thegreenroom of the television station aswe waited for our respective turns infront of the camera. When I heard myname called, I headed out onto the stage.

Earlier, I had noticed that there was ahuge tray of doughnuts sitting on a tablein the middle of the greenroom. While Iwas chatting with everyone, nobody hadtouched them, but when I came back intothe room after my appearance, I noticedthere wasn’t so much as a crumb left. Itlooked like someone had taken a vacuum

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cleaner to the tray. My publicist, whohad accompanied me to the TV stationand saw me looking at the tray, began tolaugh. “The second you walked out, theydove into those doughnuts like there wasno tomorrow.” Obviously, they had beentoo intimidated to eat in front of me.

The truth is, I love to eat a variety offoods and I love dessert (okay, maybe Idon’t eat doughnuts, but I find it difficultto turn down any type of pie). I’mhuman. I battle cravings just like anyoneelse. Over the years, I’ve certainlyimproved my diet. I eat better now than Idid in my twenties and thirties, but that’sbecause I have to. You just can’t getaway with as much when you get older,and if you do make the effort to eat more

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moderately and nutritiously, there areplenty of life-lengthening and anti-agingbenefits to be had.

It’s estimated that up to a third ofcancer cases, half of heart disease cases,and up to 90 percent of cases of type 2diabetes are entirely related to less-than-healthy diets as well as how much bodyfat a person is carrying around. On theflip side, many societies known for theirlongevity boast diets that are nutrient-rich and far more reasonable in caloriesthan those diets associated with disease.The evidence that you have a greaterlikelihood of living a longer, higher-quality life if you eat well andmoderately is undeniable.

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One thing we know about the agingprocess is that it is accompanied by aslowdown in the metabolic rate (the rateat which you burn calories). As Iexplained in the previous chapter,exercise can go a long way towardpreventing that slowdown; however,most people have to be more carefulabout how many calories they take inonce they approach their forties, or theygain unwanted pounds. I wish I couldsay that eating however much you wantis one of the privileges of aging, but infact you need to stay extra vigilant aboutcalories as you grow older. There’seven some intriguing research, which I’lldiscuss here, showing that cutting way

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back on calories can extend your life.At least as important as the quantity

of your food is the quality of your food.There are, of course, the basic buildingblocks of a nutritious diet: healthy fats,high-quality protein, whole grains, fruitsand vegetables. But beyond that, thereare also certain foods known to havepotent antioxidant powers capable ofhelping to reduce inflammation anddisarm cancer-causing agents, as well asfoods that can help lower cholesterol,preserve bone, and keep your brainsharp. Integrate these into your diet andyou can greatly enhance your ability tocounter various aspects of the agingprocess.

On the following pages, you’ll find

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an anti-aging eating plan based on all thetenets I just mentioned: don’t eat toomuch, build your diet on healthy staples,and accent it with superfoods. Inaddition, Tufts researcher Diane L.McKay will weigh in on supplementsand how to fill in any potential gaps inyour nutrient needs.

EATING FOR HEALTH ANDLONGEVITY

Thanks to a whole body of researchlooking at the connection betweencertain types of diets and longevity aswell as how particular foods affect

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disease risk factors, we know how todefine anti-aging eating. For instance,several epidemiological studies havefound that the traditional diets of peopleliving in Mediterranean countries andislands off Japan (Okinawa) seem toconfer amazing life-lengthening benefits.Other studies have found that whengroups of certain foods are included in ahealthy diet, they work together to lowerthe risk of heart disease. We also nowhave a lot of information aboutsuperfoods, foods from every categorythat have high levels of disease-fightingcompounds and/or have been shown toexact some beneficial changes in thebody.

The 20 Years Younger Diet draws

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from all these sources, but before I tellyou more about it, a little background onthree of the diets that in part inspired thisplan is in order.

The Okinawan Diet is based onresearch looking at the eating habits andlife span of the inhabitants of the RyukyuIslands (Okinawa is only one of the 161islands in this string off the coast ofJapan, but because it’s the largest, itsname is used comprehensively). It’swell known that Japanese people havehalf the heart disease rate and about aquarter of the breast and prostate cancerrate as Americans. They also have lowerrates of diabetes and Alzheimer’s-related dementia. But in Okinawa, the

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rates for all these chronic diseases areeven lower. Okinawa also has thelargest concentration of centenarians—people age one hundred or older—ofanywhere in the world.

Their secret? When Okinawans leaveJapan and immigrate to the United Statesor other countries with a Western-stylediet, they gradually, with eachsucceeding generation, take on a similarrisk for chronic disease as everyone elseliving in that country. “So these peoplearen’t living longer because they havesuch fabulous genes,” says D. CraigWillcox, MHSc, PhD, a professor atOkinawa International University andauthor of The Okinawa Program.“They’re living longer because they eat

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a healthy diet, and stay active and lean.”As co-principal investigator of theOkinawa Centenarian Study, Willcox,along with his twin brother, BradleyWillcox, MD, a clinical associateprofessor at the University of Hawaii,has been tracking the habits of the age-defying Okinawans.

The elderly Okinawans studied bythe Willcoxes ate a diet fairly high incarbohydrates, but their carbohydratescame mostly from vegetables and wholegrains plus a little fruit (in other words,they weren’t packing away lots of bakedgoods and other junky carbs). They alsoate a lot of tofu—even more than in otherparts of Japan—and their other protein

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mainstay was fish. Red meat wasn’tregularly on the menu, and when it was,it was generally used as a garnish ratherthan as the main dish. The types of fat theelderly Okinawans consumed werehealthful, something else that set themapart from typical American eaters. Dr.Willcox sums it up. “The reason thisway of eating works is because it dousesyour body with protective phytoactiveplant compounds while minimizing theunhealthy stuff like saturated fat, transfat, white flour and heavily processedfoods. In the United States, we eatexactly the opposite way.” Anothermajor difference: Okinawans eat about1,900 calories per day compared toabout 2,500 for the average American.

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What’s more, those within the Okinawanpopulation who eat about 15 percent lessthan average have the longest lives.

The life span of people in Greeceand many of the other countries along theMediterranean Sea rivals that of theOkinawans. The diets in the differentcountries ringing the Mediterraneanaren’t identical—for instance, pasta is astaple in Italy, whereas rice and potatoesare more popular in Greece—but theyhave a lot in common. You might heartheir way of eating referred to as the“Mediterranean diet,” but given thedifferences I think it’s more appropriateto call it the Mediterranean style ofeating. And when I talk about this style

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of eating, I’m talking about thetraditional pattern, no matter whichcountry, of eating plenty of olive oil, avariety of whole grains, lots of fruits andvegetables, and moderate amounts ofhigh-protein foods, mainly fish, withlittle meat.

There are many differences betweenthe Mediterranean-Style Diet and theOkinawan Diet. They incorporatedifferent types of oils and different fruitsand vegetables, and the Okinawans eatno dairy products. But both diets offersimilar benefits. Mediterraneancountries such as Spain, Italy, andFrance have about half the rate of deathdue to heart disease as the United States.And if you already have heart disease,

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switching over to a Mediterranean-stylediet is proving to be a potentiallylifesaving move. The Lyon Heart Studyof French men and women who’d hadone heart attack found that those whofollowed a Mediterranean-style diet forfour years had a 50 to 70 percent lowerrisk of having a second heart attack thanthose who followed a diet that wascloser to an American diet.

One reason the Mediterranean-StyleDiet lowers the risk of heart disease isthat it reduces cholesterol, inflammation,and the likelihood of getting type 2diabetes (diabetes doubles or triplesheart disease risk). People who switchto the Mediterranean way of eating lose

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more weight and have better blood sugarcontrol, two risk factors for diabetes.Followers of the Mediterranean-StyleDiet also have lower rates of colorectal,breast, prostate, pancreatic, andendometrial cancers, and a few studiessuggest that the diet may even helpprevent age-related brain deterioration.

One study tracking older NewYorkers for four years found that thosewho closely adhered to a Mediterraneanpattern of eating were 40 percent lesslikely to develop Alzheimer’s disease.French researchers have also found thatthe diet helps overall cognitiveperformance and memory. “Thesefindings, though preliminary, show thateating a Mediterranean-style diet may

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not only affect the risk for Alzheimer’sdisease, but also put the brakes on otherforms of cognitive decline,” saysCatherine Féart, PhD, of UniversitéVictor Segalen in Bordeaux, France,who led the French study. “Becausedementia can take decades to develop,and the Mediterranean diet may have along-term beneficial effect, it seems thatthis dietary pattern, and its associatedlifestyle, is an optimal dietary strategy ifyou want to protect your health,including your brain.”

How the Anti-AgingDiets Stack Up

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The Okinawan and Mediterranean-Style Diets have many similarities—butsome notable differences, too. Themost significant difference is thequantity of fat in the diets; theMediterranean-Style Diet allows forquite a bit more. Yet perhaps becausethe fat eaten in most Mediterraneancountries tends to be heart-healthyolive oil, the excess fat doesn’t seemto create a problem. Read on tocompare and contrast the otherdifferences.

Mediterranean-Style Diet

OkinawanDiet

percent ofcalories fromcarbohydrates

45 to 50 58

percent ofcalories fromprotein

15 15

percent ofcalories from 30 to 40 27

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fat

percent ofcalories fromsaturated fat

7 7

fruits

berries, melons,citrus, apples,pears, grapes,apricots

papaya,pineapple,mangoes,guava,bananas,watermelon,passion fruit,shikwasa(lemon)

vegetables

tomatoes, saladgreens, sweetpeppers,fennel,eggplant,onions, garlic,purslane

bitter melon,seaweed,shiitakemushrooms,burdock,eggplant,okra,broccoli,carrots,pumpkin,greenpapaya

fennel

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herbsbasil, rosemary,thyme,oregano

seeds,turmeric, hotpeppers,mugwort,basil, aloe

grains andstarchyvegetables

bulgur wheat,whole grainbread, polenta,brown rice,pasta,chickpeas,cannellinibeans, lentils

sweetpotato,brown rice,buckwheatnoodles

high-proteinfoods

chicken, duck,pigeon, quail,rabbit, lamb,anchovy,sardine,mackerel, seabream, redtuna, eggs

soy, miso,fish (mahi-mahi,banana fish,reef fish,tuna,bonito), leanpork

dairy yogurt, cheesenottraditionallyeaten

olive oil,almonds, canola oil,

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fats hazelnuts,walnuts

soy oil

beverages

water, wine(moderate withmeals), tea,coffee

water,jasmine tea,beer,awamori(Okinawansake)

A third diet with important benefitsfor anyone attempting to fight aging iscalled the Portfolio Diet. University ofToronto researchers asked people toinclude a “portfolio” of cholesterol-lowering foods such as almonds andeggplant in their diet. Each of the foodshad only mild cholesterol-loweringeffects on its own, but together theyproved to pack a big punch, lowering

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LDL (bad) cholesterol in the studysubjects by 20 percent or more,significantly cutting the risk of heartdisease. These foods—I’ll tell you whatthey are as you go along—are worthworking into your diet, too.

Whereas the Portfolio Diet isvirtually a vegan diet (it contains a littlenonfat milk and yogurt and its creatorsencourage the use of plant proteins asmuch as possible), the Mediterraneanand Okinawan diets are not vegan oreven vegetarian. They’re goodexamples, though, of how judiciousconsumption of animal foods can still behealthy if you also keep other sources ofsaturated fat to a minimum, moderateyour intake of sodium and sugar, and

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consume lots of fruits and vegetables.The Portfolio Diet, the Okinawan

Diet, and the Mediterranean-Style Dietcollectively tell us a lot about anti-agingnutrition. Yet they have drawbacks, too.Chief among them is that, with ourAmerican palates, which are used to themelting pot style of eating (a littleChinese one night, a little Italian thenext, some Mexican-influenced cuisinethe night after that), following any one ofthose diets to the letter could get tedious.One of the wonderful things aboutAmerican markets these days (and thatincludes farmers’ markets and the widerange of ethnic markets as well) is thatwe have an abundance of foods to

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choose from, many of which fall into thesuperfoods category that I talked aboutearlier. I’m all for taking advantage ofthat abundance as much as possible, andthe 20 Years Younger Diet helps you doso while still giving you the benefits ofthe Portfolio, Okinawan, andMediterranean-Style way of eating.Beginning here, you’ll find two weeks’worth of menus that draw on all three ofthese anti-aging diets, mixing in ahealthy dose of longevity-promotingsuperfoods and topping it all off with adash of convenience (no ingredient istoo hard to find or difficult to make). It’sthe perfect marriage of science andpleasurable eating: a nutritious modernmeal plan with enough variety to keep it

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interesting.The menu plans will give you initial

direction, but it’s important to be able tocreate your own healthy menus. The 20Years Younger Diet guidelines in thefollowing section will help you withthat. If you’ve been eating poorly, you’regoing to feel the effects of shifting to thiscleaner and more nourishing dietimmediately. You’ll have more energy,your head will feel clearer, and evenyour skin will look brighter. If you’realready eating fairly nutritiously, therecommendations here will help youfine-tune your diet, showing you how topack it full of the foods we know canhelp you live longer and age well. I’ll

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also be continually updating the diet onmy website,www.20YearsYounger.com.

THE 20 YEARS YOUNGERDIET

One of the keys to successfully changingyour eating habits in order to worktoward any goal (be it weight loss, alower cholesterol level, or overallhealth and longevity) is making rules foryourself. When you have these rules inplace, decision-making about food issimply easier. You know what you canand can’t eat and how much food you

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should have on your plate. I’m not sayingthat you can never deviate from yournutrition rules, but you’ll find itconsiderably easier to stay on track dayto day if you have a framework foreating. To that end, here are theguidelines for anti-aging eating. It’s acompilation of what to eat and what notto eat, how to work variety into yourdiet, and how to sprinkle it all liberallywith anti-aging superfoods.

The Guidelines

At each meal, make sure half of yourplate is covered with vegetablesand/or fruit.

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For as many meals as possible, thestarch on your plate should be eithera whole grain (such as whole wheatbread or brown rice), potatoes,sweet potatoes, or legumes (likeblack beans, pinto beans, or lentils).When you opt for potatoes, make surethey’re not fried.

Your high-protein choices should bemostly fish, chicken, or soy (see herefor exceptions to the soyrecommendation). Eat red meat nomore than three times a month.

Use mostly olive oil and canola oil.

Avoid partially hydrogenated oils

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(trans fats—see here and here) andlimit saturated fat.

Choose nonfat or 1% milk or yogurt,or calcium- and vitamin D–enrichedsoy milk.

Stick to the treat limit for your calorielevel (see chart here); that’s 150calories per day of foods high insugar (like candy) or salty snacks(like chips) if you’re taking in 1,700calories per day; 200 treat calorieson the 2,000-calorie diet, and 250 on2,500 calories. Bear in mind that themeal plans are full of examples ofhealthier treats.

Eliminate or severely limit (no more

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than twice a month) fried food, soda,or other sugary drinks (like heavilysweetened iced tea and juice“drinks” and punches, which containvery little juice). It’s okay to havefour ounces of 100 percent fruit juicedaily as one of your fruit servings,but any more than that counts as partof your treat calorie allowance. Ifyou decide to have a soda or othersugary drink, that counts as treatcalories, too.

The Plan

When you look at the plan below, you’llsee that it’s divided up into food groups.Under each group, you’ll find specific

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serving recommendations—you don’thave to follow these to the letter, but aslong as you’re close, your diet will belongevity-enhancing. I’ve also includeda list of superfoods that represent thebest of the best in the group. Superfoodsaren’t the only foods you can eat in eachcategory, but opt for them as often aspossible. Most of the foods on the listare available in your local supermarketor health food store.

The plan is written to include dailycalorie levels ranging from 1,500 to2,500. How many calories are right foryou? The “What’s My Calorie Level?”chart below will help you figure outwhere to start, and I’ll include a range of

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servings recommendations under eachcategory of food so you can see howyour calorie level plays out in practicalterms. Bear in mind that it may takesome trial and error for you to find thecalorie level that works for you, whetheryou’re trying to shed pounds or justmaintain your weight.

If you’re going to have to make a lotof changes in your present diet to switchover to this one, you could getoverwhelmed. My suggestion: Start byincreasing the amount of fruits andvegetables you eat—that alone can havean amazing impact on your health. Dothis for a few weeks, then make yournext move. Change the fats that you’reeating, then after a few weeks try to

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weed salty snacks and excessive sweetsout of your diet. Keep up the steps untilyou’ve mastered all the principles ofanti-aging eating.

What’s My Calorie Level?

Based on your weight, height, age,exercise level, and how fast you tend toburn calories, your daily calorie needsare very individual. Someone of yourexact height, weight, age, and genderwho exercises just as much as you domight need a few hundred calories moreor less per day than you do. So, keepingin mind that the guidelines below areflexible, use them as a starting point. Ifyou’re feeling too hungry or are losing

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weight too fast (or unnecessarily), moveup a calorie level. If you’re feeling toofull or not losing the weight that youneed to lose, drop down a calorie level.

If you’re…And youractivitylevel is…

Try this dailycalorie level…

A womanmaintaininghealthyweight

Sedentary 1,500

A womanwho wantsto loseweight

Sedentary 1,500 or lower

A womanmaintaininghealthyweight

Level I 1,700

A womanwho wantsto lose Level I 1,500

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weight

A womanmaintaininghealthyweight

Level II 2,000

A womanwho wantsto loseweight

Level II 1,700

A womanmaintaininghealthyweight

Level III

2,500 (possiblyhigher; see herefor ways to addcalories)

A womanwho wantsto loseweight

Level III 2,000

A manmaintaininghealthyweight

Sedentary 1,700

A man whowants tolose weight

Sedentary 1,700 or lower

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A manmaintaininghealthyweight

Level I 2,000

A man whowants tolose weight

Level I 1,700

A manmaintaininghealthyweight

Level II 2,500

A man whowants tolose weight

Level II 2,000

A manmaintaininghealthyweight

Level III2,500 + (see herefor ways to addcalories)

A man whowants tolose weight

Level III 2,500

How Much Do I Eat?

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Daily Servings According to YourCalorie Intake

Calorie Intake 1,500 1,700 2,000 2,500

Fruit 2 2 3 4

Vegetables 5 6 7 8

Grains/StarchyVegetables

5 5 6 7

Milk/Yogurt/SoyMilk

2 2 2 3

Protein-RichFoods

6 6 7 8

Nuts/Seeds 1 1 1 2

Healthy Fats 5 5 6 7

Treat Calories none 150 200 250

THE 20 YEARS YOUNGER

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DIET GROCERY LIST

Fruit

2 to 4 servings daily

Serving = a medium-size fruit (like anorange) or half a cup of berries,grapes, or chopped fruit.

Superfruits

ACAI BERRIES, BLUEBERRIES, BLACKBERRIES,

STRAWBERRIES, AND RASPBERRIES. Just ahandful or two of berries on your cerealor oatmeal in the morning turns breakfastinto brain food. Rich in polyphenols,phytonutrients that have anti-

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inflammatory and antioxidant powers,berry extract has been shown, throughanimal studies at the USDA Center onAging Research at Tufts University, toimprove memory by protecting braincells from age-related decline. “Wehave little housekeepers in the braincalled microglia, which clean up thedebris that would otherwise interferewith brain cell function,” explains ShibuPoulose, PhD, a molecular biologist atthe USDA/Tufts lab. “As we age, thesehousekeepers get sloppy, leaving debrisaround and even misdirecting theirclean-up efforts on healthy cells,damaging them. Our studies indicate thatextracts of blueberries, strawberries,and acai berries may restore microglia

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back to a functioning level.” Amongberries’ other benefits is helping tolower cholesterol. Strawberries andraspberries also contain ellagic acid, aphytochemical that has anticancerproperties.

CITRUS. We’ve long known that lemons,limes, oranges, and grapefruit are rich invitamin C, good enough reason not onlyto eat citrus for snacks and desserts butto use it in cooking as well. (Lemon-based salad dressings, fish topped withan orange and onion salsa, and avocadoand grapefruit salads are just a few ofthe ways to work citrus into meals.)Citrus fruits also contain a group ofcompounds called flavonoids, which are

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proving to be potent cancer and heartdisease fighters. One of theseflavonoids, naringenin, found in veryhigh amounts in grapefruit, can stimulateproduction of SIRT1, an enzyme thatappears to slow aging.

POMEGRANATES. Suddenly, pomegranateis everywhere. Pomegranate juices linestore shelves, pomegranate extract isinfused in tea, dried pomegranates aremixed into cereals and trail mix—youget the picture. Though pomegranate haslong been used in traditional medicine inIndia, Greece, and the Middle East,scientists are now discovering that itholds promise in preventing cloggedarteries and protecting against prostate

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and other types of cancer.

GRAPES. You hear a lot about the healthbenefits of wine, but what is wine madeof? Grapes, and for my money, goingright to the source is the best idea. Redand purple grapes get their pigment fromanthocyanins, the same beneficialcompounds found in blueberries andblackberries. Green grapes are higher ina compound called flavan-3-ols, whichfight cancer and protect the nerves.Grapes of all colors may protect againstheart disease and are also rich in anumber of phytonutrients. The twoconsidered most effective areproanthocyanidins and resveratrol,which has been making a lot of news

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lately because it’s believed to turn onthe cells’ own survival mechanisms.Some scientists believe it showspromise for the prevention of many age-related conditions, including Parkinson’sand Alzheimer’s disease, inflammation,diabetes, and cardiovascular disease.Resveratrol is mainly found in the grapeskin; proanthocyanidins are found onlyin the seeds.

Vegetables

4 to 8 servings daily

Serving = 1 cup raw greens such asspinach or lettuce or ½ cup choppedraw or cooked vegetables

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RULE OF THUMB: Vary the type and colorof your vegetables in order to consumethe most phytonutrients, vitamins, andminerals. Have cruciferous vegetables atleast three times a week and the otherson this list as often as possible.

Supervegetables

CRUCIFEROUS VEGETABLES. Arugula, bokchoy, broccoli, broccoli sprouts,Brussels sprouts, cabbage, cauliflower,collard greens, horseradish, kale,kohlrabi, mustard greens, radish,rutabaga, turnips, turnip greens, andwatercress are cruciferous vegetables.Cruciferous vegetables turn off many

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people, but maybe that’s because theyhaven’t had them prepared properly. InMediterranean countries, they’re oftensimply sautéed with olive oil instead ofsteamed, the way they’re commonlyserved here. Sautéing gives them muchgreater flavor, which is important,because you want to eat as manycruciferous vegetables as you can: Theyall share cancer-fighting compoundscalled isothiocyanates, which maydisable some of the cancer-causingsubstances in tobacco smoke and helpremove carcinogenic substances beforethey can damage DNA. Sulforaphane, anisothiocyanate found in broccoli, haseven been shown to kill cancer cells.

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EGGPLANT (PURPLE SKIN VARIETY).Eggplant is high in viscous fiber—thetype that helps trap fat and cholesteroland whisk it out of the body. That’s whyit’s a staple of the cholesterol-loweringPortfolio Diet. Eggplant’s purple skin isalso a great source of anthocyanins,which give blueberries some of theirhealing properties. Be careful how youcook eggplant. It sops up oil like asponge, so pan-frying isn’t the healthiestway to prepare it. Instead, slice theeggplant, spray it with oil, and bake it inthe oven. You can also bake the entireeggplant in its skin, then peel itafterward.

PURSLANE. You can find this green in

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farmers’ markets in the summer, and itmight even be in your backyard, growingalongside your grass. Eaten in some ofthe Mediterranean countries and in theMiddle East as a salad green, it hasunusually high amounts of omega-3 fattyacids for a vegetable (see here for moreon omega-3s). A 3½-ounce serving(about 2 cup) contains 300 to 400 mgof omega-3, covering about a third ofyour daily requirement. It’s also high inmelatonin, which may help you sleepmore soundly.

SEAWEED. There are many types ofseaweed, and their nutritional attributesvary. Those that show up regularly inOkinawan cuisine include the following:

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Kombu: Okinawans use this mild-tasting seaweed to make broth(dashi). It’s rich in heart- and bone-protecting magnesium. Like wakame(below), kombu contains fucoidan, anantioxidant that in test-tube studieskills cancer cells.

Hijiki (or hiziki): Rich in bothpotassium and magnesium, its tender,dark, curly leaves are often part of aseaweed salad mix or served aloneas a salad in Japanese restaurants.You can also buy it dried and turn itinto a salad at home.

Wakame: Wakame is the greenvegetable traditionally swirling

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around in miso soup. It’s rich inmanganese (which is part of thebody’s own antioxidant defensesystem) and folate (good for the heartand a cancer fighter). The onlydownside is that it’s very high insodium, which is why the tofu andmiso soup here substitutes kombu orhijiki for wakame.

To find seaweed, check the Asiansection of your supermarket or visit anAsian market. You can also buy itonline. Bear in mind that seaweed isn’tjust for cooking. Many markets nowcarry snack packs of seaweed that youcan eat just like crackers (though withfar fewer calories).

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MUSHROOMS. We’ve known for a whilethat mushrooms have a lot going for them—B vitamins, copper, and phytonutrientsthat boost immunity and help preventplaque formation in arteries—butgrocery stores are now also starting tocarry mushrooms that are rich in vitaminD. Since vitamin D is hard to get fromfood, this is big news. The mushroomsare exposed to UV light so that theyproduce vitamin D (just as we do). Onecup of these light-exposed portobellomushrooms provide 384 IUs of D, about64 percent of a day’s requirement. If youcan’t find these specialized mushrooms,you might want to opt for chanterelles ormorels, which have a lot of naturally

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occurring D, or shiitakes, which areeaten regularly in Okinawa. Test-tubestudies show that shiitakes ward offdisease-causing microbes and killcancer cells.

TOMATOES. If you can eat a fresh, vine-ripened tomato, you’re getting the best ofboth worlds—life-enhancing flavor,life-extending nutrients. But don’t giveup on tomatoes if you can’t find tasty,fresh ones. Both fresh and cannedtomatoes and tomato sauce are rich inlycopene, a potent antioxidant linked to areduced risk of cancer. The redder thetomato, the more lycopene it contains,and cooked tomatoes contain morelycopene ounce for ounce than raw and

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the lycopene in cooked foods is betterabsorbed by the body. Tomatoes are amajor component of the Mediterranean-Style Diet, and a number of studies in theUnited States, Italy, and elsewhere havefound that people who eat the mosttomatoes are at lowest risk for heartdisease and prostate cancer.

Herbs and Spices

Try to incorporate into your diet asoften as possible.

There are no specific serving sizes;use in amounts that enhance but don’toverpower the taste of your food.

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Super Herbs and Spices

BASIL, CILANTRO (CORIANDER), DILL, GINGER,MINT, OREGANO, PARSLEY, ROSEMARY, AND

THYME. In general, herbs and spicescontain a treasure trove of compoundsthat fight infection and chronic diseases.I singled out these nine because they’repopular in Mediterranean and/or Asiancuisine. While fresh herbs are going tohave higher levels of protectivecompounds, for the most part, driedherbs retain enough to be helpful. Thedark green herbs are rich in carotenoids,linked to a lower risk of several types ofcancer. Basil, oregano, mint, parsley,rosemary, and thyme contain rosmarinicacid, which fights infection and

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inflammation and has been shown tofight blood clots, a major cause ofstrokes and heart attacks. Ginger, longknown to help fight nausea, also hasclot-fighting abilities and is anti-inflammatory.

Basil, cilantro, dill, mint, and parsleycan be used liberally in salads—up to aquarter cup of each per four cups ofother vegetables is a good ratio. Thyme,oregano, and rosemary have a strongertaste, so they stand up well to cooking(for an example, try the Braised ChickenLegs in Red Wine with Lentils, Fennel,and Kale here). Add sliced ginger alongwith garlic to a stir-fry; chop or grate itfor a sesame-oil-and-vinegar-based

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salad dressing or marinade. To makeginger tea, simmer a 2-inch piece ofginger, sliced into 4 pieces, in 1½ cupsof water for ten minutes.

CINNAMON. Perhaps because weassociate it with not-so-good-for-youtreats (those giant cinnamon rolls sold inairports come to mind), cinnamon ishardly ever thought of as a healthy spice.But research shows that it has manybenefits, including an ability to helpcombat insulin resistance. Some studiesare indicating that cinnamon alsoreduces inflammation, can help preventformation of AGEs (for more on thesedestructive compounds, see here), andtarget and eradicate cancer cells.

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There are plenty of ways to getcinnamon into your diet that don’tinvolve mammoth-size pastries. It’soften used in Moroccan recipes, and it’sdelicious on a baked apple or inapplesauce. Richard Anderson, PhD, aresearch chemist with the U.S.Department of Agriculture’s Diet,Genomics, and Immunology Lab inBeltsville, Maryland, who has studiedcinnamon, suggests soaking a cinnamonstick in hot water and drinking it like tea,or adding ground cinnamon to coffeebefore brewing. If you have diabetes orpre-diabetes, consuming one halfteaspoon of cinnamon two times per daymay help you control your blood sugar,

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and similar amounts may decrease AGEsand inflammation in the body. If youcan’t find a way to work it into the foodsyou’re eating, you can also buycinnamon capsules at natural foodstores.

GARLIC. Garlic has an outsize reputationas a superfood—you can find claims thatit prevents everything from the commoncold to heart disease. So what’s thetruth? We do know that raw and cookedgarlic is linked to a lower risk ofstomach cancer and may have generalimmune-boosting effects. As for otherbenefits, according to Karin Ried, PhD,a research fellow at the University ofAdelaide, Australia, who’s been

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studying garlic, different forms of garlichave different effects. “Our review ofthe research found that garlicsupplements—but not raw or cookedgarlic—can help bring down bloodpressure in people with high bloodpressure,” says Dr. Ried. “It’s less clearwhether garlic, supplements or food,reduces cholesterol; the studies areconflicting.”

TURMERIC (IN CURRY POWDER OR ALONE). Ifyou like Indian food, you’re in luck. Thisstaple of South Asian cuisine gives curryits vibrant yellow color (it’s also usedto color American mustard). Turmericand one of the phytonutrients it contains,curcumin, are powerful anti-

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inflammatory agents and antioxidants.Some research shows that they both cankill cancer cells; curcumin has also beenshown to clear amyloid plaque in thebrains of mice, indicating that it mayhave potential in fighting Alzheimer’sdisease. A number of human studies arecurrently under way examiningcurcumin’s effects on preventing andtreating cancer and as a therapy forpsoriasis as well as Alzheimer’s.

Grains, Legumes, and StarchyVegetables

5 to 8 servings daily, and have atleast one serving at each meal, if

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possible

Serving = one slice of 100 percentwhole grain bread; ½ cup cookedpotatoes, corn, sweet potatoes, peas,or whole grains (like oatmeal, wholegrain pasta, or bulgur wheat); cupcooked legumes or brown rice

In addition to their other nutritionalvirtues, the grains recommended hereand used in our meal plans are all wholegrains, which are much higher innutrients and fiber than refined grains.High-fiber foods are linked to lowerbody weight (possibly because they fillyou up with fewer calories) and alsofight chronic diseases in several ways,

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among them by lowering cholesterol.Whole grains and starchy vegetablesalso have a low glycemic index. Theglycemic index (GI) is a 1-to-100ranking of the extent to which a setamount of carbohydrate raises bloodsugar. Low GI foods elicit the slowestand smallest rise in blood sugar; theyhave a GI of 55 or under. Medium GIfoods fall into the 56 to 69 range andhigh GI foods are in the 70 to 100 range.Ideally, most of your carbs will fall intothe low or medium levels, becauseeating this way has been linked toreduced risk for heart disease, diabetes,and obesity. The health benefits come inpart because low-GI foods help keepblood sugar and insulin levels in check

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and keep you feeling fuller longer. Oneway to lower the glycemic index evenfurther is to marinate them in or servethem tossed with a vinaigrette. Vinegarseems to encourage the flow of sugarfrom the blood to your cells, whichhelps keep blood sugar down.

Super Grains, Legumes, and StarchyVegetables

BARLEY. The same thing that makes amushroom barley soup so thick andhearty—a type of fiber called beta-glucan—gives barley its health benefits.Beta-glucans form a gel around foodparticles in your gut, slowing the

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absorption of sugar and starch and acorresponding slow rise in blood sugar.Preventing blood sugar spikes may helpreduce your risk for pre-diabetes andtype 2 diabetes, and helps control bloodsugar once you have one of theseconditions. Beta-glucans also slow theabsorption of fat, and may actually carryfat and cholesterol out of the bodybefore they’re absorbed, thus loweringblood cholesterol. Once they’redigested, the chemistry of beta-glucansseems to also reduce the body’s ownproduction of cholesterol. Think aboutusing barley not just in soups or sidedishes but also in grain salads, breads,and risottos.

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BLACK RICE. In China black rice used tobe called “forbidden rice” because itwas reserved for emperors and noblepeople. Happily, it’s now available toall of us—happily, because it’s loadedwith the same health-promotinganthocyanins as blueberries,blackberries, and red and purple grapeskin. In Asia, black rice is used to makenoodles, sushi, and pudding, but you cansimply throw it in a pot or rice cookerand cook it like any ordinary type ofrice. Many high-end markets now carryblack rice, and you can find it online.

BULGUR WHEAT (CRACKED WHEAT). Astaple in Middle Eastern countries,bulgur is wheat in whole grain form.

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What makes it different from and evenhealthier than whole wheat flour is itscoarseness. The thicker the cut of awhole grain, the harder your body has towork to break it down, and the smallerand shorter the rise in your blood sugarwill be: cooked bulgur wheat has abouthalf the glycemic index as whole wheatbread. Bulgur is also rich in heart-protective vitamins and minerals such asvitamin E, folate, selenium, andmagnesium. The most common way toeat bulgur is in tabbouleh, a MiddleEastern grain salad usually made with aslightly finer cut of bulgur and tossedwith parsley, mint, lemon juice, andolive oil. Use the coarser cuts of bulgurto make pilaf (it cooks up just like rice)

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and combine it with beans to makeveggie burgers.

STEEL-CUT OATS. Like barley, oats are agreat source of beta-glucans and have allthe same cholesterol-lowering effects.Opt for the steel-cut version of oatsrather than flaked oats. It takes longer tocook, but this thicker and coarser cutgives it a lower glycemic index.

LEGUMES (LENTILS; CHICKPEAS; PINTO,

WHITE, AND BLACK BEANS). Legumes arerich in both fiber and protein. They alsohave other attributes, including Bvitamins, magnesium, calcium, and iron,and a host of phytonutrients. Saponins, acategory of phytonutrients found in

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legumes, reduce cholesterol levels andhelp fight cancer. Legumes and rice areeaten around the world in one form oranother, and they make a perfect meal.It’s easy to cook legumes, but if you endup buying canned, get the low-sodium orno-salt-added varieties. If those versionsaren’t available, be sure to rinse cannedbeans well before using to reduce thesodium.

SWEET POTATOES. The sweet potato iswhere the Okinawan Diet and theAmerican diet cross paths: ManyOkinawans eat sweet potatoes daily,and, of course, they’re readily availablein the United States as well, although alltoo often are served only on

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Thanksgiving. Don’t just think of them asa holiday vegetable. Mash them, bakethem, top them with a little maple syrup,use them in soups, but whatever you do,eat them often. Sweet potatoes containnearly every vitamin and mineral andboast a host of phytonutrients. A mediumsweet potato (about 100 calories)provides 550 percent of your dailyrequirement of vitamin A in the form ofbeta-carotene. Beta-carotene from foods(as opposed to supplements—see here)is linked to a lower risk of cancer andheart disease.

Milk/Soy Milk Products

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2 to 3 servings daily

Serving = 1 cup milk or calcium-fortified soy milk; ¾ cup plain yogurt

I recommend nonfat and 1% milk andyogurt throughout this plan because milkis the main source of calcium in theAmerican diet and these foods are alsorich in magnesium and potassium. Thesefat-free and very low fat products ensureyou don’t overdo calories or saturatedfat. They’re also associated with adecreased risk of osteoporosis andcolon cancer. I’m stopping short ofcalling them superfoods because there isevidence that milk may slightly raise therisk of prostate cancer. Of course,

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anyone worried about this can switch tocalcium-enriched soy milk, a perfectsubstitute.

High-Protein Foods

5 to 8 servings daily

Serving = 1 ounce fatty fish or darkmeat poultry; 1½ ounces white fish orlight meat poultry; 60 calories tofu,which works out to 1½ to 3½ ounces,depending on the type, so checklabels; 1 to 1½ ounces tempeh (samething—it varies); cup legumes

Your protein strategy: Have any of thefatty fish listed on the following page

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three times a week. Try to get in at least12 ounces weekly, more if you like fish.Your other high-protein staples shouldbe skinless poultry, eggs, egg whites,egg white products, and soy (tofu,tempeh, edamame). Though otherlegumes (such as black beans, pintobeans, and white beans) don’t have ascomplete a protein profile as soy, it’sfine to use them as your protein sourcefor one meal daily. Limit your intake ofred meat to no more than three times amonth or less. This may seem Draconianif you’re used to eating meat severaltimes a week, but my reasoning comesby way of many studies showing thatfrequently eating red meat raises the riskfor colon cancer and increases the risk

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for heart disease. Processed meats suchas hot dogs, bacon, pepperoni, andsausages, all high in saturated fat, areparticularly unhealthful. Avoid them oreat them only occasionally.

Super High-Protein Foods

FATTY FISH (WILD-CAUGHT SALMON, TROUT,

SARDINES). In general, fish is a healthyprotein choice, but these fish are the topof the line. Not only are they richer inhealthy omega-3 fatty acids (see here)than other types of fish, but they are alsolower in mercury and other pollutantsthan many of the fish in the seafood case.The fish supply, including some fish

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farmed in other countries and imported,has become very contaminated, and Irecommend that you be careful (visit theMonterey Bay Aquarium’s SeafoodWatch website to keep updated on thesafest fish and those that are sustainablyfished:www.montereybayaquarium.org/cr/seafoodwatch.aspx

Is Soy Safe?

The messages are conflicting. On theone hand soy is referred to as asuperfood. On the other hand, somesay it might be a trigger for breastcancer. Which is true? There’s no doubtthat soy is a healthy source of protein,and a good substitute for meat. But soyalso contains phytoestrogens, weak

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forms of the body’s natural hormone,and that has raised some concerns.About 70 percent of breast cancers areestrogen positive, meaning that thehormone causes cancerous cells togrow. It could be that phytoestrogenssimply add to your estrogen load,encouraging cells to become cancerous.

Yet there is some other thinking onthe topic. It may be thatphytoestrogens compete with realestrogen for landing sites on breastand other cells, and because they’remuch weaker cancer-promoters thanestrogen, actually help protect youfrom cancer. Soy actually does seem tohave a protective effect against breastcancer when it’s consumed early in life.However, whether soy consumed inhigh amounts confers that sameprotective effect—or, conversely, aharmful effect—in adult women is stillunknown.

The American Institute for Cancer

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Research recommends limiting soy totwo to three servings a day. If you’reundergoing any anti-estrogentreatments (such as tamoxifen), it’srecommended that you avoid soyaltogether. Most important, avoid high-dose isoflavone supplements(isoflavones are an active ingredient insoy) if you’re receiving treatment forbreast cancer—and even if you’re not.There’s no evidence showing that theyhave health benefits.

Fish in general confers numeroushealth benefits. Regular fishconsumption has been linked to a lowerrisk of dementia, and a HarvardUniversity study tracking thousands ofmen found that those eating fish at leastonce a week were only half as likely to

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experience sudden cardiac death asthose who ate no fish. In that study, alltypes of fish were beneficial, but fattyfish has the added benefit of having highlevels of omega-3s. And these fish oilsmay not be the only heart-protectivefactor. Fatty fish are also low insaturated fat, and many contain vitaminD.

SOY (TOFU, TEMPEH, EDAMAME). As manypeople move away from red meat,they’re moving more toward soy, andwith good reason. Soy is a good sourceof high-quality protein and unsaturatedfat (both tempeh and edamame are alsofiber rich) and has been shown to lowerblood cholesterol. It may reduce the risk

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of certain cancers, although this is stilluncertain (see “Is Soy Safe?” at left).One of the beauties of soy is that itcomes in so many forms. Edamame areyoung green soybeans available in thefrozen section of the supermarket (bothshelled and in the pod). You can usethem in stir-fries and soups and as asnack. Tempeh is made from cookingmature soybeans and adding a moldculture (cheese is made that way, too);grains are often also added. It has apleasant, nutty taste and a satisfyingchewy consistency. Tempeh works wellin hot and cold foods and makes a greatsandwich. Tofu is made from soy milkand comes in various consistencies.Firm tofu is great marinated and baked

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or in stir-fries; soft, silken tofu worksnicely in soups (it’s often added to misosoup) or made into scrambles. There arealso a lot of soy-based prepared foodson the market that are both healthy andconvenient. Gardein, for example, makesa whole line of soy products that mimicchicken and beef.

EGG WHITES. The white of an egg is theperfect protein, with ideal levels ofamino acids (the building blocks ofprotein). Whole eggs, of course, are verynutritious, too, but one large egg containssome saturated fat (1.5 g) and lots ofcholesterol (211 mg)—almost all of itcontained in the yolk. For most peoplecholesterol in food doesn’t raise blood

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cholesterol. But if you’re one of the fewfor whom it does cause a problem(you’d know it if you lowered yourdietary cholesterol and your lab valuesimproved), egg whites are a betterchoice than whole eggs. Even if youdon’t have high cholesterol, if you’reeating a lot of eggs it’s a good idea toalternate egg whites and whole eggs tokeep your saturated fat intake low. Alsoconsider using an egg white product suchas Better’n Eggs. The ready-to-use eggwhites are convenient, they containadded vitamins and minerals, andthey’re pasteurized so there’s no risk ofsalmonella.

Nuts, Nut Butters, and Seeds

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Nuts, Nut Butters, and Seeds

1–2 servings daily

Serving = ½ ounce, about 2tablespoons nuts or 1 tablespoon nutbutter. All nuts are healthful becausethey have great fat profiles andcontain phytonutrients, but the onesbelow are standouts.

Super Nuts and Seeds

ALMONDS. Packed with a laundry list ofnutrients, phytonutrients, and healthyfats, unsalted almonds not only helpedlower LDL cholesterol in the PortfolioDiet but were largely responsible for

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reducing blood pressure. Toss almondsinto salads, eat them as a snack, addsliced ones to chicken or fish dishes, butuse restraint. They’re healthy, but, likeall nuts, still high in calories: an ouncehas 170.

FLAXSEED. Flaxseed and flaxseed oil arethe richest source of plant-based omega-3s and therefore offer all the benefits ofthese essential fatty acids. Flaxseed isalso a good source of fiber (althoughflaxseed oil is not), and it containsphytoestrogens—the type ofphytoestrogen in flaxseed is calledlignan—so the same question that dogssoy (see “Is Soy Safe?,” here) dogsflaxseed as well. In an attempt to answer

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that question, scientists at the GermanCancer Research Center in Heidelbergreviewed the research on lignans andbreast cancer and concluded thatpostmenopausal women taking in higherlevels of lignans have about a 15 percentlower risk of developing breast cancer,and that studies show no effect eitherway on premenopausal women’s risk.

There are a few things to keep inmind about flaxseed. You need to grindthem to get all their benefits; your bodywon’t break down whole ones. Becauseomega-3s oxidize (go rancid) quickly,it’s best to buy whole flaxseeds, keepthem refrigerated, then grind them in acoffee or spice grinder, a food

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processor, or high-quality blender.Grind in small batches (a week’s worthof the flaxseed called for in the 20 YearsYounger Diet is about ½ cup). Place theground flaxseed in an airtight containeror plastic bag and store them in therefrigerator. You can sprinkle groundflaxseed on cereal, add to muffin,cookie, and bread recipes, and stir intoyogurt and smoothies. Add flaxseed oilto sauces and salad dressings.

WALNUTS. Walnuts are a powerhouse ofnutrients and a good vegetarian source ofomega-3 fatty acids. They’re not quite asgood as the type of omega-3s in fish, butyour body can convert a portion of theminto the more advantageous kind.

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Walnuts are also high in vitamin E,melatonin, and ellagic acid (seeberries), and the fat in the walnuts maymake it even easier for your body toabsorb these compounds. One morereason walnuts belong in the superfoodcategory: In conjunction with an overallhealthy diet, they not only help lowerLDL (bad) cholesterol levels but bringdown the most artery-clogging type ofcholesterol, called dense LDL.

Fats

4 to 7 servings daily

Serving = 1 teaspoon of oil,mayonnaise, or healthy spread (made

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without partially hydrogenated oil); 1tablespoon light mayonnaise, lighthealthy spread, or regular saladdressing; 2 tablespoons light saladdressing; of a Haas avocado

NOTE: Nuts and nut butter can also beused as fats, so if you want more nutsthan your allotted serving (see Nuts, NutButters, and Seeds above), go ahead—just count them as a fat serving. Onetablespoon of nuts or 1½ teaspoons ofnut butter is a fat serving.

Superfats

Fats are a confusing issue, so let’s talk

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about not just superfats but yourapproach to fats in general. Longvilified, fats are actually essential tohealth and longevity, but it’s important todistinguish the healthy ones from theones that can do damage. There are twofats you need to watch: saturated andtrans fats, both of which raise bloodcholesterol levels. Limit saturated fat(found in animal foods) as much aspossible and try to avoid trans fats(found in hydrogenated oils) completely.

One of the fats you do want in yourdiet is monounsaturated fat, the primarytype of fat in olive oil. If you think youlike olive oil, get this: Greeks currentlytake in an average of 100 cups of oliveoil per year. All that oil contributes to

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longevity in a few ways. Among them:Anti-inflammatory compounds in oliveoil called polyphenols help preventcardiovascular disease and cancer. Themonounsaturated fat in olive oil’smakeup—about 70 percent of its total fat—lowers levels of LDL (bad)cholesterol and helps prevent itsoxidation. LDL oxidation leads toclogging and hardening of the arteries.The monounsaturated fatty acids in oliveoil have also been linked to a reductionof body fat storage and a higher fat-burning rate in the five hours afterhaving an olive oil–rich meal.

As wonderful as olive oil is, theremay be times when you want a neutral-

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tasting oil. That’s where canola oilcomes in. It also has a stellar nutritionprofile—it’s lower in saturated fat thanmost other oils, has about the same levelof monounsaturated fat as olive oil, andis a rich source of ALA, plant omega-3s,which I’ll tell you more about shortly.Studies show that using canola oil on aregular basis helps reduce LDL (bad)cholesterol. Others show that it slightlyraises HDL (good) cholesterol.

Polyunsaturated fats, to varyingdegree, are also beneficial.Polyunsaturated fat is the dominant fat inmost other vegetable oils. Amongpolyunsaturated oils are soybean oil,corn oil, and sunflower oil. Thesecontain fatty acids known as omega-6s,

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which are the building blocks of cellmembranes. While they don’t raiseblood cholesterol, consumed in excess,omega-6s can cause inflammation and“thicken” the blood, making it morelikely to form blood clots. That can leadto heart attacks and stroke, so you needto be cautious about overconsumingthese particular polyunsaturates.

In a different category altogether isthe type of polyunsaturated fat with themost anti-aging and overall healthbenefits: omega-3 fatty acids, found infish oils and in some plant foods.They’re linked to a reduced risk of heartdisease, cancer, and diabetes and areanti-inflammatory and integral to healthy

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brain function, and may even help easedepression. Some studies show thatpeople with higher-than-average levelsof omega-3s in their blood have a lowerrisk of dementia.

Omega-6 fatty acids compete withomega-3s for entry into cell membranes,the reason you want to keep the two inbalance. We were designed to eatomega-3s and omega-6s in equalamounts, according to ArtemisSimopoulos, MD, director of the Centerfor Genetics, Nutrition, and Health inWashington, D.C., who’s researcheddietary fats extensively. “During ourevolution, nearly all foods containedomega-3 fatty acids. But now, very fewfoods are good sources,” says Dr.

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Simopoulos. “For instance, gameanimals used to graze on grass and otherwild plants, which made their meat richin omega-3s; now cattle eat corn andother feed, which results in meatvirtually devoid of omega-3s.” Insteadof the 1:1 omega-6 to omega-3 ratio wewere designed for, the typical Americandiet has a 16:1 ratio. By contrast, thetraditional Greek diet has a ratiobetween 1:1 and 1:2, and the Japaneseratio is about 4:1.

The most potent types of omega-3sare those found in fish: eicosopentaenoicacid (EPA) and docosahexaenoic acid(DHA). However, alpha-linolenic acid(ALA), prevalent in plant foods, is still

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effective and important to include inyour diet. Dr. Simopoulos recommendstaking in 2,000 mg of ALA daily(slightly higher than that recommendedby the Institute of Medicine), and at least650 mg of EPA and DHA combined. Thebest way to reach that goal is to eat atleast one omega-3-rich food daily. “Andjust to ensure you’re getting enoughomega-3s, take a daily supplement of1,000 milligrams,” advises Dr.Simopoulos.

Your Good Fat Guide

OKAY, BUT ONLY IN MODERATION

Foods high in omega-6s: corn oil,

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sunflower oil, safflower oil, soybeanoil, peanut oil, and all the foods madefrom these oils, such as many saladdressings, sauces, and fried foods.

VERY GOOD

Foods high in plant-based omega-3,alpha-linolenic acid (ALA): flaxseed,flaxseed oil, walnuts, omega-3-enrichedfoods such as some eggs.

EXCELLENT

Foods high in monounsaturated fat: oliveoil, canola oil, almonds, cashews,avocados. Also: foods high in EPA andDHA: fatty fish including bluefish,mackerel, trout, salmon, and sardines

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(these are also low in mercury, which, inexcess, can cause a number of healthissues including damaged nerves).

Healthy Treats

Between 150 and 250 calories daily(see here to see the amount thatcorresponds to your overall calorielevel)

Serving sizes vary, so check labels tofind the appropriate portion for yourparticular treat calorie limit.

Your sweets and treats strategy: Wehave a natural predilection for foods thatare sweet, yet it’s also our Achilles’

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heel. Too many sweets, of course, addup to too many calories, and they’retypically empty calories—that is,generally unaccompanied by anyvitamins, minerals, or fiber. The onesupertreat on this list—chocolate—compensates by providing a healthy doseof antioxidants. Two other treats—poached or baked apples or pears andfruit topped with slightly sweetenedyogurt or tossed with a mix of citrusjuice and honey—are good choices, too.Eat them in moderation to satisfy yoursweet tooth without overindulging.

Supertreats

Cocoa powder and dark chocolate

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(over 50 percent cacao). Sometimes youluck out and a food that you really loveis also good for you. That’s the casewith cocoa and dark chocolate; theirhealth benefits stem from compoundscalled flavanols, antioxidants that alsostimulate your body to produce nitricoxide, which opens up arteries, reducingblood pressure. Nitric oxide alsodiscourages plaque formation in thearteries, another way it protects theheart. Scientists became clued in tococoa’s blood-pressure-lowering effectswhen they found that a PanamanianIndian tribe with a high cocoaconsumption had virtually none of theage-related rise in blood pressure and

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kidney disease (a consequence of highblood pressure) found in most societies.Their cardiovascular death rates werealso an astonishingly low 9 per 100,000people compared to 83 per 100,000 inthe rest of Pan-America. But whenmembers of the tribe moved out of theirvillages and into urban Panama City,they ate much less cocoa and their heartdisease rates shot up to those in the restof the country.

Pure unsweetened cocoa is richest inflavanols, followed by dark chocolate(at least 50 percent cacao or, as it’ssometimes referred to, cocoa). Milkchocolate usually doesn’t have too manyflavanols. The only real drawback todark chocolate is that at 140 calories per

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ounce, it’s easy to rack up a lot ofcalories if you don’t carefully monitoryour portion sizes. (Chocolate is alsohigh in saturated fat, but it’s a saturatedfat called stearic acid, which doesn’traise LDL cholesterol and may lowerblood pressure.) You can be a littlemore liberal with unsweetened cocoa: Itonly has 12 calories per tablespoon.

DON’T GET SWEET ONSUGAR SUBSTITUTES

Because maintaining a healthy weightcan be critical to longevity, it mightseem reasonable to use artificial

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sweeteners to help control calories.After all, you save 16 calories for eachteaspoon of sugar, honey, fruit juicesweetener, or other calorie-containingsweetener that you replace with anartificial one. But it isn’t at all clearwhether making the swap actually savesyou calories over the long haul. In fact,some studies show that consuming sugarsubstitutes may actually cause weightgain. The San Antonio Heart study, forinstance, tracked people who began thestudy with a similar body mass index(BMI; see here for an explanation).Seven to eight years later, theresearchers found that those people whoconsumed the most artificial sweetenerhad a BMI one point higher than those

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participants who consumed very fewartificially sweetened foods.

One explanation may be that sugarsubstitutes don’t satisfy in the same waythat real sweeteners do. Sure, a dietsoda tastes sweet and may gratify asweet craving, but that’s not the onlyway your body reads satisfaction; it alsokeeps track of calories, and it knowswhen you’re trying to fake it out. Plus,artificial sweeteners like sucralose(brand name Splenda), aspartame(Nutrasweet), acesulfame K (Sunett),and saccharin (Sweet’N Low) tend to beincredibly sweet—sweeter than anatural sweetener. That can make youbecome accustomed to very sweet foods

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and drinks so that you crave cookies,cakes, and other high-calorie foods.

There is, too, the issue of safety. Tomy mind, we just don’t know enough,even if artificial sweeteners areapproved by the FDA. Here’s what Irecommend: If you drink traditionaltypes of soda to excess and usingartificial sweeteners helps you weanyourself off all that sugar, then it may beworthwhile to use them for a short time.But beyond that, you don’t need them.Work toward keeping your intake ofsweet foods moderate, and when you doeat sweets, go for the real thing.

WHAT SHOULD YOU

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DRINK?

Beverages often get treated as anafterthought, but they’re an importantpart of a healthy diet. My suggestion:Drink at least 6 eight-ounce cups ofwater daily, and no more than about 4cups of coffee or tea (caffeine toleranceis very individual; if you’re jittery or notsleeping well, these limits may be toohigh for you). Have as much herbal teaas you like. Wine, like any alcohol, isoptional. If you do drink alcohol (seehere), have no more than one drink dailyif you’re a woman; no more than twodrinks if you’re a man. Typical servingsizes are 8 ounces water; 8 ounces tea or

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coffee; 5 ounces wine; 12 ounces beer;1½ ounces hard liquor. Here are somespecifics about the beverages you mayinclude in the 20 Years Younger Diet.

Plain water, sparkling water, or waterwith a splash of juice. The best thingyou can drink is water, no question. Ithas no calories, and it helps keep everyprocess in your body running smoothly.If you’re dehydrated you’re not going toget the most out of your workout—dehydration lowers your endurance.Water is what your body was designedto drink.

I find that people usually fall into twocamps: those who love drinking waterall day and those who find water utterly

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boring and really have to struggle to getin 6 cups a day. For those of you whoneed a little flavor, sparkling water withjuice is the perfect solution, especially ifyou’re weaning yourself off soda.Simply add a tablespoon or two of yourfavorite juice (cranberry, pomegranate,and mango are all good choices) to aglass of sparkling water, stir, and sip.

Coffee. Coffee is what you might call amixed bag. On the one hand, someresearch shows that people who drink alot of coffee (5 to 7 cups daily) have asubstantially lower risk of diabetes. Thisis likely due to compounds in coffeecalled chlorogenic acids, which helpslow the rise in blood sugar. (Decaf may

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also lower the risk of diabetes.)Chlorogenic acids are also strongantioxidants that may protect againstestrogen-related cancers. Theseantioxidants may be the reason thatcoffee drinkers have a lower risk fordeveloping dementia, Parkinson’sdisease, and Alzheimer’s, too.

Yet coffee also has its drawbacks. Itmay exacerbate ovarian cysts, and itseffects on the heart are still an openquestion. And coffee, of course, caninterfere with sleep; anything that keepsyou from being well rested isn’t doingyou any favors. To be on the safe side,follow the guidelines stated earlier—nomore than 4 cups of coffee daily—tokeep your coffee intake moderate and

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bear in mind that decaffeinated coffeecan confer the same benefits ascaffeinated without the big buzz.

Tea. Could tea be one of the reasonsOkinawans live so long? Perhaps. Itcertainly has many healthful qualities. Ingeneral, tea drinkers have a lower riskof stroke and heart disease. Tea is alsolinked to a lower risk of Alzheimer’sand Parkinson’s diseases. In one study,people who drank two or more cups ofblack tea daily were 60 percent lesslikely to develop Parkinson’s. Teadrinkers are also at reduced risk for lungand colon cancers.

The key anti-aging ingredients in teaare phytonutrients called catechins.

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Green tea and black tea contain differenttypes of catechins, but both types areantioxidants and anti-inflammatoryagents, which help prevent cloggedarteries and neutralize cancer-causingagents. Because the caffeine content oftea is one-third to half that of coffee, it’ssafer for the heart and less likely tointerfere with sleep. Nonetheless, payattention to how you feel and cap yourintake if you feel jittery.

Wine. Both red and white wine areconsumed in moderation, and usuallywith meals, throughout theMediterranean. Wine drinkers have areduced risk of heart disease and deathfrom any cause. This seems to be due to

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both the alcohol itself and thephytonutrients in wine, includinganthocyanins, phenolic acids, and apolyphenol called resveratrol (seegrapes here). Some scientists believeresveratrol shows promise for theprevention of many age-relatedconditions, including Parkinson’s andAlzheimer’s diseases, inflammation,diabetes, and cardiovascular disease.

Remember that the Mediterraneanpeople get health benefits from drinkingmoderately. Excessive drinking reversesthe rewards of wine (see “Can AlcoholHelp You Live Longer—Or ShortenYour Life?” opposite).

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Can Alcohol Help YouLive Longer—Or

Shorten Your Life?

In general, research studies show thatone to two drinks for womenand twoto up to four drinks for men isbeneficial, conferring a 30 percentlower risk of dying of heart diseaseand a 20 percent reduction of dyingfrom any cause. Yet not everyone is sosure alcohol’s benefits outweigh itsrisks. Some cite the fact that evenmoderate drinking is linked to anincreased risk of several types ofcancer, including cancer of the breast,liver, and colon. And there’s no doubtthat heavy and binge drinkingincreases the risk of cancer, damagesthe heart, and causes a whole host of

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other health problems. After a fewglasses, the law of diminishing returnstakes hold and alcohol becomesharmful, not helpful.

It’s my opinion that you can getmost of the same heart-healthybenefits from exercise, certain foods,and even doses of baby aspirin (checkwith your physician) that you can getfrom alcohol without the risk of cancerand the liver disease cirrhosis. Thoseoptions don’t have the calories ofalcohol either. One way red wine isthought to lower risks to the heart isby thinning the blood. Exercise doesthat, and so does aspirin. Wine is alsobeing touted for its resveratrol content,but grapes offer resveratrol (with theadded bonus of fiber, too). I’m not ateetotaler, but I do keep in mind thatalcohol can disrupt a healthy lifestyle.When you imbibe, you may loseinhibitions and tend to eat lesscautiously, and you’re going to be less

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likely to exercise if you’ve beendrinking or wake up fuzzy from anight of margaritas.

If you’ve had a history or familyhistory of any of the cancers connectedto alcohol (go to www.cancer.org formore information on which cancers arelinked to alcohol use), you’ll especiallywant to keep drinking to a minimum.My recommendation is the same as theAmerican Cancer Society’s: limit intaketo one to two drinks a day for men andone drink a day for women—a happymedium that may allow you to getsome of the heart-protective perkswithout the cancer risk.

Remember that the health benefitsof wine top out after a glass or two.And while moderate drinking mayprotect the heart, excessive drinkingcan damage it. Err on the side oflimiting your consumption of alcohol.

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WHAT NOT TO EAT:FOODS THAT AGE YOU

Just as certain foods slow down theaging process, others can speed it up,and you need look no further than thetypical American diet: burgers, fries,white bread, sodas, candy, doughnuts,giant muffins, sweetened coffee drinks,buffalo wings, potato chips.

These foods are rife with substancesthat promote inflammation and oxidation,raise blood pressure and cholesterollevels, and damage DNA. In that way,they raise your risk for just about everychronic disease. Here are the killercompounds that you need to either avoid

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or limit:

Trans Fats

The main source of this type of fat ispartially hydrogenated oil. This is an oil,such as soybean, put through a chemicalprocess that solidifies it into margarineor shortening. These fats were at onetime considered a healthier alternative tolard and butter, which are high insaturated fat. But now we know thattrans fat is the most dangerous fataround. It promotes inflammation and thestorage of intra-abdominal fat, and itraises LDL (bad) cholesterol whilelowering HDL, the good kind.

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YOUR STRATEGY: Always check theingredient list for “partiallyhydrogenated oil.” Often you’ll find thatfoods containing this oil still state 0 g oftrans fat on the nutrition label. That’sbecause a labeling loophole allows for a“0” if a product has under 0.5 grams oftrans (or any other type of) fat. Taking ineven one or two grams of this fat isconsidered too much, so you can seehow eating only a few servings thatcontain just under half a gram canquickly add up. So put back on the shelfany product containing partiallyhydrogenated oil. At restaurants, skippies—the crusts may be made withshortening—and pass on fried and

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heavily breaded foods. If you have arecipe that calls for shortening ormargarine, look for the kinds that aremade without any partially hydrogenatedoils, such as the Bestlife buttery spreadand the new Bestlife buttery bakingsticks.

Saturated Fat

This fat lurks mainly (though not only) infoods of animal origin such as red meat,bacon, chicken skin, whole and 2% milk,and cream. Like trans fats, saturated fatpromotes inflammation, especially ifyou’re overweight. It lodges in the fatcells and turns them into littleinflammation factories, and this can

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ultimately lead to insulin resistance,heart disease, diabetes, and cancer.

If you need some numbers asguideposts, most people can get awaywith just under 10 percent of caloriesfrom saturated fat. The Okinawan andMediterranean-Style Diets go a littlelower—7 percent. This is also theamount recommended if you have heartdisease. On a 1,500 calorie-per-daydiet, 10 percent is 15 g saturated fat; ona 1,700-calorie diet, it’s 17 g.

YOUR STRATEGY: You can’t avoid this fat,as even healthy foods such as nuts, oliveoil, and canola oil contain somesaturated fat. But if you avoid the othersources mentioned above, you’ll

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automatically significantly reduce yoursaturated fat intake. Food labels arerequired to list the saturated fat content,so when buying any type of food—frozenfoods, cheese, crackers, cereal, desserts—always compare labels and pick theitems lowest in saturated fat.

Sodium

While a little sodium is critical to ourhealth and survival—among other thingsit helps regulate the heartbeat and bloodvolume and is necessary for propernerve function—too much can age us in anumber of ways. A high-sodium dietcontributes to high blood pressure inmany people, and high blood pressure is

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the cause of 62 percent of stroke casesand 49 percent of heart disease cases (italso contributes to kidney disease andstomach cancer). Health organizationshave been recommending that Americanscap sodium levels at 2,300 mg daily andthose with high blood pressure take in nomore than 1,500 mg. But now that themajority of Americans have high bloodpressure or are considered sodium-sensitive, recent government guidelinesextend the 1,500 mg daily upper limit forpeople who are fifty-one or older,African Americans of any age, andpeople who have diabetes or chronickidney disease. My meal plan tops out at2,300 mg sodium per day; any lower isvery difficult to attain if you eat out at

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all. If you need to drop down to 1,500,adjust the plan by using reduced-sodiumbread and cheese and choosing thelowest-sodium foods you can find. Youmight also eliminate the little bit of saltin 20 Years Younger recipes.

YOUR STRATEGY: Buy the lowest sodiumfoods you can in every category. Do thisby comparing food labels when you shop—pretty soon you’ll have a repertoire ofstaples and won’t have to be so vigilant.Because you never know how muchsodium’s been added to restaurant food,assume the worst. On days that you eatout, make sure the meals you eat at homeare very low in sodium (aim for no morethan 400 mg).

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To meet the 2,300 mg sodium limit,the menus beginning here are very lightin salt; perhaps lighter than you’re usedto. If you’re finding it a toughadjustment, take out the salt shaker andsprinkle just a few crystals on the foodon your plate. This will give you a muchstronger hit of saltiness than if you’dpoured a lot more salt into the food as itwas being prepared.

Sugar

Americans are eating way too muchsugar, and not just white table sugar, buthigh-fructose corn syrup, honey, fruitjuice sweetener, and maple, brown rice,and agave syrups, too. Much of this

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sugar is coming from sodas and othersugary drinks, which contain about 10teaspoons of sugar per 12 ounces (andmany people are buying 16-and 24-ounce servings). Here’s the problemwith all that sugar: The nutritionallyempty calories promote obesity, wreakhavoc on the system of anyone whoseblood sugar is even a little high, andcause the formation of age-promotingAGE compounds (see the followingsection).

YOUR STRATEGY: While the naturallyoccurring sugar found in fruits and milkis fine, limit added sugar (the stuff yousweeten your coffee with and the sugarfound in sweet beverages, desserts,

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candy, and unexpected places such assalad dressing and barbecue sauce) to nomore than 8 percent of your totalcalories. That’s 30 g of added sugar on a1,500-calorie-per-day diet, 34 g on a1,700-calorie diet, and 40 g on a 2,000-calorie diet. Glance at the sugar columnon the nutrition label and see howquickly you can hit your limit. There are33 g of sugar in a 12-ounce soda; 25 g ina roll of Life Savers. I’d skip sodas andsugary beverages completely—not onlyare they excessively high in sugar, butyour body barely notices those caloriesbecause liquid calories don’t fill you upnearly as well as calories in solid food.

Unfortunately, nutrition labels don’t

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distinguish added sugar from naturallyoccurring, so you have to use theingredient list to figure it out. If there’sno fruit or dairy in the ingredient list,then all or nearly all the sugar is added.For something like ice cream or flavoredyogurt, it’s impossible to tell whatpercent of sugar is from the milk andwhat’s coming from added sugar, butfigure it’s at least half and half.

ANTI-AGE-ING COOKING

The way you prepare a food affects itshealth properties. Add a little oil to asalad or lightly sauté vegetables in oiland you’ll absorb a lot more carotenoids

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because they tend to cling to fatparticles. Steamed or microwavedvegetables tend to retain more vitamin Cand other nutrients than fried or roasted;and the longer a vegetable is cooked, thefewer nutrients it retains.

Cooking meat, poultry, and fish atvery high heat (frying, grilling, andbroiling) creates heterocyclic amines(HCAs), which are known to promotecancer. Other carcinogens produced bygrilling are polycyclic aromatichydrocarbons (PAHs); they’re formedwhen fat drips out of the meat (as wellas vegetables and even bread rubbedwith oil) and comes back as smoke thatis absorbed by the food.

Though nutrition experts have been

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sounding the alarm about HCAs andPAHs for years now, there’s anotherdangerous side effect to high-temperature cooking that’s just startingto show up on the radar: AGEs. Aptlynamed, these “advanced glycation endproducts” speed up the aging process.We form AGEs in our bodies as well asconsume them; they’re contained in manyfoods. When AGEs hit a critical massthey can cause inflammation, cloggedarteries, cataracts, wrinkles and saggingskin, and kidney and nervous systemdamage. AGEs are formed in the bodywhen sugars, such as blood glucose,combine with amino acids, the buildingblocks of proteins and other substances.

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High blood sugar is a major trigger ofAGE formation because it means there’sa lot more sugar available to combinewith amino acids. “The higher yourblood sugar, the more AGEs you’llform,” says Jaime Uribarri, MD,professor of medicine, Mount SinaiSchool of Medicine in New York City.A nephrologist (kidney doctor), Dr.Uribarri has been researching the effectsof AGEs on kidney disease.

While eating sugar doesn’tnecessarily make you more susceptibleto AGE damage (unless you gain somuch weight from your sweet diet thatyou develop high blood sugar), certainfoods that contain high levels of AGEsdo. Fresh fruits and vegetables, bread,

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and grains are lowest in AGEs, whilefoods of animal origin, such as meat,poultry, fish, and cheese are highest,particularly when they’re cooked at highheat. “AGE levels rise when foods arecooked, and the higher the cookingtemperature, the more AGEs produced,”says Dr. Uribarri. “Grilling, broiling,roasting, searing, and frying are theworst offenders.”

For instance, AGEs in beef go upninefold when you broil it; twelvefoldwhen stir-fried. But use a lowertemperature cooking method such asmicrowaving or stewing, and AGElevels only triple. Sautéed tofu has sixtimes the AGEs of raw, but boiled tofu

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has only 20 percent more. Potatoes, likemost fruits and vegetables, are very lowin AGEs to begin with, but turn them intofrench fries and levels spike a staggeringeighty-nine-fold. So far, of all the foodsDr. Uribarri and his colleagues haveanalyzed, fried bacon is the worstoffender. The runner-up is roastedchicken skin (another good reason,besides lowering the fat content of yourmeal, to remove the skin from poultry).

People who regularly consume a highAGE diet have significantly higherlevels of AGEs in their blood. But whenthey’re placed on a low AGE diet, notonly do blood levels of AGEs fall—byabout 30 percent—but more important,so do markers of disease risk, such as

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inflammation and oxidative stress. Themenus starting here are good examplesof how to lower your intake of AGEs.Most of the meat, poultry, and fish arepoached, steamed, or stewed. Many ofthose foods are marinated, too: Cookingwith a sauce containing vinegar or lemonjuice tends to reduce AGE formationduring heating, another good way toreduce your risk.

HOW LOW CAN YOU GO:THE SCIENCE OF CALORIERESTRICTION

One of the hottest topics among anti-

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aging researchers is calorie restriction,consuming an exceptionally low numberof calories as a strategy for lifeextension. The 20 Years Younger Diet isnot a calorie restriction diet along thesame lines as those being researchedright now (though it can help you loweryour calorie intake enough to loseweight). But I thought you might beinterested to know a little about it. It’sdefinitely a subject you’ll be hearingmore about in the future.

The connection between calorierestriction and longevity was first madein the 1930s when studies showed that inmice, cutting calories by 30 to 50percent but keeping their diet nutritiousextended their life span by 50 percent.

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Calorie restriction has even been shownto double the life span of some insects.And now major research institutionssuch as the National Institute on Agingare investigating whether it will work onhumans—and whether it’s evenpractical. Some people aren’t waitingfor the results; the Calorie Restriction(CR) Society International, anorganization devoted to the practice, hasupwards of 4,000 members.

How It Works

Why would significantly restrictingcalories extend life—and even make youhealthier? One reason is that it lowersbody fat and, as you might remember

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from chapter 1, excess body fat is linkedto inflammation and insulin resistance,among other harbingers of disease. Also,when you’re not getting quite enoughcalories, your body responds by slowingdown its metabolism. In this context, it’simportant to understand that“metabolism” doesn’t just refer to therate at which your body burns calories.Metabolism also refers to otherchemical reactions in your body,including cell division. When themetabolism slows, the body shifts itsfocus from cell growth and reproductionto repair and maintenance of tissues,which slows down the aging process.

Calorie restriction has been found toslow down both “primary aging,” the

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damage done to cells from things likefree radicals, and “secondary aging,” thedevelopment of diseases such as cancer,says Pennington Biomedical ResearchCenter’s Donald Williamson, PhD.Pennington is one of the three researchcenters in the country carrying out thelargest human calorie restriction study.It’s called CALERIE and is funded bythe National Institute on Aging. Whenresearchers measure cellular biomarkersof aging (such as telomere length andresponsiveness of the immune system) incalorie-deprived rats, 90 percent of thebiomarkers stay at youthful levels.Calorie-restricted rats and mice alsopostpone, or don’t ever get, cancer and

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diabetes.In animal studies, calorie restriction

starts in what’s roughly the equivalent ofthe late teenage years in humans. “Basedon this research, the ideal age to startcalorie restriction would be agetwenty,” says Dr. Williamson. “Butthere’s some evidence—still iffy—that itcould do you some good starting later, atage forty or even fifty.” The differencewould be that you’d likely get secondaryaging benefits—that is, a lower risk oflife-threatening disease—rather thanmuch deterrence of primary aging.

Is It Worth It?

I was once talking to a friend about

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calorie restriction when he said, “I’mnot sure if it helps you live longer or itjust feels that way.” I get his point. It’shard to live on such a low-calorie diet.What’s more, it will take decades toknow whether calorie restriction canextend human life without harmfuleffects because studies such asCALERIE are only just getting started.But we may have some clues becausediet surveys were conducted in Okinawabeginning in 1949 and repeated atvarious intervals afterward. “Based onthe surveys, it looks like the oldergeneration in Okinawa has been taking infewer calories than needed since theywere in their twenties,” says OkinawaInternational University’s Dr. Willcox.

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Perhaps that’s one reason why theOkinawans, who’ve stayed slender alltheir lives, have managed to live solong. It’s also interesting to note thatwhen researchers tested the blood ofOkinawans in their seventies to measurethe hormone DHEA, their levels weresignificantly higher than those ofAmericans of the same age. BecauseDHEA is known to diminish with age,higher levels are indicative of a moreyouthful biology. (Calorie-restrictedanimals also have higher DHEA levels.)

The CALERIE studies are alreadyshowing that calorie restriction reduces—no surprise—obesity, and that it alsolowers inflammation and insulin

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sensitivity. It improves a number ofother heart disease risk factors as well:LDL cholesterol, blood pressure, andheart rate go down, and the bloodbecomes less likely to clot. But doesn’tplain old diet and exercise accomplishall this? Yes, but based on animalstudies, a calorie restriction diet ispoised to do more. One reason is thatcalorie restriction isn’t just any oldweight-loss diet; it’s an incrediblynutritious one, in which every bite (andyou don’t get many!) counts. High levelsof vitamins, minerals, and phytonutrientswork in tandem with the slowing of themetabolism to stave off aging as long aspossible. Another way calorierestriction differs from a typical weight-

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loss diet is that even after you loseexcess weight, you continue restricting—for life—taking in about 20 to 25percent less than your daily energy needsbefore you began the calorie restriction.(So if you maintained your weight at2,000 calories before you startedrestricting calories, then you’d still eat20 to 25 percent less—1,500 to 1,600calories per day—even after you’ve lostweight.)

Now here’s where, to my exercisephysiologist mind, it gets complicated.Calorie restriction’s anti-aging effectshinge largely on slowing downmetabolism. Exercise does just theopposite; it speeds it up. Dr.

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Williamson, though, puts it inperspective. “Exercise does play animportant anti-aging role. It helps youmaintain the fat loss you’ve achievedthrough calorie restriction; that’s criticalbecause excess body fat hastens aging.And exercise has its own effects onaging, such as reducing inflammation andreducing chronic disease risk,” he says.“But based on lab animal research,exercise alone doesn’t extend life; youhave to add caloric restriction to the mixto get the deep cuts in primary aging.”

The big question is, how low intocalorie restriction can most people go?If you’re eating 2,000 calories a daynow, a 20 to 25 percent restriction willtranslate into about 400 to 500 fewer

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calories a day (a level you can meet byfollowing the lowest calorie plan on the20 Years Younger Diet). You don’t haveto become rail thin to reap benefits, andno one should dip below a body massindex (BMI) of 18.5. (BMI is a measureof weight in relation to height. Calculateyours at 20YearsYounger.com.) Andthere are some other caveats, says Dr.Williamson. Calorie restriction isn’t foranyone younger than age twenty (it mightinterfere with growth and development)or older than sixty-five, because of therisk of losing muscle and bone alongwith body fat. Plus, there’s evidence thatcarrying a little more weight isprotective in your older years.

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We have a lot to learn before we canmake any practical recommendationsabout calorie restriction. Until we getmore information, it’s best to stick withwhat we know: a healthy diet coupledwith a vigorous exercise regimen can goa long way toward increasing your lifespan.

While research into calorierestriction is in its preliminary stages,we have an abundance of evidence onthe benefits of dietary supplements.Coauthor Diane McKay is a leadingexpert in the subject; you’ll hear fromher next. She helped develop theformulations for my Bestlifesupplements.

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A REASONABLEAPPROACH TOSUPPLEMENTS

By Diane L. McKay, PhD

When Bob Greene contacted me to helpdesign a line of supplements, I washappy to hear he was committed tosticking with the science and producinga responsible line of supplements. Whatalso sold me on the project is that, likeme, he firmly believes that the ideal wayto get your vitamins and minerals isthrough a nutritious diet. However, thereis a place for supplements—as

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insurance, to help fill the gaps on daysyou don’t meet all your nutrient needs.Supplements are a lifesaver for manywhen it comes to those few nutrientsneeded in levels above and beyond whateven a healthful diet can provide (likecalcium, vitamin D, and, for some,vitamin B12).

The 20 Years Younger Diet is ahighly nutritious diet, one designed tobolster your intake of fruits, vegetables,and whole grains, the foods so manypeople neglect. Without adequate intakeof these foods, you’re certain to miss outon some of the nutrients you need to keepaging at bay. But even if you’re buckingthe trend and actually eating a healthful

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diet, there’s still a case to be made fortaking supplements for all of the reasonsI stated above.

Someday, your doctor or nutritionistwill be able to tailor a supplement toyour individual needs based on yourgenes. But until the science ofnutrigenomics (also called nutritionalgenomics) yields more definitive clues,there are some general recommendationsyou can follow. I recommend certainsupplements in moderate doses, notexceeding the levels suggested by theInstitute of Medicine (IOM), theorganization that creates therecommended dietary allowances(RDAs). In most cases, the researchdoes not support a need for higher levels

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of any one vitamin or mineral, and highdoses of some can even be harmful. Forinstance, you can quickly reach toxiclevels of vitamin A (retinol) and certaintrace minerals like zinc withindiscriminate use of high-dose ormegadose dietary supplements.

Again, aim to get all nutrients firstand foremost from a healthful diet.Supplements aren’t a substitute forhealthy eating. However, a multi canoften provide some insurance, especiallyat certain stages in your life. Somenutrients also require specialconsideration. I’ll discuss them here,too.

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Multivitamin and MineralSupplement

While a multivitamin and mineralsupplement may help seal up most of thecracks in your diet, it doesn’t cover youon phytonutrients, nor does it providefiber—these you best get from food. It’sespecially important to take a multi ifyou’re eating fewer than 1,500 caloriesdaily, you’re a vegan or vegetarian,you’re highly athletic, or you have hadgastric bypass.

Anti-Aging HormoneSupplementation

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One of the natural consequences ofaging is a decline in the production ofcertain hormones, resulting ineverything from thinning hair tomuscle loss to lack of libido. It stands toreason, then, that adding backhormones in the form of medication ordietary supplements may halt thehormonal effects of aging. Butunfortunately, it’s not that simple.“There can be side effects thatoutweigh the benefits,” says John J.Merendino, Jr., MD, an assistant clinicalprofessor at the George WashingtonUniversity School of Medicine. Here’sthe rundown on the hormonesupplements most commonly used inanti-aging treatments.

Human Growth Hormone (hGH)

hGH is made by the pituitary gland atthe base of the brain and is essentialfor normal growth and development,

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especially during childhood andadolescence. With age, productiondeclines, prompting such effects as lossof muscle mass and an increase inbody fat. In studies looking at hGHsupplementation, people gettinggrowth hormone have had moremuscle mass, less body fat, and anincrease in the capacity for aerobicexercise. “But they’ve also had anincrease in certain problems, includingarthritis and diabetes,” says Dr.Merendino. hGH treatment may helppeople with a medically relateddeficiency, but is widely thought to betoo risky for normal, aging adults—though there are vocal proponentsdespite the fact that giving hGH toanyone who is not diagnosed ashaving a deficiency is not approved bythe Food and Drug Administration(FDA). Increased exercise and animproved diet also result in higherhGH levels in healthy adults—without

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any negative side effects.

Testosterone

Waning testosterone levels in men(and in women) result in a somewhatreduced interest in sex, less musclemass, and less stamina. So far researchlooking at supplemental testosteronefor normal aging hasn’t been toopromising. “Most trials have yieldedgenerally disappointing results, withsome increase in muscle mass but noclear benefit in terms of bone density,sexual function, or sense of well-being,” reports Dr. Merendino. “Andthere are risks, including a worseningof sleep apnea, prostate enlargement,and possibly excessive red blood cellproduction, which can lead to stroke.”

Hormone Replacement Therapy (HRT)

Whereas testosterone levels decline

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slowly in healthy men, womenundergo a fairly abrupt and significantdecline in their sexual hormones—estrogen, progesterone, and, yes,testosterone—at menopause. Theestrogenic effects of over-the-countersupplements such as those derivedfrom soy are relatively weak, butwhat about HRT? Is it safe? Hormonereplacement therapy definitely hasanti-aging benefits, such as animprovement in bone density and adecrease in hot flashes and thedryness of the vaginal walls thattypically occurs with menopause. Butthere are also fairly clear risks, such asan overall increase in breast cancerand, possibly, heart disease amongwomen on HRT. Weighing the risks andbenefits is something best done inconversation with your doctor.

DHEA

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The one hormone widely used for itsreputed anti-aging effects that can beobtained legally without a prescriptionin the United States (it’s a dietarysupplement and therefore doesn’tneed FDA approval) is DHEA,dihydroepiandrosterone. DHEA is ahormone made by the adrenal glands,and its levels in the bloodstream fallwith age in both men and women. Byage eighty, most people have about 75percent less DHEA than they did at agetwenty-five. DHEA has testosterone-like effects, and some women whotake it get excessive facial or bodyhair. It also has estrogenic effects, andsome men who take it get breastenlargement. It may also interact withhormone receptors in the brain thatare important for mood regulation, andmany proponents believe that DHEAhas antidepressant properties. Yetdespite its reputation, data fromcarefully done studies does not

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support the idea that DHEA turns backthe clock, and studies have also shownthat quality control in the production ofmany commercial DHEA preparations isquite poor. The upshot: pass on DHEAsupplements unless your doctorprescribes them.

Research showing the connectionbetween longevity and multis isn’tdefinitive, but it’s suggestive. Forinstance, a Washington State Universitysurvey of about 78,000 middle-agedpeople found that those who took a multifor ten years had a 16 percent lower riskof developing heart disease. However,it’s tough to get a read on whether or notmultis help stave off age-relateddiseases or slow the aging process

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because people who take multis tend tohave healthier diets as well. Is it themulti or the diet? Probably acombination of both. When you shop fora multivitamin and mineral supplement,opt for one in which the daily values(DV) of each nutrient are around 100percent except for those noted below, aswell as calcium and magnesium. (Thereason multis don’t offer more calciumis that the pill would simply be too bigto swallow.) Instead of listing all of therecommended levels for each age andgender group on dietary supplementlabels, manufacturers use the term DV.

YOUR SUPPLEMENT STRATEGY: Considertaking a standard multivitamin and

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mineral tablet daily. Here are some tipsfor finding the right one:

Look for multivitamins that areformulated at around 100 percent DVfor most of the nutrients listed. Somenutrients may be listed at higher than100 percent—B1, B2, and B12 are afew examples—but that is okay sincethey are not toxic at these levels.

Make sure they have at least 100percent DV for vitamin D, and forwomen under 50 years old, 100percent DV for folic acid.

Avoid multis with more than 100percent DV for vitamin A, zinc, and,

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if you’re a woman over 50 or a manof any age, iron.

Don’t be lured by added herbs. Thereis no evidence that multis with addedherbs provide any additionalbenefits, and they’re often a waste ofmoney. Most herbs don’t provide anyappreciable nutrients, and are presentin low quantities or quantities belowwhat might be considered beneficial.Some might also interfere with theabsorption of certain nutrients.

For men, look for a formula with nomore than 8 mg iron. For womenunder 50, look for a formula with atleast 18 mg iron. After menopause, a

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woman’s need for iron drops backdown to 8 mg, the same amountrecommended for men. (This is theprimary difference between multiformulas for men versus women, andyounger versus older adults.)

Vitamin D

The vitamin D deficiency in this countryhad been called a “silent epidemic.”About 77 percent of Americans havelow levels of vitamin D in their blood,according to a government survey.That’s worrisome considering howcritical D is for building and maintainingbone; helping to prevent cancer, heartdisease, and diabetes; and improving

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immune function. You don’t want to below in D: This is one nutrient with aclear case for supplementation.

Vitamin D is formed when sunlighthits the skin, but if you’re not out in thesun much, or use sunscreen or clothing tothwart UV rays (as you should—seehere), it’s easy to fall short. This isespecially true if you have dark skin.Melanin protects the skin from the sun,but it also inhibits the skin’s ability tosynthesize vitamin D. (Light skin, on theother hand, synthesizes D with littleexposure, which makes sense on anevolutionary level since lighter-skinnedpeople traditionally lived in the northwhere light was scarcer.) People whoare obese are particularly susceptible to

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low levels of D, as are older adults whooften don’t convert sunlight into Defficiently. Because the sun is weaker inwinter, it’s also possible to have adeficiency during the colder months,especially if you live in northernlatitudes (above Denver, St. Louis, SanFrancisco, or Washington, D.C.)

And you’re not going to find muchvitamin D occurring naturally in foods.It’s in a few types of fish and mushroomsthat have been exposed to light (asmentioned earlier, mushrooms purposelygrown to be high in vitamin D havebegun hitting the market), but otherwise,the D in your diet has to come fromfortified milk, or dairy products made

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with fortified milk (don’t assume there isvitamin D in all yogurts and cheeses),some cereals, and spreads made withoutpartially hydrogenated fats (like Bestlifebuttery spread and spray).

Studies show that fortified foods do agood job of helping many people meetrecommended levels for vitamin D,though scientists are now trying todetermine if supplementing with D cangive you a disease-prevention edge. OneCanadian study of about 6,500 womenfound that those supplementing withmore than 400 IU of vitamin D daily cuttheir risk of developing breast cancer by25 percent. Other studies have shownthat vitamin D supplementation may helplower the risk of colon cancer, prostate

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cancer, and even death from any cause.Supplementing with both D and calcium—but not D alone—appears to reducethe risk of bone fractures.

YOUR SUPPLEMENT STRATEGY: Get a bloodtest to determine your vitamin D level. Ifyou’re deficient or have a low level,follow your doctor’s recommendation—that might be a high dose (prescriptionlevel) of D for a few months to get bloodlevels back up. Once you’re back to anormal level, or if you are already atnormal levels, make sure you get aminimum of 600 IU from all sources(supplements and fortified foods, and thefew foods containing D) if you’re anadult age seventy or younger; 800 IU if

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you’re seventy-one or older. This isconsistent with the current IOMrecommendation; however, someresearchers think it may not be highenough. (Look for reports on vitamin Dnews as well as updates on all facets ofanti-aging nutrition onwww.20YearsYounger.com.)

Your multi should give you at least600 IU (800 IU if you’re over ageseventy). Try to get much of your D fromfoods first, and the rest through a vitaminD supplement. If you choose asupplement, look to see that it containsvitamin D3, which is used moreefficiently by the body than D2.

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Calcium

Besides its critical role in building andmaintaining bone—especially importantas you age and bone turnover slowsdown—calcium also helps regulatemuscle contractions (includingcontraction of the heart) and bloodpressure. Some evidence suggests thatcalcium protects against colon cancer,too. Calcium works in tandem withvitamin D to assist certain functions inthe body, and you need to consume themtogether in order to absorb the calcium.So, take your calcium supplement at thesame time as your multi, or, if you needextra D, take a combined calcium/Dsupplement.

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Given that adults need a lot ofcalcium—1,000 mg calcium up to agefifty, then 1,200 mg for women over agefifty and men over age seventy—andmost Americans aren’t meeting thisrequirement, taking a supplement is agood idea for many people. You canalso meet the requirement with acombination of supplementation andfood. The 20 Years Younger meal planin Part II manages to pack 1,000 mg ofcalcium into most day’s menus, sogetting adequate calcium through food isdoable. Still, it’s not all that easy,especially when you’re keeping a lid oncalories.

Although bone density peaks in young

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adulthood it’s important to get adequateamounts of calcium and vitamin Dthroughout your life to keep your boneshealthy. In five separate studies in whichelderly people took 700 to 800 IU ofvitamin D and about 1,000 mg ofcalcium per day, hip fractures fell byabout 24 percent.

YOUR SUPPLEMENT STRATEGY: Women agefifty or younger and men age seventy oryounger need 1,000 mg calcium daily.Meet your needs with food first, thenadd a supplement. To get 1,000 mgthrough food, try this mix:

Consume two cups of nonfat or 1%milk, calcium-fortified soy milk,

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and/or 1–1½ cups nonfat or low-fatplain yogurt daily (that supplies 600to 700 mg calcium).

Eat a wide variety of nutritious foods,a la our meal plan, which contributesanother 300 mg calcium.

If you aren’t making the entire 1,000 mgthrough food, I recommend a calciumcarbonate supplement (check the label—it will tell you the source of theproduct’s calcium) taken with vitamin Dor a combined calcium/D tablet. Take nomore than 500 mg of calcium at onetime. A good strategy: take one tablet inthe a.m. and the other in the p.m.

If you’re a woman age fifty-one or

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older or a man over the age of seventyand getting calcium through food asoutlined above, you’ll need to addanother cup of milk, calcium-fortifiedsoy milk and/or plain yogurt or take a300-to-500-mg calcium supplement.Also, after age fifty it’s a good idea toswitch from using a calcium carbonate–based supplement to one made fromcalcium citrate. As you age, the level ofacid in your stomach drops, and in thatenvironment calcium citrate is betterabsorbed.

Vitamin B12

B12 and another B vitamin, folate (also

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called folic acid), are essential forproperly functioning DNA and for thecreation of certain proteins. Anythingthat influences DNA influences aging, sogetting enough of this vitamin is critical,particularly because a severe deficiencycan cause permanent neurologicaldamage to your limbs and brain, andeven dementia. Vegans and vegetariansare at risk because B12 is found only inanimal foods, though you can find it incertain fortified breakfast cereals andsoy milks. Consider a supplement if youdon’t eat meat or eggs. The risk of a B12deficiency goes up in all people after theage of fifty. About 10 to 30 percent ofpeople over the age of fifty have

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atrophic gastritis, low stomach acidsecretion, and stomach acid is requiredto properly absorb B12.

In gauging your B12 intake, it’s alsoimportant to consider how much folicacid you’re getting in your diet (therecommended amount is 400 mcg formen and nonpregnant women). Folicacid can affect the blood in a way thatmakes it difficult for a doctor to tell ifyou have a B12 deficiency. If you’resupplementing with folic acid (manywomen hoping to get pregnant do), youneed to supplement with B12 as well, nomatter what your age. If you take a multi,then you’re covered—a good multi likethe type we recommend here will cover

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you for both. Be aware that if you’reeating a lot of foods that are fortifiedwith folic acid, you may be tipping thebalance and getting a lot more folic acidthan B12. It’s possible that you may noteven be aware that you’re eating folicacid–enriched foods. In 1996, in aneffort to make sure pregnant women gotenough folic acid (it prevents neural tubebirth defects), the FDA publishedregulations requiring the addition offolic acid to enriched breads, cereals,flours, cornmeals, pastas, rice, and othergrain products. Thus, manycarbohydrates that you may eat on aregular basis contain added folic acid.However, whole grain versions usually

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aren’t fortified—another reason toswitch to whole grains.

Countering MacularDegeneration with

Supplements

Macular degeneration, the leadingcause of blindness in the United States,begins with blurring in the center ofyour field of vision and can progress tototal blindness. At age sixty, you’vegot a 2 percent risk of getting it; afterage seventy-five your risk jumps to 30percent. It’s unknown whether dietarysupplements can help prevent maculardegeneration from developing—to tellfor sure, people would have tosupplement from childhood throughoutlife, which is very costly. But there’s

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research suggesting that people whotake multivitamin/mineral tablets for atleast ten years have a lower risk ofdeveloping the disease. The longer themulti is taken, the better the protection.

It’s clear that once you get maculardegeneration, supplements can slowits progression. In AREDS (Age-RelatedEye Disease Study) people with theintermediate stage of maculardegeneration given 500 mg of vitaminC, 400 IU vitamin E, 15 mg beta-carotene,80 mg zinc, and 2 mg copper were 25percent less likely to progress toadvanced macular degeneration in afive-year period. The study is beingcontinued without beta-carotenebecause of the link between beta-carotene and increased cancer risk(see here).

Even though the AREDS studycouldn’t discern whether taking thesupplements helps at early stages ofmacular degeneration, talk to your

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doctor to see if it’s appropriate for youto take specially formulated AREDSsupplements. They’re available fromcompanies such as Icap and Bauschand Lomb (Ocuvite).

YOUR SUPPLEMENT STRATEGY: The RDAfor B12 for adults is 2.4 mcg daily. Mostmultis provide more—about 6 mcg.That’s the amount you should be gettingif you’re age fifty or younger to helpcounter all the folic acid that’s beenadded to foods. If you’re over fifty, youmight consider taking a multi providing50 mcg B12 (or a vitamin B12 supplementwith at least 50 mcg). It’s a safe dose,and it helps ensure that you’re gettingenough if you’ve been diagnosed with

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atrophic gastritis. If you take a separateB12 supplement, either an oral or asublingual supplement will work.

Supplement Safety

While certain types of supplements maybe helpful, there are some circumstanceswhen supplements can actually beharmful. Here’s what you should knowbefore you shop.

If you’re prone to kidney stones, becareful with calcium. Ask your doctorbefore taking calcium and vitamin Dsupplements. Most kidney stones are amix of calcium and oxalates—compounds found in a variety of plants

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such as tea and whole grains. For peopleprone to kidney stones, taking in toomuch calcium can trigger stoneformation. Yet even if you have atendency to develop kidney stones, youstill need to get adequate calcium. Somestudies show that supplementing withcalcium may actually protect againstforming stones but only when thesupplements are taken with a meal. Thisstrategy reduces the likelihood of kidneystone formation because you absorbmore calcium when you consume it withfood. Take them outside of a meal andmore winds up in the kidneys, wherethere’s a greater likelihood of thecalcium binding with oxalates andforming stones.

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In addition to taking calciumsupplements with a meal, spread outyour dose through the day, taking nomore than 500 mg calcium at a time asnoted earlier; that should prevent anyproblems. We also know that consumingplenty of fluids is one of the best ways toreduce your risk of kidney stones.Reducing your sodium intake might alsobe helpful because sodium in highamounts (the amount typically consumedby most Americans) can leech calciumout of your bones and the calciumeventually ends up in your kidneys.

Since vitamin D helps your bodyabsorb calcium, high doses may impairkidney function by causing too much

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calcium to be absorbed. But it takes a lotof vitamin D—50,000 IU daily—tocause this problem.

If you’ve been diagnosed withprecancerous colon polyps, cap folicacid at 400 mcg per day or less. Someresearch indicates that supplementationmay actually spur polyps to becomecancerous. Though folic acid isgenerally protective against cancerbecause it helps repair DNA andpromotes growth of healthy cells, inexcess, that same mechanism mighttrigger the growth of any cancer cellslurking. The research is still verypreliminary, so it’s unclear at what pointin your life you should avoid excess

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folic acid, and how much is too much ifyou have polyps (what we do know isthat the upper limit for everybody is1,000 mcg per day).

Because most multis offer 100percent of the daily value for folic acid,consider taking it every other day if youare also consuming a lot of fortifiedfoods. Missing out on all the othervitamins and minerals a multi providesevery other day shouldn’t pose aproblem for you if you’re consuming ahealthy diet. The only exception isvitamin D, and for that I recommendtaking a separate supplement. Before youdecide to switch to taking a multi everyother day instead of daily, check labelsto find out which foods in your diet are

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fortified with folic acid, particularlylabels of cereals, breads, and energybars. (See here for more on preventingfolic acid overload.)

Even if you haven’t any reason tothink you’ve got precancerous polyps inthe colon, sticking to no more than 400mcg of folic acid daily is probably wise,especially if you are over age fifty. Asnoted earlier, another reason to avoidhigh doses at that age is that too muchfolic acid can cover up a vitamin B12deficiency, to which people over agefifty are prone. Meanwhile, continue toeat foods naturally high in folate such asoranges and spinach—all the evidencepoints to naturally occurring folate as

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being protective. If you are under agefifty and plan to become pregnant, or ifyou are currently pregnant, you need tosupplement with at least 400 mcg offolic acid daily. This is essential forhelping to prevent a neural tube defect inyour child and trumps concerns aboutcolon cancer.

Avoid supplementing with beta-carotene beyond levels in a standardmulti. Beta-carotene is an antioxidantplant pigment that gives plant foods suchas carrots and cantaloupe their orangecolor and is also found in dark greenvegetables. Your body converts beta-carotene, alpha-carotene, and a fewother carotenoids to vitamin A as

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needed. Numerous studies show thatpeople with high levels of beta-carotenein their diet and in their blood have alower risk of cancer, so researchersfigured that supplementing with it mighthelp ward off the disease.

That’s when they got a big surprise.In two large studies, beta-carotenesupplements were given to smokers andasbestos workers, the people most proneto lung cancer. Instead of offeringprotection as hoped, the beta-carotenesupplementation increased the incidenceof lung cancer and death. As for othercancers—such as pancreatic, breast, andprostate—the beta-carotene had noeffect.

Fruits and vegetables that contain

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beta-carotene are also infused with othercarotenoids and nutrients that worksynergistically with one another topromote health. Removing beta-carotenefrom the food and delivering it alone inpill form does not have the same effectas consuming it in foods.

The take-home: Getting beta-carotenethrough food is important. However,while moderate levels of beta-carotenein your multi are safe (3 to 6 mg of beta-carotene daily, the equivalent of 833 IUto 1,667 IU vitamin A is fine) andprobably helpful, don’t take separatebeta-carotene supplements. A typicalmulti splits up vitamin A between beta-carotene and straight-out vitamin A

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(retinol). Check the back of the bottle—ideally, the multi should contain no morethan 4,000 IU of vitamin A total, with nomore than 50 percent beta-carotene.

Avoid supplementing with vitamin Ein amounts greater than 200 IU.Vitamin E, like beta-carotene, looked sopromising as a safeguard against cancerand heart disease. It’s also a powerfulantioxidant. Some studies have shownthat E from food and supplement sourcesmay improve your chances of staving offheart disease. But in 2005, a review ofthe research found that in nine out ofeleven major studies in which peopletook 400 IU or more of vitamin E fromsupplements alone, not only was it not

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protective, but it seemed to actuallyincrease the risk of heart failure,gastrointestinal cancer, and dying fromany cause—the more vitamin E, thehigher the risk. Other research hasconfirmed the results and even shownthat E supplements may slightly increasethe risk of stroke. How to make sense ofit all? It may be that the study subjectswere taking too much vitamin E. Or toolittle: In one study, most of the deathsoccurred in “noncompliant” people whodidn’t actually take their vitamin E tabletas they were supposed to.

And there are still studies showingthat vitamin E may improve yourchances of staving off heart disease. Forinstance, in the Harvard’s Women’s

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Health Trial, which had 20,000 womentaking 600 IU of vitamin E or a placeboevery other day for ten years, there wasa 24 percent drop in deaths from heartdisease in women over age sixty-fivetaking vitamin E as compared to thosetaking the placebo (for younger women,there was no effect). While it’s safe totake as much as 400 IU of vitamin Edaily, the evidence suggests that a loweramount, about 200 IU, may be morebeneficial. Most multis only have about30 IU, so a separate supplement might beappropriate (especially if your diet islacking). Buy the natural form (d-alpha-tocopherol) and take it with a meal;otherwise it may not get absorbed into

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your system. If you find that it’s nearlyas expensive to buy 200 IU tablets as400 IU, then buy the latter and take a pillevery other day.

Because supplements are sold over thecounter, it’s easy to assume that they areall safe and beneficial. Not necessarilyso. To sum up, here is what you shouldkeep in mind when you shop.

Multivitamin and mineralsupplements can be helpful, but makesure that you purchase one that iswell balanced.

Never megadose—that is, take double

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or triple (or more) of the levelsrecommended by the Institute ofMedicine—even if you’ve read that avitamin or mineral has no knowntoxicity.

If you have any type of healthcondition, always discusssupplementation with your doctorbefore stocking up.

Always bring a list of supplementsyou are taking with you when you seeyour doctor. Some supplements caninterfere with certain drugs, and yourdoctor needs to know what you’retaking when prescribing medicationsfor you—or even when diagnosing

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your condition.

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CHAPTER 4

Recapturing YourSkin’s Youth

By Harold A. Lancer, MD, FAAD

THERE ARE ALL KINDS OF THINGS you cando to make your skin look younger—butwhy bother creating an illusion when,with a good skin care routine, you canmake your skin actually be younger? I’mtalking about a true turning back of the

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clock. As you restore good health toyour skin, all the machinery that’sslowed down due to natural aging ordamaging environmental effects (such asthe sun) will kick back into gear,creating real physiological changes.Your skin will behave like its former,more metabolically upbeat self. As aresult, it can be firmer, smoother, moreuniform in color, and altogether moreradiant.

Whether skin “looks” young or “acts”young might seem like splitting hairs, butthere’s a significant difference betweenthe appearance of young skin and skinthat frequently and naturally refreshesitself, regularly churns out the fibers thatgive it structure and elasticity, and

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rapidly repairs itself when necessary—all hallmarks of youthful, undamagedskin. Let me put it to you this way: Youcan slip into a pair of Spanx to disguisea flabby belly, but that doesn’t make youfit and slim. Once you slip out of theSpanx, there is that flabby belly, backagain. In the same way, you can rub amoisturizer onto your skin and get itlooking dewy and even give yourself abit of a glow. Or apply makeup thatdeflects light, drawing attention awayfrom the lines and wrinkles on your face.But these are fleeting, superficialsolutions. What you really want to do ischange what’s going on beneath thesurface of your skin so that you get it

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working properly again, just like it usedto work twenty years ago. A proper skinhygiene program is truly age reversing.And, in most cases, no involvedprocedures are necessary.

YOUTH AND BEAUTY

Your skin, of course, is the cover of the“book” of who you really are. It givesclues to your inner physical andpsychological self. But if we’re honestabout it, we primarily pursue thatyouthful appearance because in allcultures, youthfulness is synonymouswith beauty and beauty is synonymouswith good health, fertility, success, and a

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good life.Although beauty is in the eye of the

beholder (and never has a greater truthbeen spoken), I think you’d be hardpressed to find anyone who doesn’tadmire smooth, glowing skin. It’suniversally held by every culture, everyethnicity, both genders, and the wealthyand the less fortunate that firm, resilient,even-toned, radiant skin communicateswell-being and beauty. Good skin issexy. Great skin is sexier! It’s your bestcalling card, the attribute that’s going tomake the most indelible impression oneveryone you meet.

One way you can recognize well-maintained skin is by its radiant glow.When it’s in top form, light skin will

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have a rosy gleam to it; dark skin willlook luminous. This is a sign that theskin is getting adequate blood flow andis readily replenishing and repairingitself. So if you want to look twentyyears younger, you need to go for theglow. And the bounce. Universallyadmired skin also has elasticity. Pushgently and it will rebound without amark. It has a healthy fullness to it, too.How plump is the pillow? Are all thefeathers in there and fully fluffed? Andwhat do the pores look like? Small (themore imperceptible, the better), uniformpores are the gold standard in skin, asign that it’s looking and acting young.

I’m not just talking about the skin on

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your face. Most people think skin carestarts at the hairline and stops at thechin, but if you think about it, andespecially if you’re a woman, your neckand chest area are often just as exposedto the perceptive public. I tell mypatients that the neck, chest, andshoulders (as well as the upper part ofthe back, if you want to be completelythorough) frame the face, and that thoseareas deserve the exact same tenderloving care. Sometimes I’ll see a patientwho needs to pay more attention to herneck-chest zone than to her face, nodoubt the result of having spent yearslavishing care from the chin up whileignoring everything beneath it. All areasof your body, right down to your

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fingertips, should reflect the samemaintenance and repair. Environmentaldamage happens all over, so I’m goingto be reminding you again and again notto forget the terrain beneath your chin.Get the glow and make sure it extendsdown below!

SMART, MODERN, DO-IT-YOURSELF SKIN CARE

Despite what you may have heard, thereis no one miracle in a bottle, magic-bullet ingredient, dramatic procedure, orhighly elaborate regimen that willreverse aging. What it takes instead is a

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combination of the healthy practicesoutlined throughout this book—regularexercise, nutritious eating, and goodsleep—with a simple, at-home, anti-aging skin care plan. You don’t need tospend a lot of money and you don’t needto spend a whole day caring for yourself.Simplicity will get you cost-effective,visible results from head to toe.

You’ll notice that I said “skin care.”This do-it-yourself approach is a newway of thinking about anti-aging as itrelates to appearance. It’s been a longtime since anyone talked about home-based skin care. Instead, peopleconcerned about aging are being urged tomake a beeline to the nearest purveyorof line fillers and wrinkle-freezers, or to

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head for a clinic offering skinresurfacing laser treatments. It’s notuncommon for patients to come in for thefirst time and ask straight away forBotox or a laser procedure that a friendhad done, without any thought to theirown particular needs. I think that’s a bigmistake, and I always ask them to atleast start with good skin hygiene beforeadvancing to the next step. Though thereis a place for doctors’ office peels,injectables, and laser treatments, youprobably won’t need any of them if youhave an effective skin care program likethe one I’m going to introduce you to.And, while there are famous faces thathave obviously “had work done” (and

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then some!), I think you’d be surprised athow many lovely, glowing faces you seeon the screen, in business, and in politicsthat are attributable to nothing but aproper method of skin care. And thisseems to be a growing trend.

What constitutes good skin hygiene?The method I developed for my patientsinvolves three basic steps for your face,neck, and chest—polishing the skin,cleansing it, then nourishing it—and twosteps for your body, hands, and feet. Thesimple steps I recommend work to makethe skin biologically more youthful inmany ways, including by boosting thecirculation in the skin so it receivesmore oxygen and reparative nutrients,revving up the turnover of skin cells to

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banish dullness and dryness, and rousingthe sleepy collagen- and elastin-makingfactories to diminish lines and wrinkles.

There are a few reasons why thissystem is different from others and whyit works so well, but foremost is the factthat it targets the stratum corneum, theoutermost part of the epidermis, which isthe top layer of the skin. Almost everyproduct and procedure you hear abouttargets the dermis, the layer of the skinthat lies below the epidermis. A lot ofskin repair does take place in thedermis. However, when you focus solelyon that layer, you miss the boat; not muchreparative activity can take place if youignore the stratum corneum. I’ll tell you

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more about the physiology of the skinbeginning here, but in brief, the stratumcorneum has long been thought of as aninactive, virtually plastic film coveringthe dynamic parts of the skin. Now weknow that many of the signals thatgenerate anatomical change in the skincome from the cells in the stratumcorneum. What’s more, in order foractive ingredients to get into the dermis,they must have a clear path through thattop layer.

To that end, the first two steps in theanti-aging skin care method I’ll beintroducing to you clear awayimpenetrable debris (a combination ofdead skin cells, cosmetics, and dirt)that’s accumulated on the surface of the

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skin, allowing the nourishingcomponents in step three a direct routeinto the lower layers. When thosenourishing ingredients are able to get inand do their work, significant changeoccurs.

The most important thing about thismethod is that… it works! But of nosmall consequence is that it also allowsyou to fight aging while still maintainingaspects of your appearance that reflectwho you are. You still look like you. Tomost of the patients over the age of fortythat I see in my office, that’s essential.I’ve never had a patient tell me thatshe’d like to look eighteen again. What Ido commonly hear is “I simply want to

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look healthy—because I am healthy. Ijust want my skin to reflect that.” Manypeople I talk to have also seen theconsequences of being overstretched,overplumped, or overneutralized andthey know that’s not what they want.Instead, they want to look refreshed—like a more rested version of themselves—and they want to take an active role incaring for their skin. They see it as partof taking control of their own overallwell-being, and they’re right:Committing to good skin care goes handin hand with committing to the otherstrategies in this book for achieving totalbody health.

Sticking to the polish-cleanse-nourishmethod is something anyone can fit into

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his or her life. And if you like, you canalso go further, taking it to the next levelby adding other, more specialized (butstill simple) steps to deal with specificproblems like deep lines, acne, rosacea,or excessive dryness. After you seeimprovements in your complexion fromconsistent care, you may even find thatyou have the desire for greater changes.Dermatologist-provided anti-aging“touch-ups”—chemical peels, lasertreatments, and injectables—can be partof a healthy skin care regimen, too, aslong as the procedures you have doneare appropriate to your particular skinand executed with care. But I wouldnever recommend that you seek any

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interventions without first trying thethree-step method in this book.

What you put on your skin isimportant. Lotions, creams, exfoliators,toners, serums, and so on, provided youchoose good ones, can have a visibleimpact on your skin. But I don’t believethey are as important as the method ofskin care you use. The right method—that is, the polish-cleanse-nourishmethod—both stimulates changes in theskin and ensures that the therapeuticcompounds you put on it hit their targets.You can have the best skin care productsin the world, but if the active ingredientscan’t get into the deeper layers of theskin, they’ll simply sit there on thesurface, inert and ineffective. The skin

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hygiene secret is in the sequencing—puzzle solved!

The method I’m going to tell youabout is uncomplicated and requiresvery little actual time to complete—butyou do have to stick to the routinewithout fail. And you can’t depend onpolishing, cleansing, and nourishingalone. Staying out of the sun, sheddingthe tobacco habit, reducing your alcoholintake, eating a more selective diet,developing a regular exercise program,striving for significant and restful sleep,and, finally, managing stress, are allimportant as well. So is drinking at leastsix glasses of water a day, and by waterI don’t mean a beverage that contains

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water like coffee or iced tea. (I canalways tell which of my patients havefallen off the “lifestyle wagon” by thequality of their skin.) When you have allthese proactive and precautionarymeasures in place, you’re going to see areal turnaround in the health of your skin.Let’s talk about why.

YOUR SKIN, UNCOVERED

I like to call skin your “best accessory”because, while a stunning ring or astriking scarf or a great watch attractsattention, nothing catches the eye quitelike beautiful skin. But the truth is, as thebody’s largest organ and with miles and

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miles of capillaries and nerves, millionsof oil and sweat glands, and countlesshair follicles and cells allcommunicating with one another, skin ismore like an entire outfit. It’s all-encompassing, a community unto itself.

Understanding a little bit about theanatomy of skin can help you bettergrasp the changes you’ve seen as you’vegotten older, as well as give you aclearer picture of how certaintechniques, products, and procedureswork to change how it functions. As youmight guess, the skin is a very complexorgan, and it’s not necessary to knowhow every sweat gland and blood vesselworks. So let’s just go over the parts ofthe skin’s makeup that are both

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instrumental in aging and particularlyresponsive to anti-aging measures.

If you were to look under amicroscope at a tiny swath of skin, you’dsee layer upon layer upon layer. Thestratum corneum alone, which is theutmost top of the skin, has more thantwenty layers. It’s easiest, though, to

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think of the skin as divided into threeparts: the epidermis with its top “sheet,”the stratum corneum; the dermis; and thesubcutaneous tissue.

Stratum Corneum

Glance down at your hand. What you’relooking at is the stratum corneum, abrick-and-mortar construction of flat,tightly packed cells called keratinocytes(the bricks) enveloped in lipids (themortar). The stratum corneum is thickeron the areas of the body that need greaterprotection, such as the soles of the feetand palms of the hands.

In some ways this topmost layer (orlayers, really) functions a little like a

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raincoat, keeping excessive moisture andharmful microbes and environmentaltoxins out. However it also has the veryimportant task of keeping adequatemoisture in the skin. It does this with thehelp of a biological stew of amino acidsand other elements, including one callednatural moisturizing factor (NMF). NMFabsorbs water from the atmosphere,keeping the stratum corneum soft andpreventing it from developing cracks.

Although they still serve an importantpurpose, by the time keratinocytes reachthe surface of the skin, they are actuallydead cells. They’re created in the layersbeneath the stratum corneum, then worktheir way to the top, aging and dyingalong the way. This process—called

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cell turnover—can take anywhere fromtwenty-six to forty-two days. Like shellswashing up on the shore of a beach, thedead cells arrive at the very top layer ofthe stratum corneum, where they’reroutinely sloughed off. It’s thissloughing-off process that helps the skinstay radiant.

When cell turnover slows down,which it does naturally with age and alsoas a result of injury such as sun damageor a lack of moisture in the skin, the oldcells stick together and accumulate onthe surface. That’s why older or injuredskin often looks lackluster and thereason it becomes more impenetrable,making it harder for therapeutic skin

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care products to do their job.The good news is that though the

stratum corneum is made up of primarily“dead” cells, it is far from a lifelessentity. When properly stimulated andcleared of the very top cells, it sendsvarious signals down to the layersbelow, among them orders for increasedproduction of new cells. When thatoccurs, cell renewal speeds up againand the skin regains its glow.

Epidermis

One of the main activities going on in theepidermis is the production ofcompounds that keep the skin hydrated.The epidermis is where NMF and fats

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such as cholesterol, triglycerides, andceramides are produced, then used tocreate the “mortar” in the stratumcorneum.

The epidermis is also a melanin-making factory. Melanin, otherwiseknown as pigment, is made by cellscalled melanocytes. It not only colors theskin and hair, but it helps protect againstdamage from ultraviolet (UV) rays. Themore melanin you have (and thus thedarker in appearance your skin andhair), the more protection against UVrays your skin will provide. So skinactually has its own sunscreen—but notnearly enough, especially white skin.Black skin has been shown to have a sunprotection factor (SPF) of 13.4, whereas

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light Caucasian skin has only an SPF of3.4. Yet no matter where you fall on thatspectrum, you don’t want to dependsolely on your natural SPF. Everyoneshould wear sunscreen, and I’ll talkabout it at length beginning here. Alsobear in mind that, except in small areaswhere it forms age spots, the amount ofmelanin produced in the epidermisdecreases with age, which can give theskin a pallor. Tanning, though, isn’t theanswer to restoring vibrancy to yourcomplexion—it actually has the oppositeeffect.

Dermis

The dermis is home to the primary

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scaffolding of the skin: collagen,proteins that give the skin shape anddurability; and elastin, proteins that giveit resilience. Primary production of thesestructural protein fibers grinds to a haltat about age twenty-five, the reason skinbegins to lose its bounce and fullnessand starts forming lines and wrinkles.With age and environmental offenderssuch as the sun, collagen and elastinbreak down, causing an even greaterloss of the healthy plumpness that makesskin look smooth and unlined. Itshouldn’t be surprising, then, that a lot ofanti-aging skin care is aimed at “wakingup” fibroblasts, the cells that createcollagen and elastin.

Fibroblasts in the dermis also

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produce compounds calledglycosaminoglycans (GAGs). GAGs aregel-like and form the “soup” in whichthe collagen and elastin reside. As theproduction of GAGs slows with age, thecushioning in the skin that they formflattens out and causes the skin towrinkle and depreciate. Since GAGs—and in particular one called hyaluronicacid—also help the skin hold on towater, their loss can make the skin dryand flaky.

Woven into the dermis are sweatglands, nerve endings, and blood vesselsthat bring nutrients to the skin andremove wastes. Hair follicles alsooriginate in the dermis and are

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connected to the sebaceous glands,which create the oily substance sebum.Sebum helps keep the skin soft andimpervious to water, and it’s also one ofthe culprits behind acne. When sebum isoverproduced, it clogs the hair folliclesand pores (through which it’s secreted)and mixes with bacteria, causing anangry inflammatory response.

Subcutaneous Fat

Aside from providing insulation andcushioning, the subcutaneous fat layergives the skin volume and shape. Youmay want to lose fat in other areas ofyour body, but not here. Unfortunately,the subcutaneous layer does shift and

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diminish as the years go by, causingcertain areas of the face and other partsof the body to sag. Folds near the nose(called nasolabial folds), jowls, andwrinkles are all related to the movementand loss of subcutaneous fat.

SKIN DIFFERENCESAMONG INDIVIDUALS

The specific makeup of your skin willreflect your ancestral heritage as well asyour gender and lifestyle. Black skin, forinstance, tends to have a thicker stratumcorneum and dermis, a denser fabric ofcollagen and elastin fibers, and more

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tightly packed pores, oil glands, andsweat glands than white skin. For allthese reasons—and because greatermelanin content makes people of colorless susceptible to the ravages of UVrays—dark skin shows less conventionalsigns of aging. However, dark skin has amuch more reactive biology than lightskin, leading to different problems withskin repair. For this reason, dark skinoften scars rapidly and dramatically.

Brown skin, such as that of people ofAsian, Mediterranean, Middle Eastern,Latin American, and American Indianheritage as well as combined ethnicities,typically has the best of both worlds. Itshares a similar structure with blackskin, which makes it visually age more

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slowly, and, like white skin, it’sgenerally much less likely to scar.Brown skin also responds somewhatmore predictably to lasers and otherprocedures than black skin.

There are some slight differencesbetween male and female skin, too. Menusually have thicker skin, more collagenand elastin tissue, and more sweat andoil glands than women. However, menalso tend to get more exposure to theelements, so any advantage they have inskin construction is often canceled outby environmental factors. It’s sometimesthought that men don’t show their age asobviously as women, but I’m inclined tobelieve that’s more perception than

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reality. Some of the most successfulmovie actors have craggy, timewornfaces; an actress who wore her age asnoticeably would be lucky to get a walk-on part. I believe that’s simply becausewe’re more accepting of facial aging inmen than in women—not because menage better.

HOW THE SKIN AGES

True or false: Lines, wrinkles, and allthe other hallmarks of aging skin are justa sign that nature is taking its course.The answer is true and false (I admit, itwas a bit of a trick question). Here’s thepart that’s true. Some of the aspects of

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aging are unavoidable; you might saythey’re part of the human condition. Andgenetics certainly plays a role, so if yourparents’ skin aged well, yours may agenicely, too (and, of course, if their skinaged badly there’s an increasedlikelihood that yours won’t fare so welleither). So, yes, in some sense, lines,wrinkles, sagging, dryness, dullness,spider veins—all that is just naturedoing what nature does. That’s calledintrinsic (“from inside”) aging.

Skin Care Mistake #1

Going to Sleep with Makeup On

You’ve already had your makeup on

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all day, what harm could a few morehours do? As it turns out, a lot. Allcosmetic products that provide colorand illusion leave a toxic chemical filmon the skin’s surface that can causeirritation, inflammation, dehydration,and clogged pores. No matter howtired you are at night, take the time tometiculously wash your face, neck, andchest.

However, in most people, the degreeto which those signs of aging I justmentioned are apparent is determined byenvironmental factors—things such assun exposure, smoking, diet, airpollution, and other things that youfrequently have some control over.That’s called extrinsic (“from outside”)aging, and it can even override genetics

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to some degree. Your skin may behavelike your mother’s in almost all respects,but if she’s a smoker and you’ve neverindulged, she may end up far morewrinkled than you. Conversely, if sheavoided the sun all her life and yousunbathed in the yard with a reflectorevery summer of your teens andtwenties, you’re not likely to have assmooth a visage as your mom.

Generally, intrinsic and extrinsicaging combine to give you the face yousee in the mirror. I have a ninety-five-year-old patient who illustrates the pointbeautifully. This woman is some kind ofEnglish royalty and she has beenpampered since birth. She has outlivedfour, maybe five husbands and is always

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asking me to set her up on dates, thoughshe won’t date anyone over sixty-five.But here’s the thing: She could be sixty-five herself. She’s never really been inthe sun and her skin is smooth, pink, andbaby fresh. There is not a single brownspot on her face. She has never hadsurgery, laser resurfacing, or chemicalpeeling, although she does religiouslyfollow the skin care recommendationsI’ve given her. There is one area inwhich my patient does show signs thatshe’s a “woman of a certain age”:volume—everything that contributes tothe skin looking full and taut like a well-filled balloon. The plumpness of herskin has depreciated, creating some

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sagging and folds. Given her age, I’d saythat my patient still has a geneticpredisposition to slow volume loss, butshe, like everyone, couldn’t avoid italtogether. Even so, her meticulous careof her skin all these years has paid off.

Let’s take a closer look at how someintrinsic and extrinsic factors age theskin.

Genetics and Volume Loss

Genetics holds a lot of sway over howwell you fare in the natural agingprocess. Some people’s cell turnoverdoesn’t slow down as quickly as others’,and their skin is simply better equippedto weather insults such as sun and

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pollution than people from a lessfortunate gene pool. Their telomeres, theend pieces of chromosomes that helpkeep cells healthy, are long, and theirbodies are inherently good at repairingcell DNA. And, as I discussed here, theymay have a slower-aging racial heritagein their favor.

I see the biggest influence of geneticson my patients in the amount of volumethey lose from their faces as they growolder. I believe that about 80 percent ofthe depreciation of soft tissue,particularly in the face, is intrinsic. Evenif you care for your skin as well as myninety-five-year-old patient, there is notmuch you can do with skin care productsalone to stop volume loss from

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happening. (You can, though, fill the“pillow” back up with injectables.)

Depreciation of collagen and elastinas well as the gel-like GAGs they swimin contributes to volume loss, but thereal culprit is the shifting and decline offat in the subcutaneous layer. In otherwords, it’s not the pillowcase; it’s thefeathers inside. Some bone loss andchanges in muscle can occur, too, furthercollapsing the structure beneath theepidermis.

Together with gravity and years andyears of facial expressions, these factorsalter your features and even the shape ofyour face. A youthful face is an invertedpyramid, with peaked cheeks and the

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chin as the pinnacle. As the cheeks startmelting downward—the air is let out ofthe balloon—an older face tends to lookmore like a regular pyramid. The nosecan also look bigger with volume loss(partly because the cheeks are smaller),and even the position of the eyebrowscan shift.

More marks of the natural agingprocess:

thinner, more fragile skin

drier, mottled skin

wrinkles, furrows

fine lines

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lack of bounce

increased pore size

lack of uniformity of color

loss of luminescence

Sun, the #1 Ager

Think, for a minute, of a few classictypes. On the one hand, you’ve got theIrish rose, someone who, living innorthern climes, has had little sunexposure. On the other hand, you havethe rugged cow wrangler, the personwho has spent virtually a lifetimeoutdoors in the heat. One is blessed withnear flawless skin; the other’s face is as

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tough and wrinkled as an old leatherjacket. Need I say anything more? Well,actually, I do need to say more, becausemany people still don’t get (or maybedon’t care) how insidious the sun reallyis.

Your skin’s deepening in color whenexposed to the sun is a sign that UV raysare not welcome. A tan occurs when theepidermis and dermis produce moremelanin as a way of protecting the skinagainst UV damage. (Sunburn is a signthat UV damage has already occurred—skin turns red when living cells in theepidermis and dermis becomedamaged.) But melanin can only protectyou so much. UVB rays, thoseresponsible for sunburn and tanning,

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penetrate deeply into the skin, but UVArays go further, and once they get there,they create free radicals, rogue forms ofoxygen that degrade collagen and elastinand make it difficult for the skin torebuild them. Free radicals caused bysun exposure also create somethingknown as cross-linking: chemicalbridges between protein molecules inthe skin. This makes the skin harder andless elastic (think again of that leatherycowboy) and contributes to thedevelopment of wrinkles.

Something else you should knowabout UVA rays is that they’re sneaky—they stream right through glass. Alongwith UVBs, they’re the primary cause of

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age spots, raised clumps of pigment orother skin cells often found on the handsbut which can crop up anywhere on thebody. As further insult, UV rays thin theblood vessel walls so that they bleedand show through the skin. The bloodvessels also dilate when collagen breaksdown, causing red blotchiness to appear,too.

The darker your skin, the moreprotection your own melanin is going toafford you. However, even if you havevery dark skin, UV light and heat stillcreate damaging free radicals. And alltypes of skin are susceptible to sun-induced skin cancer, which I’ll talk moreabout here.

More marks of sun damage:

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skin discoloration

uneven texture

Smoking and Oxygen Flow

Did you know that the skin of peoplewho smoke takes longer to heal?Nicotine narrows the blood vessels inthe skin, depriving it of the oxygen andnutrients it needs to repair itself. But thedamage doesn’t stop there. Likesunshine, cigarette smoke degradescollagen and elastin and creates freeradicals that harm skin cell DNA (airpollution can have this effect, too). Plus,every time smokers drag on a cigarette,

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they pucker up, an action that, over time,deepens the vertical lines above the lips.

You can really see the differencebetween smokers and nonsmokers, andresearchers at Case Western ReserveUniversity in Cleveland have done agood job of documenting that differencein several studies on twins. In oneparticularly striking case study, theylooked at fifty-two-year-old identicaltwins, who had always lived in the sametown, had about the same amount of sunexposure, and even had the same job.The difference between them is that onewas about a pack-a-day smoker whilethe other never smoked. When you lookat pictures of the two women, thatdifference is clear: On a photo damage

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(sun damage) scale of 1 to 5, the smokerwas a 5 while the nonsmoking twinreceived a grade of 2. In photographs ofthe two women, the smoking twin hasmuch deeper lines on her cheeks andabove the lips—she looks at least tenyears older than her sister.

More marks of damage fromsmoking:

an unhealthy pallor

wrinkling all over the body

dry skin

Acne, Rosacea, and Stress

Acne? Probably about 20 percent of the

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people I see in my office never hadadolescent or teen acne, yet now herethey are in middle age as pimply as asophomore on a prom date, crying, “It’snot fair. I get acne and wrinkles at thesame time!” They’re right. It isn’t fair,but it can happen, and the culprit is thesame one that bedevils kids: hormones.As menopause approaches, estrogenlevels fluctuate, tipping the estrogen-testosterone balance in favor oftestosterone. Testosterone pumps up theskin’s sebum-making machinery, causingan overproduction of oil that canultimately clog the hair follicles andpores and trigger breakouts. Estrogencan help modulate the inflammation

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caused by acne, but when your estrogenlevels dip as they do in menopause, youhave less natural protection frombreakouts.

Skin Care Mistake #2

Locking Yourself in to One Skin Type

Patients always ask me, “What’s myskin type?” I can tell them what theirskin type is at that moment, in thatlocation, during those particularweather conditions, but I can’t tellthem what their skin type will bewhen they fly to Miami the next dayor even what their skin type will belater that afternoon. What I’m gettingat is that skin type changes from dayto day, hour to hour. In the morningyou might be dry and flaky, by noon

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greasy with larger-looking pores. Theweather outside, indoor heat and airconditioning, dietary changes, a bout ofexercise, the menstrual cycle—all thesethings can change your skin “type.”(One exception is sensitive skin. Ifproducts and inclement weatherconditions easily irritate yourcomplexion, see here.)

I know this can make skin care alittle complicated, but it’s also thereality. Still, if you keep your routinesimple and stay open to amending itwhen necessary, you should be able tocope. If you buy products for one skintype, choose “combination skin” or thekind that lines up with your usual skintype, then be prepared to treatproblems as they happen. If, forinstance, your normally dry skin turnsoily, a toner can be useful. If youbecome ruddy, a redness relief productwill fit the bill. If your skin becomes

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dry, you may need a fortifiedmoisturizer. Get to know how yourskin behaves at different times and indifferent locations so that you cantailor your program accordingly.

Some people are also surprised tofind that they develop rosacea as they getolder. Rosacea is a chronic conditioncharacterized by redness andinflammation typically caused byswollen blood vessels (primarily on theface, although sometimes in other places,too). In some people, the skin becomesdry and flaky, in others, oily and pimply.Rosacea usually develops between theages of thirty and fifty and is morecommon in women and fair-skinnedpeople. It’s thought to be passed along in

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families, and it’s far from rare—about14 million Americans suffer fromrosacea. Early signs of rosacea caninclude flushing when you drink alcoholand facial swelling, small visible bumpson the face and watery or irritated eyes.It’s important to see your dermatologistif you suspect you have rosacea, becauseit’s tricky to treat. It makes the skinextremely sensitive and it can bedebilitating. One study found that 41percent of people with rosacea said thecondition caused them to avoid going outin public.

Acne and rosacea have a few thingsin common, and one of them is that stressalmost always makes it worse. As partof the response to stress, the adrenal

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glands, ovaries, and skin produce moretestosterone, stimulating the sebaceousglands, which can lead to breakouts. Theskin may then become inflamed and healslowly—two other conditions linked tothe stress response. Stress can alsoimpair the skin’s barrier function,making it easier for irritants to get in andmoisture to get out. That’s one reasonthat stress also makes rosacea worse. Ina survey of seven hundred rosacea-sufferers by the National RosaceaSociety, 91 percent reported that theircondition flares up when they’restressed.

Another way stress may play a rolein acne is by encouraging poor eating

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habits. Many people toss all dietarycaution to the wind when they’re underpressure, and although there aren’tspecific foods (chocolate included) thatcause acne, some evidence suggests thata high glycemic and low protein diet canworsen existing breakouts. And dietdoes potentially have a significantinfluence on the complexion, so healthyeating is imperative for healthy skin.(For more on how diet affects the skin,check my websitewww.lancerskincare.com.)

Given the connection of stress toacne and rosacea, relaxation techniquessuch as meditation and yoga, as well asgoing on vacations—anything that helpsease the pressure of your daily life—can

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go a long way toward keeping your skinhealthy. Lower your stress level andyou’ll lower the wear and tear on yourcomplexion, too.

AS EASY AS ONE, TWO,THREE: POLISH, CLEANSE,NOURISH

Nearly every dermatologist has a storyabout a patient who, in response to therequest “Show me what you’re using onyour skin,” drags in a suitcase full ofproducts. There’s no need to spendextreme amounts of time or money onyour skin. If you have three good

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products—a polisher (exfoliant), acleanser, and a nourisher (a topicalcream, lotion, serum, oil, or mist withanti-aging ingredients)—plus asunscreen, and take the time to performthree steps, once in the morning and oncebefore bed, you’ll be on the path toyounger acting and younger looking skin.

Skin care is relativelyuncomplicated. Choosing products,unfortunately, isn’t as simple. The sheernumber of anti-aging products ondrugstore shelves is staggering. Add tothat products sold in department stores,spas, and doctors’ offices and thechoices become mind-boggling. Despitethe vast array of options, I often hadtrouble finding exactly what I was

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looking for. Products either didn’tdeliver on their promises, didn’t workfor all of my patients, or required anelaborate regimen. What was missingwas combined simplicity and efficacy,so I set out to fill the gap by creating myown line of products, LANCERx(lancerskincare.com). The productswere years in the making, andincorporate some ideas of my own, suchas pairing reparative ingredients withoxygenating ingredients that increasetheir effectiveness. I put a lot of time andeffort into them, and I didn’t skimp onanything: The ingredients are of thehighest quality, in therapeutic amounts,in first-rate formulations. My patients get

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great results from the products—I seethe evidence in my office every day.

The LANCERx line is notinexpensive (although compared toadvanced procedures or plastic surgery,it’s reasonable!), so it may not be foreveryone. However, you may find it’sworth the investment, especially whenyou consider that so many of theproducts in drug stores and departmentstores are what you’d call “glorifiedmoisturizers.” LANCERx products havea true therapeutic benefit.

Keep in mind that though productsare important, just the sequencing of thisanti-aging method is going to do a lot foryour skin. Nighttime steps 1 and 2

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increase circulation and promote cellturnover as well as clear the path forstep 3: delivery of beneficial nutrients.These are the three critical steps. It’s notnecessary (or recommended for mostpeople) to polish twice a day, so in themorning your third step is applyingsunscreen. Sunscreen doesn’t change thebehavior of the skin the way the othersteps do, but it prevents damage, whichis just as important as repairing damage.

While these steps target aging and aregreat for treating acne as well, I’vefrequently seen them repair skin thatonce seemed irrevocably damaged.About a year ago, a patient of mixedancestry came to see me. She was partHawaiian and part Middle Eastern. I

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was taken aback when I first saw her:she had big black circles around hereyes like a raccoon. “Okay, you’ve gotmy attention,” I said. “What’s the story?”

The patient, who was only thirty-two,had noticed a few sun spots on her faceand went to see her aesthetician. Shegave her some lightening cream, whichcaused a terrible red and prickly rashthat, when it finally went away, left morespots. She went to another facial spa (aso-called medispa), where somethingcalled a “soft light” laser treatment wasused over her entire face with the aim ofremedying the situation. That’s when theraccoon circles surfaced. When I heardthat part of the story, I wasn’t surprised.

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Her type of skin is vulnerable to damagefrom lasers and other therapeutic lightsources, a topic I’ll talk about in moredepth beginning here. The inflammationcaused by the “soft light” laser createdscarring, which gave my patient the ringsaround her eyes. It took about sevenmonths, but we were able to reverse it—strictly with the three basic steps I’mrecommending to you.

These steps, which I outline below,are important to do every day. Don’tslack off! Consistency is key. No matterhow tired you are, don’t fall into bedwithout performing your skin careroutine first. Your skin repairs itselfwhile you sleep; just imagine it trying todo so with all kinds of pollutants, dead

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cells, and oil in its way.

Polishing

Most people call this step exfoliation,but I like to call it polishing because theword gives you a good visual image ofwhat you’re going to accomplish:removing the sludge (dead skin cells) toreveal fresher, smoother skin. Think of itas taking the tarnish off silver. There aretwo types of polishers: mechanicalexfoliants, which can be anything from aloofah or rough washcloth to a scrubwith tiny grains or crystals that rub offdead cells, and chemical exfoliantsmade of enzyme-based ingredients fromplants such as pineapple and papaya that

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dissolve dead cells. I happen to thinkthat a combination of both tiny scrubbersand enzymes works best. Loofahs andwashcloths aren’t as efficient, and theycan harbor bacteria unless you washthem thoroughly after every use.

When you remove the top layer ofdead skin cells, you’re not removing allof the stratum corneum (which you’llremember is made up entirely of tightlyknit dead cells), but you are removingthe dysfunctional cells that have lingeredon top too long, causing the skin to lookdull and flaky. As those cells are sweptaway, the layers below get the messageto create new skin cells, helping toaccelerate cell turnover and bring forthfresh cells. Remember, too, that

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removing those cells also makes way forthe nourishing topical ingredients you’regoing to add in step 3. Polishing has afew other benefits as well. As youexfoliate, you’ll be both increasing thecirculation to the skin, giving it aninstant glow, and helping to oxygenatethe cells, which will increase theeffectiveness of reparative proteins andantioxidants.

WHAT TO LOOK FOR: In my own polishingproducts, I use a combination ofmechanical and chemical exfoliants.Most products tend to be one or theother, so faced with a choice, go for themechanical kind, preferably one madewith sea minerals, birch bark, walnut

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shell, or apricot kernels. Choose aproduct that will polish your skinwithout abrading it. The “scrubbers”should be superfine and the productemollient enough to feel comfortable onyour skin—that’s the mark of high-quality chemistry.

If you prefer to use the type ofexfoliant that dissolves dead cells, lookfor one with natural exfoliating enzymessuch as bromelain (derived frompineapple) or papain (from papaya). Agood polisher is worth paying extra for.

Cleansing

If polishing is a little like going into amine and blowing up the rocks

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surrounding the gems, cleansing is likebringing in a cart to carry all the debrisaway—it helps you get rid of everythingthat you’ve loosened up by exfoliating.The gems are now exposed. Thatmetaphor aside, you’re not going forstrip-mining here. The removal processshouldn’t leave your skin too dry orirritated. A good cleanser will gentlyremove makeup, sunscreen, dirt, excessyeast, and bacteria and be oil-dissolvingenough to remove sebum and other gunkcaught in the pores without leaving afilm behind. Yet a cleanser shouldn’t beso harsh that it leaves your skin feelingvery taut or itchy—which is what soapis likely to do.

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WHAT TO LOOK FOR: I’ve had somepatients ask me if you need a differentcleanser for your eyelids and the answeris no. You should be able to safely usethe same product on your entire face,neck, and chest. What you should belooking for in a cleanser is a product thatstrikes a balance between clearing theskin of dead cells and debris and leavingsome of the skin’s natural oils intact.Many companies that make cleansers areafraid of creating a product that is overlydrying, so they add humectants(substances that promote waterretention) and other moisture-gatheringcompounds to their formulas, and as aresult the products leave a film on theskin. It’s a bit like the concept of a

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combination shampoo and conditioner,cleaning and moisturizing in one fellswoop. It may be convenient, but it isn’tideal.

The moisturizing benefit of this typeof cleanser may be fine for people whoare acne prone or have rosacea, but foranti-aging purposes, choose a strongercleanser. Most cosmetic cleansers thesedays employ synthetic cleansers calledsyndets, which are pH neutral and don’tleave a film on the skin. Soaps, on theother hand, drive fats out of the skin andcan leave a residue. Your goal should beto find a cleanser that is pleasant to use,non-irritating, non-inflammatory, andsoothing—but thorough. Try it out on the

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soft, non-sun-exposed skin on the insideof your arm; if the cleanser doesn’tcause any redness or irritation, chancesare it will be okay for your face, neck,and chest. One surprisingly good optionis simple baby shampoo, a gentle butthorough cleanser that you can use onyour face as well as on the skin on yourbody.

Some cleansers have addedexfoliating ingredients such as salicylicacid, papaya, pomegranate, or alphahydroxy acids (see here). This can helpfurther refine the stratum corneum andprep the skin for nourishment. Manyproducts will give you information aboutextras such as exfoliating ingredients ontheir labels. If you don’t find what

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you’re looking for, go on to drugstore orbeauty product websites and survey theoptions. You can often read aboutproduct details, including activeingredients.

Nourishing

Although I recommend that you nourishthe skin from the inside out—eating rightand taking the supplementsrecommended in chapter 3 will helpincrease your collagen production andreplenish your skin with antioxidants—there is only so much you can influencethe skin through diet. Eating all theoranges in the world won’t give you thetherapeutic amounts of vitamin C you

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need to restore the health of your skin.Plus, there are compounds we know canimprove the skin that you can’t getthrough diet at all. That’s where topicalnourishment comes in.

Nourishing products shouldn’t beconfused with moisturizers. Though mostof them do help the skin retain moisture,nourishers’ main role is to deliverantioxidants, vitamins, and other anti-aging ingredients to the stratum corneum.They can come in many forms, includinglotion, cream, or serum formulations. Asa general rule, be sure to choose aproduct that feels and smells good toyou. It has to be pleasant to use or you’regoing to conveniently “forget” to put iton, which will ensure that you get no

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benefit at all. Just as with exercise, youhave to be consistent with skin care, andthat means complying with all threesteps on a regular basis.

WHAT TO LOOK FOR: Some nourishers maybe labeled as reparative lotions, some asanti-aging creams, others as anti-wrinkletreatments. What’s most important is thata) they have active ingredients (andenough of them) to make the skin behaveyounger, and b) you like the formulation.

Through research, we’ve been ableto determine that many compoundschange the skin. But it’s still a somewhatinexact science. We know a lot aboutretinoids—derivatives of vitamin A that

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I’ll discuss shortly—but the benefits ofother ingredients are still somewhatpoorly defined. Still, we know that ifyou open up the doors on the skin, whichyou effectively do by polishing andcleansing, and allow these ingredientsin, they will effect positive changes inyour skin, provided they’re in sufficientamounts and well formulated.

A beneficial day and nighttimenourisher will contain severaltherapeutic ingredients, among themantioxidants. There are manyantioxidants used in skin care products,and one is not necessarily better than thenext; they just use different metabolicpathways to protect the skin. Thefollowing are some that you should look

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for.

Vitamin C—Vitamin C helps stopfree radicals caused by sun exposurefrom doing damage and may evenprovide a barrier to the sun’s rays. Calso protects the collagen youalready have and goads thefibroblasts into producing more.Many products now feature vitamin Cas an active ingredient. However, notall C is created equal; some formsare very unstable. Be wary ofproducts that have turned brown; thisindicates that the C has oxidized andlost potency. Look for C in the formof L-ascorbic acid, the form the bodymost easily recognizes and gets the

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best anti-aging results.

Vitamin E—You’ll usually seevitamin E on the ingredients list asalpha tocopherol. Vitamin E, aneffective free radical scavenger, isespecially good at helping to fightinflammation and keeping the skinmoisturized. Bear in mind thatvitamin E is also a preservative, usedto keep cosmetics from spoiling, so ifyou see it on the ingredients listing, itdoesn’t necessarily mean it’s there inthe amount necessary to make yourskin younger. Look for E close to thetop of the ingredients list.

CoenzymeQ-10 (CoQ-10)—This

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antioxidant can regenerate the skin,and its small size makes it easy toabsorb. This is one of the ingredientsin my Tri-Defense CoQ-10 (whichalso contains green tea and sodiumhyaluronate). Newer to the market isidebenone, which works similarly toCoQ-10.

Coffeeberry, Green TeaPolyphenols, Resveratrol—Theseantioxidants are increasinglycropping up in skin care products,and they may have some benefits.Here’s the caveat. On a microscopiclevel and in the lab, these and otherantioxidants such as pomegranate,grapeseed extract, licorice, and soy,

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cause some activity within skin cells.When they’re applied to the skin on areal, living being, it’s difficult to sayif they have much effect. I think theycan be helpful if they’re used in largeenough concentrations, butconcentrations in most over-the-counter products are probably toolow. Expect minimal benefits.

Besides antioxidants, a goodnourishing product may also includepeptides/pentapeptides. This group ofamino acids has a range of anti-agingeffects. Some of them, such as palmitoylpentapeptide-4, help repair brokencapillaries and stimulate GAG synthesis

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and collagen production. When collagenbreaks down, it forms peptides, and thepeptides signal the skin to make newcollagen. Topical peptides have beenshown to do the same. Other peptideingredients work a little like neurotoxinsto relax wrinkles on the skin.

Whichever type of nourisher youchoose, keep in mind that it’s one of themost important products that you’ll use.Don’t skimp when it comes tonourishers; it’s where you should putyour money.

YOUR NEW SKIN CAREROUTINE

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Evening

1. Polish—Using an exfoliant, polishthe damp skin on your face, neck,and chest area for 60 to 90seconds or according to theproduct instructions. Rinsethoroughly with lukewarm water.(Note: If you’re wearingfoundation, cleanse first, polish,then cleanse again. There’s noneed to use a makeup remover—if your cleanser can get rid ofsebum and pollution, it should beable to get rid of all your makeup,even mascara.)

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2. Cleanse—Massage your face(including your eyelids), neck, andchest with a non-irritatingcleanser for one minute. Rinsethoroughly with lukewarm waterand pat dry.

3. Nourish—Apply a nourishingproduct with free radical–scavenging antioxidants on yourface, neck, and chest.

Modifications forSensitive Skin

I have about ten patients a day who

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tell me that they have sensitive skin.Some of them actually do have highlyreactive skin; others think they do. Mypoint is that sensitive skin is often inthe eye of the beholder. The kind ofsensitive skin that calls for cautionarymeasures is skin that burns, stings, hasuneven color distribution, is pale andflaky, or is red and flaky in response toany kind of irritant, whether theirritant is wind, sun, altitude andtemperature and humidity changes, oringredients in topical products. Peoplewho have genuinely sensitive skinalso see changes in response tocaffeine, alcohol, and spicy and acidicfoods. Stress can send sensitive skininto a tizzy, too.

What generally occurs is that theseirritants jar the vascular, nervous, andimmune regulatory systems in the skin,causing blood vessels to spasm anddilate. Maintaining a healthy lifestyle—eating well, getting adequate sleep,

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exercising, and controlling stress—goesa long way toward keeping sensitiveskin calm. Sensitive skin also respondsbest to simple skin care. The morecomplex the products, the more likelythey are to hit a trigger. Always lookfor products that are free of alcohol,witch hazel, fragrance, and color. Whenbuying a polisher, look for one that has“gentle” on the label.

To adjust the polish-cleanse-nourish method for sensitive skin, startwith two gentle products formulatedfor sensitive skin, one cleanser andone nourishing cream; skip thepolisher for now. Cleanse and nourishin the morning and the evening forone week. If everything is nice andpeaceful, add in the polisher thesecond week. Watch your skincarefully. If there is any sign ofirritation, pull back to polishing once aweek, then see if you can gradually

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increase it without starting theinflammatory roller coaster.

Morning

1. Cleanse—Massage your face(including your eyelids), neck, andchest with a non-irritatingcleanser for one minute. Rinsethoroughly with lukewarm waterand pat dry.

2. Nourish—Apply a nourishingproduct with free radical–scavenging antioxidants on yourface, neck, and chest.

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3. Protect—Follow with an SPF 30sunscreen, preferably one thatalso contains antioxidants.

HOW TO SHOP FORPRODUCTS

The question most people have aboutskin care products is “How do you knowif you’re getting what you’re payingfor?” Nobody wants to shell out hard-earned cash for anything that doesn’tdeliver. The truth is it’s difficult to knowif an expensive product will work betterthan a less expensive one. I know frommy own experience developing

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LANCERx that the raw components youpurchase to put into an anti-agingproduct can be expensive. When, say, ananti-aging serum is priced at onehundred dollars, it may have a highconcentration of antioxidants, peptides,or other ingredients that have beenshown to make skin look more youthful.The greater the volume of theseingredients in a product, the more costlyit is to produce and, of course, the moreexpensive the retail price is going to be.But how do you know for sure that thereare therapeutic levels of activeingredients in a hundred-dollar serum?Therein lies the problem. Whether it’s avitamin C cream from a high-end line or

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a vitamin C cream sold at chaindrugstores for one-tenth the price, therereally isn’t any way to tell exactly whatyou’re getting.

There are, though, some clues. If theproduct has an ingredients list either onthe label or within the packaging, look tosee where anti-aging components such asvitamins and antioxidants fall. Thefarther down the list they are, the weakerthe concentration of those ingredients.For the most part, you should not expectlow-priced products to contain morethan low amounts of active ingredients.There is no way a cosmetics companycan pump up the volume of activeingredients and keep prices very low.It’s also important to realize that a

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product’s effectiveness depends on morethan just the potency of the activeingredients. In order for theseingredients to reach the areas of theepidermis and dermis where they dotheir work, they require “vehicles”—molecules that encapsulate or otherwisecapture the ingredients and deliver theminto the skin. Delivery ingredients, too,can be costly.

None of this means that low-pricedproducts aren’t helpful—many of themare—but it means you shouldn’t expectthe parting of the Red Sea (or, more tothe point, the return of your face to itshigh school luster). The bottom line isthis: A high-priced product from a

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reputable company may indicate thepresence of beneficial concentrations ofhelpful ingredients and efficient deliverysystems, but it’s no guarantee. Lower-priced products tend to have lowerconcentrations of the anti-agingcomponents you need, but can still turnback the clock a little bit—especially ifyou use the polishing-cleansing-nourishing method of skin care. If you’rewilling to pay for one or two higher-priced items, spend your money on agood nourisher first, a good polishersecond. Those are the most importantproducts.

Which brings me to another pointabout skin care products. There is noone magic ingredient destined to be your

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personal fountain of youth. Attainingbeautiful, youthful skin requires asystem, and all the pieces need to be inplace. You can’t just slap on a creamwith coffeeberry or green tea and call ita day. Don’t be lulled into the conceptthat one superduper ingredient is theHoly Grail.

DEFENSE! PROTECTINGYOUR SKIN FROM THESUN

Since my practice is in sunny SouthernCalifornia, there’s nothing I hear morethan the lament “I shouldn’t have spent

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so much time in the sun.” Well, yes,that’s true. A lot of my patients, such asBob, grew up when the only sunscreenavailable was the zinc oxide lifeguardsused to coat their noses. But what’s pastis past. Let’s talk about now, becausewe know for sure that UV rays areincredibly damaging, and that they notonly accelerate the aging of the skin butalso put us at risk for skin cancer. Thefigures are startling: one in fiveAmericans will develop skin cancer in alifetime. Not all skin cancers are deadly(though even the milder ones can bedisfiguring), but sun exposure alsoincreases the risk of the most seriousform of skin cancer, melanoma.According to the Skin Cancer

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Foundation, melanoma rates are rising,and although melanoma has a goodsurvival rate if you catch it early, therate of survival falls to 15 percent if thedisease advances.

Everyone needs sun protection:people with white skin, people withbrown skin, people with black skin. Forinstance, in a 2010 study, black womenliving in Florida had a 60 percent higherrate of melanoma than black womenliving elsewhere. I think the message ofthis study is clear: no matter what coloryour skin, you can’t afford to shrug offsun protection.

If you haven’t yet begun using asunscreen every day, start now. Here are

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some sun protection guidelines to go by.

Start with sun avoidance. The best wayto avoid sun damage is to stay out of thesun. Seek shade whenever possible, andif you have to be out, try to avoid thehours when the sun is strongest, ten a.m.to four p.m. Wear protective clothing,too. The darker and more tightly woventhe clothes, the more protection they’llafford. (Save gauzy whites for summernights—a white T-shirt only has an SPFof 5.) You can also buy clothing with abuilt-in SPF, or wash it with a laundryaid such as Sun Guard, which givesclothes a higher SPF.

Be smart about SPFs. A product’s SPF

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refers to how long you can stay out in thesun without burning. For instance, if youtypically burn in ten minutes withoutprotection, wearing an SPF 15, you canprobably stay in the sun for 150 minuteswithout burning. But that presupposes afew things. One is that the sunscreenyou’re wearing is absolutely as intact asit was when you first applied it.Sunscreen degrades and gets rubbed offeasily; in fact, after two hours, an SPF30 drops down to an SPF 15, if notlower.

For ultimate protection, you need toreapply sunscreen every two hours. Andwhat is ultimate protection? Withsunscreen it’s never 100 percent, nomatter how high an SPF you choose, so

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sun avoidance is really your bestdefense against UV rays. Always wearan SPF 15 or higher, but also be awarethat the numbers top out. An SPF 15blocks 94 percent of rays; an SPF 30blocks 97 percent. Thus, an SPF 30doesn’t offer twice the protection of anSPF 15; it just has more activeingredients so more of them may stay onas the sunscreen starts to degrade andrub off. That’s helpful, but again, youdon’t want to be lulled into thinking youcan stay in the sun longer than youshould.

Choose effective ingredients. Theactive ingredients in sunscreens fall intotwo categories. As their name suggests,

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chemical absorbers—aminobenzoic acid(PABA), avobenzone, ecamsule, andoxybenzone, to name a few—work byabsorbing radiation. Physical blockers—the minerals titanium dioxide and zincoxide—work by reflecting and scatteringrays. Because chemical absorberspenetrate the skin, they’re morecommonly linked to skin irritation.Physical blockers aren’t absorbed,which is why they often leave a whitesheen (and why they’re considered thesafest choice for kids). My LANCERxcontains a mix of both types of activeingredients, and some other sunscreensdo as well.

What’s critical is that you select a

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product that protects against both UVAand UVB rays. As you might remember,short-wave UVBs cause sunburn, whichis of course very damaging to the skin.But although long-wave UVAs don’tcause a burn, they reach way down to thedermis and wreak havoc on cell DNA.SPF numbers refer only to protectionagainst UVB rays, so it’s difficult to tellif a product also deflects UVAs basedsolely on its SPF (the FDA has longbeen promising to come out with a ratingscale for UVAs, but it’s yet tomaterialize). But there are clues. Lookfor the words “broad spectrum” on thelabel or check the ingredients list;avobenzone, ecamsule, and zinc oxidegive the most extensive UVA coverage.

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Consider children’s sunscreen. Mostsunscreens formulated for youngchildren and babies have just abouteverything you’d want: they’rereasonably priced, have a high SPF,have zinc oxide or other blockers thateffectively protect against both UVA andUVB rays, and have fewer chemicalsthat get into the bloodstream (there’s noevidence that the chemicals do harmonce they’re in there, but we do knowthat the body absorbs them).

Here are some other tips for choosingand using sunscreen:

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The brand or ingredients in asunscreen are important, but not quiteas important as whether you use it,and you’re only going to use it if youlike it. If it’s not easily applied, or ifit feels slimy or smears, toss it andbuy another one. Some of the higher-priced sunscreens are also higher-quality sunscreens, meaning thatthey’re formulated not just forprotection but for comfort as well.And in the long run they’ll save youmoney. I tell my patients that they’llsave themselves a lot of money onlasers and fillers if they just stay outof the sun and protect themselveswhenever they are exposed.

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Apply sunscreen every day of theyear, all over your body. UV rayspenetrate clouds and some of themeven penetrate glass, including carwindows—the left sides of the facesin this car-centric country are usuallyfive to ten years more aged inappearance than the right (it’s theopposite in England). In a perfectworld, you’ll reapply every twohours. Always reapply afterswimming, even if the label says yoursunscreen is waterproof.

Slather on your sunscreen thirtyminutes before you go out. That willgive the active ingredients time tobind with the skin so they can do

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their work.

Don’t worry about getting yourvitamin D from the sun. You mayknow that the skin, when exposed tosunlight, manufactures the all-important nutrient vitamin D. Therehas been some concern that sunscreenprevents the production of vitamin Dand, indeed, many people don’t getenough D—there seems to be anepidemic of vitamin D deficienciesin this country and it’s now beenlinked to everything from cancer toautoimmune diseases like rheumatoidarthritis and Crohn’s disease. Itdoesn’t make sense to exposeyourself to cancer-causing rays to

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increase your body’s production ofvitamin D so, if you’re deficient,look to your diet or a vitamin Dsupplement to make up the difference.See here for more information onvitamin D.

Be advised that indoor tanning isn’tsafer than outdoor sun exposure. Youcan still get a burn, and studies haveshown that people who use tanningbeds are at higher risk for melanomathan nonusers.

Skin Care Mistake #3

Not Applying Enough Sunscreen

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Sunscreen is not moisturizer. You haveto lay it on thick, and few people do:One study found that most peopleapply only 25 to 50 percent of therecommended amount. When SPFs aretested in the lab, cosmetic scientistslayer the cream on uniformly andheavily—a lot thicker than most peopledo at the beach. The recommendedamount to cover an adult body is oneounce (think shot glass). In otherwords, you’ve got to really glob it onso that it looks white (your skin willabsorb it within a few minutes, sodon’t worry about the aesthetics). Ifyou’re spending days outdoors andnot using up a tube of sunscreen inabout two days, you’re not usingenough.

HELP FOR DEEPER LINES

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AND WRINKLES

If, for whatever reason—maybe youdon’t have genetics on your side or werea sun worshipper in your earlier years,or a smoker—you have deep lines andwrinkles, you may need to add an extrastep or two to your routine to get theresults you want. You can benefit fromgoing the extra mile, but not necessarilythe extra ten miles. In most cases, simpleis always better. Slapping fifteendifferent products on your skin every daywon’t make it superior—it will onlytake you more time (not to mention costyou more money).

The best way to take your skin care

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routine to the next level is to add eitheran alpha hydroxy acid (AHA) or aretinoid product—or both—to yourarsenal. There are lots of anti-agingingredients out there, but these two typesof interventions have the best trackrecord.

Alpha hydroxy acids. AHAs, as they’recommonly known, have exfoliatingcapabilities. They dissolve the lipids(the “mortar,” as you’ll remember frommy earlier anatomy lesson) that holdtogether the dead cells in the stratumcorneum. As they exfoliate, AHAs alsoget skin cell turnover back on track. Forsome people, polishing alone doesn’tclear the skin well enough to stimulate

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accelerated cell turnover.Among the AHAs, glycolic acid

(made from sugar cane) has the smallestmolecules, so it penetrates quickest anddeepest; however, other AHAs can beeffective, too. Lactic acid (from milk),malic acid (from apples), and tartaricacid (from grapes) are AHAs that youwill likely also find in reparativecreams, cleansers, and other skin careproducts. AHAs are also used in highconcentrations in in-office face peels.

The results you’ll get from using anAHA product depend on theconcentration of the acid. Most over-the-counter products have fairly lowconcentrations—about .5 to 1 or 2percent—but they smooth the skin

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somewhat. You can also buy productsthat have 5 to 10 percent concentrationsof AHAs, and they do more, helping tolighten age spots and get rid of finelines. (I have an over-the-counter 10percent glycolic acid product atlancerskincare.com.) Higherconcentrations of AHAs are generallyused in peels that need to be supervisedby a physician (see here).

What’s critical to an AHA product’seffectiveness is the way it’s beenformulated. AHAs can be hard on theskin—they sting—so they must bebuffered or toned down with otheringredients. Too much buffering negatesthe power of the AHA, so it’s a delicate

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balance. How well the manufacturerwalked that line, though, is hard to judgefrom the label. Choose a product from areputable company and give it a monthor so to see if it works. You willundoubtedly have some stinging ortingling at first (that tells you that theAHAs are having some effect), but itwill likely go away as your skinbecomes accustomed to the product.While it’s okay for your complexion toturn a light pink, if there is real rednessand swelling along with the stinging, it’sa sign that the product is too irritating toyour skin and you may need to tryanother.

Alpha hydroxy acids can be usedeither in the morning or at night. If you

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use an AHA product in the morning,apply it before your sunscreen andnourisher. If you use it at night, applyafter cleansing.

Retinoids. Retinoids, synthetic versionsof vitamin A, are one of the greatestdiscoveries of cosmetic science. Theyreally work to reverse years of sun andenvironmental damage to the skin. Insome ways, they’re similar to alphahydroxy acids—they help slough offdead cells. But retinoids go further,signaling the skin to produce newcollagen and hyaluronic acid. Dependingon the strength and type of the retinoidyou’re using, the skin responds fairlyquickly: lines and wrinkles smooth out

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and the skin tone becomes brighter andmore uniform. Retinoids are an effectivetreatment for acne, too.

Retinoids come in different forms.There are several prescription-onlycreams—tretinoin (Retin A), taxarotene,and adapalene among them—of varyingstrengths. These are generallyprescribed when the problem affectingthe skin originates from the lowersections of the dermis, and aresometimes recommended to treat acne,rosacea, and discoloration of the skin. Aclinical exam by your dermatologist willtell you if you need a prescriptionretinoid. He or she can also help youdecide which one is right for you and

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give you samples to try.You should know, though, that there

is a downside to retinoids. While yourskin will generally adjust to them, theycan be very irritating, so it’s imperativeto work with your dermatologist tofigure out the best formulation for you.You may need to start with a lower-strength product. Retinoids also makethe skin more sensitive to the sun and toenvironmental factors such as altitude;this is the reason they are best appliedbefore bed (though you still need toavoid sun exposure as much aspossible). When you’re using aprescription retinoid, be careful aboutthe other products you’re using. Acleanser or toner that never irritated

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before may suddenly make your skin redand flaky. If you’re also using an alphahydroxy acid, use the AHA in themorning and the retinoid product atnight. If for some reason you can’t applythe AHA in the morning, apply the AHAMonday, Wednesday, and Friday nightsand the retinoid Tuesday, Thursday, andSaturday nights. It’s important to get agroup of products that all work welltogether so that you can continue to havea good skin hygiene program.

Many over-the-counter products nowcontain retinol, retinal, and other formsof retinoids. I, for instance, use retinol inmy AM/PM Nourishing Treatment andFortified Moisturizer. Over-the-counter

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retinoids are alternative versions of theprescription-strength retinoids, and theycan still make a difference in your skinwhen used regularly. They are much lessirritating, too, so it’s something toconsider if you have particularlysensitive skin. But even if you don’thave sensitive skin, OTC versions are agood place to start. Look forretinol/retinal products that also containanti-inflammatory ingredients such asgreen tea polyphenols.

If you’re using an over-the-counterproduct for twenty-one days and don’tsee improvement, talk to yourdermatologist about the possibility of aprescription retinoid. Prescriptionretinoids are considerably stronger than

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the OTC counterparts, and theysignificantly smooth and brighten skinwhile also making it more even in tone.Whether you’re using a prescription orover-the-counter retinoid, check withyour doctor before taking anysupplements that contain vitamin A,which can be harmful at high levels.

Here are two problems that can beaddressed by supplementing your regularroutine with alpha hydroxy acids or aretinoid (or both), along with a fewother therapeutic products.

FOR DEEP LINES

At night, after cleansing as younormally would, use a nourisher or

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separate product containingcoenzymeQ-10 (see here for more oncoenzymeQ-10). If you use a separatecoenzymeQ-10 product, use that first,then apply your nourisher, and finallysmooth on a 10 percent glycolic acidcream.

In the morning, put on a collagen-boosting vitamin C–rich productafter cleansing (if you’re using atoner to deal with acne, apply it afterthe toner). Vitamin C creams cansting a bit, particularly under certainconditions (such as high altitude). Ifthe stinging is too intense, cut back toevery other day until your skinadapts.

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FOR EXTENSIVE SUN DAMAGE

In the evening, apply a retinol creambefore you put on your nourishingproduct. Sun damage puts you at riskfor skin cancer, so make certain thatyou see your dermatologist everyfour to six months for checkups.Practice sun avoidance and use asunscreen daily without fail.

Skin Care Mistake #4

Relying Only on “Natural” Products

Natural may be “in” and sound good,but the fact is, these products hardlyever deliver on their promises (besidesthe fact that “natural” is a nebulous

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term that could mean virtuallyanything—in skin care products, thesame goes for “organic”). Cosmeticscience has made some incrediblebreakthroughs in the past few years,and it’s only the tip of the iceberg. Ifyou’re devoted to using only naturalproducts, you’re going to miss out! Thisisn’t to say that there is no use fornatural ingredients. For instance, manyuseful antioxidants are from naturalsources such as grapes, papaya, andtea. However, products that are madesolely from natural ingredients tend toleave gaps in the treatment. Look forproducts that have medical results toshow for themselves and producepharmaceutical-grade activity, yethave over-the-counter availability.Those are the products that will trulychange, correct, and improve your skin.Strive to look natural, not cling tonatural products.

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SOLVING SPECIALPROBLEMS

Sometimes the polish-cleanse-nourishmethod isn’t enough or needs to bealtered if you have a particular skinproblem. Here are additional steps totake for special needs.

ACNE

Use a cleanser made specifically foracne, such as LANCERx ExfoliatingBlemish Cleanser (cleansers for acneusually contain benzoyl peroxide orsalicylic acid), followed by anondrying toner. If you have

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sensitive skin, some cleansers madefor acne sufferers may be too harsh.Some people with acne believe thatthe drier the skin, the better. If youdry out your stratum corneum toomuch, it sends a signal below toproduce more oil. Watch yourresults: if the product isn’t working,move on.

Follow with a redness relief productwith soothing ingredients such aslicorice root, bisbolol (made fromchamomile), and sodium hyaluronate.My Rapid Redness Relief containschamomile, cucumber, resveratrol,and evoida, a traditional Asianherbal therapy.

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ROSACEA

Twice daily, use a soothing,nondrying toner (see above) aftercleansing, but only if you have oily,red, inflamed rosacea. Skip the tonerif you have the dry form of rosacea.

After cleansing (if you have the drytype of rosacea) or toning (if youhave the oily kind), use a rednessrelief product (see above).

SEVERE DRYNESS

In the evening, use a rosewater sprayto hydrate and calm inflammation,followed by a nighttime moisturizerfortified with vitamins and proteins

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after applying your nourisher.Grapeseed oil (the kind you can buyin the grocery store) is a goodinexpensive moisturizer. A costlier,but extremely effective moisturizer isBulgarian rose oil (seelancerskincare.com).

CREPE-Y SKIN OR DRYNESS AROUND THE EYE

Put on an eye cream after yournighttime nourishing step. Theproduct should have everything yournourishing cream has, but belightweight, have lowerconcentrations, and be formulatedspecifically for the eyes. Grapeseedoil, the kind traditionally used for

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cooking, also works as an eye cream.Apply the cream from just under youreyebrow down along the top eyelid,then under the eye all the way up towhere the bottom lashes begin. Mynew Eye Bright Illuminator Rxcontains a comprehensive formula ofpeptides, chealators, and antioxidantsto reduce the appearance of under-eye dark circles and puffiness aswell as fine lines and wrinkles.

HYPERPIGMENTATION

At night, before you nourish, use aproduct specifically designed tolighten pigment and that containsproperly formulated hydroquinone.

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The most common causes of skindiscoloration are sun damage,inflammation from some kind ofinjury, and medication. Otheringredients such as niacinamide,malic, pyruvic, and lactic acids cancontribute to partial improvement,but hydroquinone works best. Eventhough hydroquinone is sold over thecounter, it’s controversial, so talk toyour dermatologist about it beforeyou give it a try.

GIVE YOUR NEW ROUTINESOME TIME

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Say you’ve never done much more toyour skin than wash it with soap andwater and use a moisturizer. Now you’regoing to be not only giving it a deepcleaning, but also introducing topicalingredients that are going get your skinback in gear. Your new routine shouldn’tcause pain, but your skin might suddenlybecome drier and more sensitive.

In a few days, all the junk skin on topwill be gone. Those layers of dead cellsmay have made your complexion lookdull but they also kept out a lot of things—irritants as well as any potentiallyhelpful ingredients in products you mayhave been using. Now that those layersare gone, you’ve got delicate, newly

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minted skin; fresh dollar bills thathaven’t been crinkled up yet.

Here’s where patience and a littlepracticality is a virtue. If your skinbecomes tight and dry, polish once everythird night or only once or twice a weekuntil your skin recovers. After abouttwenty-one to twenty-eight days, youshould be able to go back to polishingmore often. See how much your skin willtolerate as you gradually up thefrequency.

Skin Care Mistake #5

Not Eating Enough Dietary Fat

Fat is higher in calories than other

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macronutrients, so I can see why youmight be trying to avoid it, andcertainly, fat should be eaten inmoderation. But if you’re on a severereduced-fat diet, you’re doing yourskin a disservice. Dietary fats, includingcholesterol, are instrumental in theproduction of sebum, the oilysubstance that helps protect andlubricate the skin. Fat is also used bythe body to make estrogen andtestosterone. The skin not onlyproduces estrogen and testosteroneitself—skin is an endocrine organ—butrelies on the sex hormones for optimalfunctioning.

So do include fat in your diet, butnot just any kind of fat. Avoid transfats (partially hydrogenated oils) andsaturated fats (such as those in meatand whole dairy products) and optinstead for mononunsaturated fatssuch as olive and canola oils and foodssuch as avocado and nuts. Use the 20

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Years Younger Diet recommendationsfor healthy fat intake as outlined inchapter 3 to guide you.

Also bear in mind that you may haveto adjust your polishing according tohormonal shifts or travel. If you findyour skin is oilier, polish morefrequently. If you travel to a high altitudeor desert where the air is very dry, scaleback. If you’re in the humid tropics, youmight even need to polish twice a day.One of my goals is to see you get into aregular skin care routine, but don’t setyourself on automatic. It’s important toreally pay attention to your skin so youcan give it what it needs when it needsit.

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Collagen repair begins immediatelywhen you “injure” the skin, which iswhat, in a sense, good skin care does.The results come from this repairprocess, but it can take anywhere fromsix to eight weeks to see those results.So don’t expect to see your skin changeovernight. Just hang in there andconsistently stick to the polish-cleanse-nourish routine.

ALL-OVERYOUTHFULNESS: BODY,HANDS, AND FEET

When was the last time you looked at

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your whole, unclothed body in themirror? I thought so. Rarely do we givea glance to parts of our body other thanthe face. I’ve already talked about theimportance of caring for your skin fromthe hairline to the breast line. But we’reliving in a world where more and morepeople are revealing parts of theirbodies. Shorts, sleeveless dresses,short-sleeve shirts, shorter skirts with nostockings, sandals, and slingback shoes(even in winter). More exposure meansthe need for more comprehensive skincare. Even if you’re relatively modest,you don’t want to have the face ofsomeone twenty years younger but thehands and feet of someone past his orher prime.

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But perhaps even more than that, Ifind that people want the skin on theirbody, and particularly the hands andarms, to feel better. They want it to feelsofter, smoother, and silkier. That’s allpossible with some easy skin care steps.

The anatomy of the skin on your bodyfrom the collarbone down, including thehands and feet, is dramatically differentfrom the skin on your face. The stratumcorneum, epidermis, and dermis aremuch thicker, and the subcutaneous fattakes on a life of its own depending onhow much stored body fat you have. Theskin on the body also has a slowermetabolism, a more leisurely paced skincell turnover, and it sheds dead cells at a

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more measured rate. Oil glandproduction and hair growth is unhurried,too, and the oil and wax secretions aredifferent. Because everything is in slowmotion relative to the behavior of theskin on the face, skin on the body doesn’tneed the same degree of maintenance—but it still needs maintenance.

Restoring the Skin on the Body

When you ask people how they care forthe skin on their body, most say, “Oh,soap and some lotion that smells nice.”They don’t realize that they can do betterwhile still keeping skin care verysimple. It’s generally a two-stepprocess. You need a mild, non-detergent

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body cleanser and a hydrating lotion.Something as basic as Cetaphil’s BodyWash and Moisturizing Lotion can do thejob. Moisturizing lotions are mostly amatter of taste and need. You may wantto use a light one in the summer, aheavier one in the cooler, drier months.What matters most is that you apply itdaily after showering while your skin isstill slightly damp.

If you have more intense sun damage,excessive dryness, discoloration, tinybumps on the upper arms (calledkeratosis pilaris), rough elbows, loose,crepe-y skin on the front of the arms, orother problems, I recommend you takebody skin care to the next level. Hereare the steps to add:

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Polish. Use an exfoliating bodyscrub in the shower on an as-neededbasis. You may, for instance, use iton the backs of your arms, elbows,knees, and lower legs two times aweek but use it on the rest of yourbody only once a week. Look for ascrub with tiny scrubbers that alsocontains anti-inflammatoryantioxidants (I like green tea and useit in the LANCERx Body Buffproduct).

Step up moisturizing. Swap yourregular lotion for an alpha hydroxyacid moisturizer that containsglycolic or lactic acid, especially if

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you have very dry skin.

Give Your Hands More TLC

Because they’re exposed more than otherparts of the body (sometimes even morethan the face and neck), the hands can getconsiderable environmental and sundamage. Over the years, that results in adepreciation of color and texture and theappearance of fine lines, sun spots, andcrepe-y skin. Intrinsic changes alter thehands, too. Just like the face, the handslose fat and the deficit of volume makesthem look old and scrawny.

Hand repair does have its limits, butyou can do a lot to restore the supplenature of the skin on your hands by

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decreasing dryness and the fissures thatmake them feel rough. You can alsoimprove the color of the hands andsoften sun spots. It takes these two steps:

Skin Care Mistake #6

Reusing Loofahs and Cleansing ClothsWithout Washing Them

Using a loofah, a washcloth, or acoarse-textured Japanese cloth canhelp exfoliate your skin. However,how often do you wash yours? Youneed to wash it after every use;otherwise all those old dead skin cellsyou’re removing will cling to the cloth,presenting a nice banquet for bacteria.When you go to use it again, you’reincreasing your risk of infection. Makesure to wash yours regularly!

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Polish. Use an exfoliating bodyscrub on your hands two times aweek.

Moisturize. Once a day, use an alphahydroxy acid moisturizer thatcontains glycolic or lactic acid.

If you have significant sun damage onyour hands, I’m afraid that even a goodskin care routine won’t repair it. Youneed to look into peels and lasers.Likewise, skin care can’t repair volumeloss. For that you may want to talk toyour dermatologist about fillers.

Fixing Your Feet

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The soles of the feet, like the palms ofthe hands, have a very thick stratumcorneum. They develop a callusedcovering for protection, which isn’tmuch of a problem on the palms, but itcan get very dry and cracked on the feet,especially as you get older. The way todeal with it is fairly simple. Apply aglycolic acid foot cream daily for two orthree days, then once or twice a weekafter that as needed. Alpha hydroxy acidcreams for the feet are different from theones you use on your face. The AHApercentages are sometimes lower thanthose that might be used in a cosmeticpeel, yet because they have a differentpH, they’re able to deeply exfoliate the

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callused skin on the feet.Use the glycolic cream after

showering. Pat your feet dry, thenmassage a light layer of the cream allover the bottom of the foot, including inbetween the toes and anywhere else thatis cracked and callused. A good creamwill work well without any additionalhelp from a pumice stone or otherscrubber.

Anti-Aging Nail Care

As the nails age, they grow more slowlyand can become dull and brittle.Eventually, they can become very thickand more curved, too. So you can seewhy good manicures and pedicures are

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an important anti-aging strategy. Good isthe key word. The risk of infection fromunclean nail care facilities is high—Ihave one patient who still hasn’trecovered from a life-threateninginfection he got from a manicure—soyou have to use caution.

Conservative trimming of the nailswill keep them clean and smooth, andkeeping the cuticles gently pushed backcan help prevent infection. The RollsRoyce approach to nail care is to buyyour own instruments (such as clippers,cuticle pushers, nail brushes, and emeryboards) and have a manicurist come toyour home. That way you avoid anypotential bacterial outbreaks in a salon.The more affordable and cost-effective

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approach is to bring your own tools tothe salon and ask the manicurist to usethem. That way, you’re in charge ofkeeping things clean (up to a point).Whenever you get home from a manicureand pedicure, take a shower and washyour hands and feet thoroughly. That willreduce the potential of anything youpicked up at the salon causing aninfection.

WHEN YOU NEED A MOREAGGRESSIVE APPROACH

When you care for your skin properlyand it begins looking refreshed and

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radiant, any thought you might have oncehad about plastic surgery ordermatologist office touch-ups maydisappear. Some people, of course, wantmore, and some people need more.When they do, and after I’ve had themtry alpha hydroxy acids or retinoids, Ioffer them a conservative, progressiveapproach to smoothing out lines andwrinkles, replacing volume, improvingskin texture, and doing away with sunand age spots.

These anti-aging upgrades, I mightadd, can all be done without plasticsurgery, a message that seems to begetting across. In the last few years, thenumber of plastic surgery procedureshas dropped while the number of

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nonsurgical treatments has increased—and I don’t think it’s completely due tothe economy. For one thing, theinnovations in injectables and laserprocedures have made these treatmentsthe top choice of men and womenseeking to look more naturally youthful.Erase for a moment the picture in yourmind of expressionless faces andfreakishly inflated lips. When you see askilled board-certified dermatologist,those aren’t likely to be your results.Instead, peels, injectables, and laserprocedures—coupled with good skincare—can simply make you look healthyand refreshed.

Plastic surgery has its place, and in

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my opinion it’s best used to repairsomething that has been damaged or ismisshapen. Obviously, the shape ofsomeone’s nose or asymmetric breastswill not respond to topical treatments.The downside of relying on dramaticaesthetic measures such as face-lifts,brow-lifts, and eyelid surgery is that nomatter how well done the procedure is,your face won’t match the rest of you.That’s another reason I believe that morepeople are pursuing less invasiveinterventions. When you opt for thesurgical blade, it’s often like remodelingthe kitchen but leaving the rest of thehouse looking outdated. But the head-to-toe extreme makeover is not what mostpeople want (or should have).

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The menu of anti-aging touch-upsavailable continues to grow, with someoptions falling out of fashion as other,more sophisticated treatments take theirplace. When laser treatments and peelsfirst became popular, they were quitesevere—a controlled burn that requiredmajor recovery time. But fewdermatologists use those drasticprocedures anymore. Whereas thosetreatments worked by triggering a majorhealing response, many of the treatmentswe use now are more like tickling: Theytrigger a natural restoration of the skinthat results in an increase in volume andfirmness and a healthier tone. Theseprocedures wake up the machinery.

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Instead of walking out of your doctor’soffice looking like you were in a housefire, you might be a little pink (there canalso be some very mild bruising), butyou can go out to dinner that night withminimal makeup.

Each type of treatment has manyvariations. There are, for instance,dozens of different types of lasers.You’ll need to discuss the specifics withyour dermatologist—your, I stress,board-certified dermatologist. I am aboard-certified dermatologist, whichmeans that along with my regularmedical training, I completed a three-year residency in dermatology andpassed a test administered by theAmerican Board of Dermatology. Of

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course I’m going to recommend that yousee a board-certified dermatologist forinjections, laser procedures, andanything else involving diagnosis andtreatment of medical, surgical, andcosmetic concerns of the skin, hair, andnails. This is not just me beingterritorial. Every day in my office I seewhat happens when patients receivetreatments from people who are notqualified or experienced in giving them.Not only do people get overfilled ortreated with the wrong kind of laser, butthe person treating them often missesmore serious problems. Do yourhomework. The American Academy ofDermatology can help you find a board-

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certified dermatologist in your area(www.aad.org/findaderm). For more onwho should and shouldn’t treat you, youcan also go to my websitewww.lancerskincare.com.

When someone needs more than skincare to address aging, I have him or hertry the least invasive procedure first, andthen we go from there. Here’s what Ibelieve is a good progression.

First Stop: Microdermabrasion

Microdermabrasion is a technique that“sands” the superficial layers of theskin. Dermabrasion is a similartechnique, but it causes much greaterwounding and has a longer healing

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process. In most cases, I don’trecommend it and certainly not as a firststop. Microdermabrasion, which isgentler, uses an abrasive wand and avacuum suction to remove the dead skincells. It’s good for sun-damaged skin,age spots, superficial pigmentation, finelines and wrinkles, clogged pores,blackheads and whiteheads, and somemild acne scars. The neck and chest canalso be treated to blend the skin andremove any sun damage found in thatarea. The procedure takes only about ahalf hour, and there’s little or no healingtime.

Second Stop: Chemical Peels

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Before a patient tries lasers orinjectables, I almost always recommenda chemical peel first. Peels are like anextra-effective polish and cleansesession: they deeply exfoliate the stratumcorneum to refresh the skin, smoothlines, and lighten brown spots. They canalso be used to remove precancerouslesions. Peels involve the application ofa liquid or paste. They can be of varyingstrengths; some use alpha hydroxy acidsolutions, some a mix of acids. The skingenerally responds by peeling, the sameway it does after a sunburn, and it maytake a week or ten days to heal. Somepeels—phenol peels, for example—stripthe skin so thoroughly that they can be

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painful and require weeks of healingtime. These typically aren’t doneanymore.

The effects of peels can last from oneto several months. You can have themdone solely on your eyelids, or sectionby section, all over your body. If you’rehaving a peel on your face, it’s usually agood idea to do your neck and chest, too,so there isn’t a disconnect betweenwhat’s above and what’s below the chin.

While not all skin care treatments arerecommended for every color skin, allskin colors can handle some form ofchemical peel. Your dermatologist canadvise you on what type of anti-agingpeel will remedy your particularconcern. Some are best for acne, some

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vanquish blotchiness, and others canminimize wrinkles. In my office wetypically combine peels withmicrodermabrasion. Polishing the skinfirst lets us apply the peel to a primedcanvas (so to speak), setting the stage fora clean, smooth, and more predictableresponse.

Third Stop: Lasers

The next step along the touch-upcontinuum is laser resurfacing. Einsteinlaid the groundwork for the invention oflasers (light amplification by thestimulated emission of radiation)—that’show far back they go. In 1963, theybecame medical grade, and I’ve been

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using them myself since the 1970s. Buttoday’s lasers are nothing like the oneswe used back then, when there wereonly two suitable for dermatologicaluse, both of which burned the skin andrequired major recovery time. Today’slasers are highly refined, and the skinheals quickly after most treatments ifproperly done on well-primed skin. (Ican’t overemphasize the need for skinconditioning before a procedure!)

Lasers and other energy-basedtreatments generally work by triggering ahealing response that leaves skin softer,smoother, and tighter. But that’s really ageneralization, because there are somany energy-based treatments availablenow and they all have their unique

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means of reaching a particular end.There are, for instance, treatments forbrown, blotchy discolorations on theskin. Some lasers are used for correctingfine lines, scars, or pore enlargement.Some tone or tighten skin. Othersremove hair or broken blood vessels.There are lasers that specialize inremoving tattoos as well as permanenteyebrow and lip lines. There are evenliposculpting lasers that work from theinside (this is an invasive procedure) totighten and contract the skin. And not allenergy-based treatments use lasers.Other technologies include infraredlight, which uses heat (versus light) totighten loose skin; intense pulsed light

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(IPL), a tool effective for redness,rosacea, and excess melanin, and forimproving color and pore size;radiofrequency, which helps producenew collagen; and light-emitting diode(LED), which helps with acne,wrinkling, and pigmentation.

If you’ve tried a chemical peel andwant to go to the next step, start with anonablative laser treatment. Also callednonwounding lasers, these are best atmaking minor corrections on the skin,firming and improving tone and texture.They work beneath the top layers of theskin to trigger collagen production andother repair mechanisms. Another optionis fractional resurfacing, which deliversa series of microscopic, closely spaced

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laser spots to the skin whilesimultaneously preserving the normalhealthy skin between those spots. This isa good option for improving fine lines,wrinkles, brown pigmentation, sun spots,age spots, and acne scarring. Andbecause the laser preserves the healthyskin, the healing is rapid. The entire facecan be treated in about forty-five minuteswith very little discomfort; there’s noneed for pain medication and nosignificant downtime. Both types of lasertechniques require several sessionsspaced three to four weeks apart.

The most invasive type of lasers arecalled ablative. Because they go deepand effectively vaporize the top layer of

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the skin, they create dramatic results inonly one treatment—you get more bangfor your buck. However, these lasersrequire significant finesse and there’smore healing time (seven to ten weeks).

Laser treatments are not without risk.Some can cause loss of pigment,scarring, or an unattractive change inskin texture. If you have black or brownskin, be sure to go to a dermatologistwho is well versed in treating darkerethnicities. And no matter how your skinlooks to the naked eye, be certain yourdoctor also knows your ethnic heritage,especially if it’s mixed. In 1998 Iintroduced a scale that dermatologistscan use to predict whether their patientsare appropriate candidates for laser

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treatments. The scale assigns a number,1 through 5, to each grandparent of thepatient. Grandparents who were Africanget a 5; grandparents from Nordic areasget a 1. The total is then divided by 4 toget the patient’s LES (Lancer EthnicityScale) score. The lower the score, thelower the risk of scarring and unevenpigmentation after laser treatments. Hereare a few other suggestions. Remember:Procedure means risk!

Don’t get lasered at the mall. Everyday I see scars from laser treatmentsperformed by people who shouldn’tbe operating the equipment even ifthere is no law against it. Lasers canbe damaging if they’re not used

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properly. Go to a board-certifieddermatologist who will perform thetreatment him- or herself, preferablyone with years of experience andmany different lasers (that waythere’s a greater chance that he or shewill use the absolute best tool for thejob).

Be prepared for the cost. Lasertreatments can run into the thousandsof dollars.

Know the likelihood of success. Dolasers work for everybody? No,although they have a very goodrecord. Patients tend to fare better iftheir skin has good elasticity and they

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are relatively thin. Talk to yourdoctor about what you canreasonably expect from the treatment.Realistic expectations are a must.

Last Stop: Injectables

Injections of compounds that plump upor freeze wrinkles and firm slack skinshould be last on your list ofinterventions. The concept of injectingsomething into the body to increasevolume seems relatively new, but even ahundred years ago, fat fillers were usedto help in recovery from battle wounds.There are also reports in the medicalliterature going way back of peopleinjecting themselves with oil and waxes.

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The first big commercially useddermatologic filler was silicon, andsome doctors are still using it today.There’s no law against it, but thereprobably should be. Unlike otherinjectables, silicon doesn’t dissolve, soeven if the initial injection doesn’ttrigger an inflammatory immuneresponse, eventually the immune systemwill wake up and the body will start towall off the silicon, creating rock-hardtissue and other problems. Don’t gothere—it’s not worth it.

Modern fillers and wrinkle-freezerseventually dissolve. Fillers not only fillthe space where collagen and fat used tobe, but also stimulate a controlled

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response in the skin (not anunpredictable one as happens withsilicone) that triggers collagenproduction, creates volume, and attractswater to the skin. Depending on whichtype of injectable you choose, they’regood for improving fine lines andwrinkles, making lips fuller, fillinghollow cheeks, and plumping up deepfolds. Injectables tend to be used aroundthe mouth, eyes, cheek, jaw, brow, andbridge of the nose. But they can be usedanywhere there is tissue volume loss(hands, breast, buttocks, for instance).

Wrinkle-freezers, also known asneurotoxins, work by blocking the nervereceptors on the muscle to inhibitwrinkle formation. Think of it this way.

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Water in a cup ripples when you tap it;frozen water doesn’t. It sounds like itwill feel weird, but there’s no oddsensation. After treatment, patients canstill frown and smile normally, but whenthey do, the crinkles around their eyesand forehead are greatly diminished. Theeffects last about four months.

Most patients get neurotoxininjections to address crow’s feet andforehead lines, but you don’t want a totalelimination of lines and faults in theskin. You want a reduction; otherwiseyou’ll look so altered that it will beobvious from a hundred yards away thatyou’ve had Botox. You want to lookfresh and radiant, not “fixed.”

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How Much Do INeed?

As a general rule, tell your doctor howmuch of a change you want to see as aresult of an injectable treatment. Next,ask him how much of a change hethinks you should pursue. Average outthese two—then cut the sum in half.You can always go back and get more,which may be inconvenient, but farbetter than walking away from theoffice looking overplumped or toofrozen. Too much of a filler can distendthe skin and result in a very unnaturallook that becomes permanent becausethe skin has been overstretched. Toomuch of a neurotoxin can obliterateyour facial expressions. The goal is tolook younger, not like you’re in acoma! One of my patients, who comes

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to see me all the way from the EastCoast, always says, “Don’t give me mymoney’s worth.” In other words, don’toverfill. It’s a smart request.

Your dermatologist can help youdecide which brand-name filler orfreezer best meets your needs. Somefillers are made from compounds naturalto the body like collagen and hyaluronicacid, while others are made fromsynthetics. Botox is the most famousneurotoxin, but there are others on themarket, too.

Injectables are relatively reasonablein price—they start at a few hundreddollars—but they require somewhat of acommitment on your part. While it varies

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from person to person, you’ll probablyneed filler injections about twice a year,sometimes more often depending onwhat’s used. That’s not only because thefillers don’t last, but also because theclock keeps ticking, meaning you’ll losemore volume and have more to fill astime goes on. Most people are pleasedwhen they see their faces looking twentyyears younger, but some people get alittle too pleased. They want more andthey begin to get a distorted idea of whatlooks attractive. That’s when you startseeing frozen foreheads and platypuslips, a sign that both the patient and thephysician have lost their sense ofproportion and artistry. It’s also a signthat injections have become an unhealthy

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addiction.It’s a dangerous addiction, because

even though most fillers and wrinkle-freezers eventually dissipate, there’sstill a chance of permanent damage.Think about a balloon. If you keep fillingit up, it begins to lose its original shapewhen the air is gone. That’s whathappens to the face or any part of thebody if you’re not conservative withfillers. In the case of injectables, less ismore. Before you embark on treatment,make sure that you and yourdermatologist agree on appropriategoals.

Order from the Menu Sensibly

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The beauty buffet is wide, but Iencourage you to use restraint. You’llhear a lot about all the differentprocedures that can make you lookyounger, but there’s no need to jump onthe bandwagon at every turn. When youtake good care of your skin, you may notneed to spend a lot of money or takerisks to turn back the clock. Rememberyou’re not just going for the illusion ofyouth; you want your skin to act younger.

Think, too, about how a skin careregimen can keep your complexionyouthful and vibrant for life. It’ssomething you can always do by yourself—you don’t have to worry about aprocedure wearing off and going throughthe whole thing again… and again… and

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again. Skin care is easy, it’s quick, it’srelatively inexpensive, and you are inthe driver’s seat.

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CHAPTER 5

Rejuvenating Sleep

By Ronald L. Kotler, MD, DABSM

A MAN, NINETY YEARS OLD, was asked towhat he attributed his longevity. “Ireckon,” he said with a twinkle in hiseye, “it’s because most nights I went tobed and slept when I should have sat upand worried.” That little tale, true or not,was a favorite of Dorothea Kent, anactress who hit her prime in the 1930s.

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Kent frequently played the quintessentialdumb blonde, but she was smart if shethought that there was an associationbetween long life and sleep. In fact, shegot it exactly right.

Anyone can tell you that getting agood night’s sleep makes you look andfeel better, but now we also know forcertain that lack of sleep predisposesyou to several life-shortening diseases.Research shows, for instance, that itdoesn’t take long for someone with asleep deficit to begin developingproblems related to obesity. Not onlydoes the body’s ability to process sugarbecome impaired, but the hormone thatmakes you hungry increases and the onethat tells you you’re full decreases,

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setting the stage for ample weight gain.There’s also evidence that getting lessthan six hours of sleep per night canincrease your risk of heart disease,stroke, and depression. Finnishresearchers have even found that gettingless than seven hours of sleep increasesthe risk of early death by 26 percent inmen and 21 percent in women.

Sleep is like the air we breathe; weneed it to be healthy in virtually everyway, as well as to be safe. Skimping onthe proverbial forty winks can lead toserious injury, sometimes evenpremature death. The National HighwayTraffic Safety Administration estimatesthat each year more than 100,000 people

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crash on the highways because ofdrowsy driving. Many are killed orpermanently injured.

So getting enough sleep doesn’t justmake you look and feel better—it’spowerful preventive medicine. Just asyou eat healthfully and exercise toimprove and maintain your well-being,it’s essential to follow a regimen thatpromotes adequate and restful sleep.

A lot happens while you’re sleeping.During the day when you’re active, yourenergy resources are directed towardmaintaining your body. But at night, theconstruction crew gets to work. It’sthought that the body regenerates boneand muscle as you sleep while alsorepairing and synthesizing proteins that

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are critical to every part of the body,from the immune system to the skin.Regeneration of connections in the brainand consolidation of memories andemotions are also believed to take placeduring sleep, undoubtedly one reasoncognition is better when you’re wellrested.

One of the biggest myths is that youneed less sleep as you get older. That’ssimply not true. In general, adults pastthe age of about eighteen need seven tonine hours of sleep. It’s thought thatexactly how much each individual needsis genetically determined, and it’simportant to figure out exactly whatworks for you. Aim for the amount of

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sleep that makes you feel refreshedthroughout the day. While there are rareindividuals known as “short sleepers”who can get by with fewer hours ofnightly slumber, most people who sleepless than seven hours per night build upa sleep debt and have trouble stayingawake during the afternoon. This is yourbody’s way of telling you not tosacrifice your much-needed sleep.

Interestingly, there is evidence thatregularly sleeping more than nine hoursmay put you at risk for life-threateningdiseases such as diabetes and obesity.But this isn’t nearly as big a problem asnot getting enough sleep, particularly asyou get older. As you age, you need justas much sleep but it becomes

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increasingly difficult to get as muchsleep. Age-related changes in the sleepcycle diminish the amount of deep,restorative slumber you experience eachnight, which not only affects the qualityof your sleep but also makes it harder tosleep through the night without waking.Waking wouldn’t be so bad if you couldfall immediately back to sleep; however,it’s common for people to have troubledozing off again. People with insomniaoften find themselves tossing andturning, worrying about not gettingenough sleep—a self-perpetuating cycleif there ever was one.

Dire as that sounds, there’s actually alot you can do to compensate for changes

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in the sleep cycle and improve both thequantity and the quality of your sleep. Inchapter 4, Dr. Lancer talked about skinhygiene; here, I’m going to talk aboutsleep hygiene: healthful practices thathelp you nod off at night and maintainrestorative sleep. Sleep hygiene isactually connected to skin hygiene, justas it’s linked to healthy eating, exercise,and other anti-aging topics in this book.When you’re well rested, you’re goingto have the energy and inclination toexercise and cook nutritious meals, aswell as be less likely to shrug off yourskin care regimen. Your skin is going tolook more refreshed, too. Being wellrested will also put you in a morepositive frame of mind, helping you cope

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better with youth-sapping stress. Sleepsimply gets you operating in high gear.

The tenets of sleep hygiene will makea lot more sense once you understand thedifferent phases of sleep and thebiological rhythms that govern them.

AGING AND THE SLEEPCYCLE

Whether or not you’re aware of it, yourbody runs on a clock; several clocks, infact. An area of the brain called thehypothalamus generates what’s known asbiorhythms, cyclical patterns thatregulate just about every physiological

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process in the body. The menstrual cycleis an example of a monthly biorhythm;appetite, body temperature, bloodpressure—and sleep—are all influencedby daily biorhythms. When we talk aboutsleep, we refer to its biorhythm as acircadian rhythm (circa means “around,”dian means “day”). The sleep-wakecircadian rhythm is determined by ahighly complex interaction between lightand neurotransmitters in the brain. Whenit’s dark, our bodies are programmed toseek sleep, and when it’s light they’reprogrammed to stay awake. Our use oflight bulbs to light up our night hasskewed things slightly, but wheneverything is working properly, ourbodies are still inclined to follow the

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sleep-wake schedule we evolved with:on average, sixteen hours of wakefulnessand eight hours of sleep.

To stick to this schedule, the bodyreleases chemicals that wake you upwith the morning’s light and keep youalert for several hours thereafter.Between one and six p.m.—the exacttime can vary from person to person—you’ll probably feel a dip in energy andmaybe even feel like falling asleep. It’sso predictable that many countries builda midafternoon break (the siesta) intotheir day, and if you don’t nap you’veprobably developed some way ofcoping, perhaps taking a coffee break,visiting the office vending machines, or

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walking around the block to shake offdrowsiness. As the day goes on, you geta second wind, but you also build upwhat’s known as a sleep drive—a desireto sleep that gradually increases as youstay awake. During the evening, furtherbiochemical changes in the bodyincrease the sleep drive until finally, byabout eleven p.m. for most people, youwant—and need—to go to bed.

The sleep-wake circadian rhythm isan elegant, well-designed system;however, it does change at differenttimes of life. Adolescents and teenagers,for instance, experience a shift that cuesthem to go to sleep later and wake uplater. Aging has an impact on thecircadian rhythm, too. It’s very common

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for people ages sixty-five and up toexperience the opposite of theadolescent/teenage phenomenon: Theircircadian rhythms tell them to go tosleep earlier and wake up earlier.

If you’re getting enough high-qualitysleep, it doesn’t necessarily matter whenyou go to bed and get up. But other age-related physiological changes can makegetting enough high-quality sleepchallenging. And what is high-qualitysleep? Stage 3 sleep, also known asdeep or slow-wave sleep.

When you’re asleep, your brainexists in one of two states: non-REMsleep or REM sleep. REM stands forrapid eye movement and it describes the

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stage of sleep in which most dreamingoccurs. The complete cycle of non-REMand REM sleep takes about ninetyminutes, then starts all over again.During REM sleep you’re virtuallyimmobilized; you might twitch a bit, butyou have limited movements in yourarms and legs. When you first nod off,you go immediately into non-REM sleep,then you go into REM sleep, togglingbetween the two so that you go intoREM sleep about four to six times pernight. The first bout of REM is only oneto five minutes long, but REM sleep getsprogressively longer through the night sothat you’re in it an average of eighteen totwenty-two minutes per episode. REMsleep makes up about 20 to 25 percent of

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an adult’s night sleep, and that figurestays pretty constant as you age. Thereason that REM sleep is important isnot fully understood, but it’s believed tocontribute to overall emotional andpsychological well-being.

Non-REM sleep is the type of sleepyou need for repair and restoration of thebody. Unlike REM sleep, non-REMsleep changes as you get older,beginning at around age thirty. Non-REM sleep is divided into three stages,1, 2, and 3. Stages 1 and 2 are the lighterstages of sleep. Stage 3 is known asdeep or slow-wave sleep (each phase ofsleep has distinctive brain waves thatare measurable on high-tech monitors),

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and it’s what you need to feel refreshedin the morning. For some reason that hasyet to be discovered, deep sleepdiminishes greatly as you age. By thetime you reach your seventies andeighties, your slow-wave sleep can beminimal or totally absent. What’s more,the slow-wave sleep you do have isn’tas deep as it was when you wereyounger.

The age-related ebb of slow-wavesleep presents a few different problems.With less deep sleep, you spend moretime in the lighter stages of sleep, so notonly do you get less refreshing sleep, butyou’re often in a stage from which youcan be easily awoken. And because thedepth, not just the length, of your deep

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sleep changes with age, you can be moreeasily awoken in stage 3 sleep, too. Acreak in the floor, the slam of aneighbor’s car door, and you’re up.

Your vulnerability to beingprematurely awakened changes throughthe years. When my son was about twoyears old, we took him to a wedding.During the reception, he crawled underthe table and fell fast asleep. Despiteblasting music and people dancing allaround us, he remained in a deep sleep.At age two, he had the luxury of havingplenty of stage 3 sleep. Now consider afifty-four-year-old man, who as an emptynester decides along with his wife that itmight be nice to leave their quiet, tree-

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lined suburban home and spend a fewnights a week in the city. On the firstnight in their little studio apartment, itbecomes clear that sleeping is going tobe a challenge. The sound of sirens,traffic, people talking and partying in thestreet—sounds that probably wouldn’thave bothered him if he were in histwenties—wake him up repeatedly. Nowevery time he spends the night in the city,he wears earplugs.

When you become a lighter sleeper,you are susceptible not only to externaldisturbances (e.g., honking horns and caralarms) but to internal ones as well. Soif, like many people as they age, youhave some sort of medical condition orcomplaint, it becomes increasingly

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likely that pain or discomfort will wakeyou up. Gastric reflux (otherwise knownas heartburn), arthritis, a bum knee orother orthopedic problem,breathlessness from heart or lungdisease, hot flashes associated withmenopause, prostate issues that createthe urge to urinate—any of these canleave you staring at the ceiling at twoa.m. And as you get older, you may bemore likely to take medications thatdisturb sleep. Asthma medicines, forinstance, can be stimulating. Someantidepressants and heart and bloodpressure medications can causewakefulness, and diuretics can make theurge to urinate hard to ignore.

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Good restorative sleep habits areyour best defense against disruptedsleep, but there are some conditions thatcan’t be fixed with good sleep practicesalone. If you think any of the followingthree problems might be causing you tolose sleep, it’s important to find ways tocure or cope with them as yousimultaneously begin implementing thesleep hygiene advice I outline in thischapter.

OBSTRUCTIVE SLEEPAPNEA

According to the American Sleep Apnea

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Association, sleep apnea affects about12 million Americans, but the vastmajority of cases goes undiagnosed. Ifyou have sleep apnea, you might liedown, fall asleep, and progress intostages 1 and 2. Then, just as you’regetting ready to descend into deep slow-wave sleep, the muscles in the back ofyour airway collapse, obstructingbreathing. At first this just causessnoring, but as the airway narrows andairflow becomes either partially or fullyblocked, the brain responds by sending apowerful message to the airway musclesto open up—and they do. However, thebrain’s message also triggers the releaseof catecholamines, stimulating hormonesthat prepare the body to either fight or

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flee a potentially harmful situation (the“fight or flight” response). This not onlydisrupts the normal progression of sleepbut also increases the risk of high bloodpressure, heart attack, and stroke.

Obstructive sleep apnea can hit atany age, and the likelihood ofdeveloping it increases as you get older.Like a lot of areas in the body, theairway muscles can begin to sag as youget older, increasing the risk that whenthey relax (everyone’s airway musclesrelax during sleep; it’s just a question ofhow much) they’ll block the flow of air.Being overweight makes you more proneto sleep apnea. If you aren’t feelingrefreshed when you wake up, are feeling

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extremely fatigued, wake yourself (oryour bed partner) up by snoring, or havebeen witnessed to stop breathing as yousleep, it’s essential that you see yourphysician.

A sleep study is necessary to confirmthe diagnosis of obstructive sleep apneaand to determine its severity. During asleep study, you spend the night at asleep center, where you’re hooked up tovarious monitoring devices. (Make sureyour sleep study is performed at a centeraccredited by the American Academy ofSleep Medicine—www.aasmnet.org.) Ifyou do have obstructive sleep apnea, theprimary treatment is nasal CPAP(continuous positive airway pressure).This is a device that blows air through

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your nose to the back of your throat andkeeps your airway from collapsingwhile you sleep. Sleep apnea can alsobe treated by the use of an oralappliance typically made by a dentist,removal of the tonsils, or surgicalcorrection of a deviated nasal septum. Ifyou’re overweight, weight loss alonecan lead to a dramatic improvement.Depending on the severity of your sleepapnea, your physician may advise you towear CPAP as you sleep while youwork on losing weight.

MENOPAUSE

The most obvious menopausal symptom

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to disrupt sleep is hot flashes. But youdon’t have to have hot flashes to sufferfrom menopausal-related sleepproblems. I have seen plenty of patientswho were great sleepers all their livessuddenly experience insomnia eventhough they’re not having hot flashes.Fluctuating estrogen and progesteronelevels can be wildly disruptive toregular sleep patterns and make itdifficult to drift off at night. When awoman has hot flashes to boot, it’s adouble whammy, with hormonal changesmaking it hard to fall asleep and the hotflashes making it hard to stay asleep.

Some women find relief with the helpof a light sleeping pill. Hormone

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replacement therapy is another option,though it’s important to discuss the riskswith your physician (see here for moreon HRT). If you’re looking for a naturalsolution, you might try black cohosh, aNative American herb that can help withhot flashes. Hot flashes can also be lessdisruptive if you wear very light clothesto bed (there are even special pajamasand nightgowns in “dry” wicking fabricsmanufactured for people with nightsweats), avoid spicy foods, and use afan to cool you down.

GASTRIC REFLUX

One of my patients likes to tell me that

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when he was a teenager he could eat aPhilly cheese steak and half a pizza atmidnight, go to bed, and sleep like ababy. Now in his fifties, he has to waitfour hours from his last bite in theevening before he can go to bed.Otherwise, he lies down and the nextthing you know, he’s starting to coughand has an acid taste in his mouth—heartburn, the more common name forgastric reflux.

Gastric reflux, which occurs whenfood and stomach acid come back upinto the esophagus, is yet another maladythat becomes more common as we age.There are a couple of reasons why. Oneis that it’s not unusual for the tiny hole inthe diaphragm that allows the esophagus

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to connect to the stomach to becomedefective with age. The hole gets biggerand the stomach pushes up into the chest—it’s called a hiatal hernia—allowingthe food and acid that should be goingsouth to move north. Gastric reflux canalso occur when a little muscle calledthe esophageal sphincter, whichseparates the esophagus from thestomach, becomes stretched out. Thesphincter usually does a good job ofkeeping the contents of the stomach frommoving back up, but when it’scompromised, heartburn happens.

Since gastric reflux is worse whenyou’re reclining, it can make sleepdifficult to achieve and maintain. And

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there can be more serious consequences.I have had patients whose reflux ledthem to bring up food and acid that thenwent through their vocal cords and intotheir lungs while they were sleeping.They ended up in the emergency room atthree a.m. with pneumonia. Anything likethat, however, is less likely to happen ifyou take preventive measures. Like myformer cheese-steak-and-pizza-eatingpatient, give yourself a three- or four-hour stretch between your last bite andbedtime. If that’s not possible, start yournight’s slumber in a comfortable chair soyou don’t lie in bed wide awake becauseof the discomfort.

You’ll be less likely to experiencereflux if you shift the bulk of your

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calories to the earlier part of the day (agood practice regardless) and eat arelatively small dinner made up of low-fat, non-fried foods—meals, in otherwords, in line with the recommendationsin chapter 3. Skip acidic fruits andvegetables, mints, candy, alcohol, andcaffeine at night. Use antacids asnecessary, but if you’re using them everynight, you need to see your physician. Adoctor can diagnose the cause of theproblem and suggest remedies. Someprescription medications such as H2blockers and proton pump inhibitors cansuppress acid production and be veryhelpful. If medication doesn’t work,discuss surgical options with your

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physician.

There are other problems beyond thesethree that can lead to disrupted sleep.Restless legs syndrome, which producesuncomfortable sensations in the legs anda desire to move them, is one. Acondition called propriospinalmyoclonus, which involves suddenmovement that keeps you from fallingasleep, night terrors, and sleepwalkingare other conditions to see a sleepspecialist about.

GETTING A GOOD

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NIGHT’S SLEEP: AN 11-POINT PLAN

So far, we haven’t found a way to shiftthe balance of light and deep sleep inolder people back to its younger andmore restful ratio. But we have foundthat there are many ways to compensate,and if you maintain healthy sleeppractices, you can still get all therejuvenating sleep you need to fightdisease and ensure that your bodyfunctions in top form regardless of age.The following sleep hygiene tips aretried and true. Check them off your listand you’ll raise the odds considerably ofgetting a good night’s sleep. Believe me,

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you’re going to find that they work awhole lot better than counting sheep.

1. Be Consistent

The best way to make certain that youget seven to nine hours of sleep eachnight is to go to bed and wake up at thesame time every day—or close to it.Even if you pride yourself on being afree-spirited, spontaneous kind ofperson, your body yearns for a regularschedule. A bedtime that zigzags fromeleven p.m. one night to three a.m. thenext, then back to eleven p.m.—with acorresponding crisscross of wake-uptimes—throws your system off and canlead to sleep disruption.

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When it comes to consistency, Ireally try to practice what I preach. I getto bed about eleven p.m. weeknights andget up at about seven a.m. On theweekends I might go to bed an hour laterand sleep an hour later, but I try not tovary it more than that. Think about whathappens when you stay up until two: toget eight hours of sleep in, you don’t getup until ten. Maybe you’ll try to return toyour regular schedule and go to bed ateleven, but because you woke up at tenthat morning, you’re not tired at eleven,so you stay up a few more hours… Yousee where I’m going with this. Divertingtoo far from a regular pattern sets you upfor a vicious cycle of insomnia and

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disturbed sleep.As part of your consistency plan, try

to get outside every morning (or sit by awindow) so that you have someexposure to light. Morning is a greattime to exercise outdoors. Morning lightexposure helps set your clock for theday, helping you to feel tired enough tosleep when bedtime rolls around.

2. Have a Bedtime Routine

Have you ever felt absolutely exhausted,dropped into bed, then had troublefalling asleep? This is a commonscenario, because even if you feel tired,your brain needs time to wind downbefore it can slip into sleep. It’s not

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enough to have a relaxed body; you alsoneed a relaxed brain. Very few peoplecan work on the computer, answer e-mails, or watch TV until eleven p.m.,then turn off their brains, roll over, andfall fast asleep. And this is particularlytrue of people prone to insomnia. Onereason it’s so difficult to do is becausemany of the devices we use in theevening involve light, which, as you’llremember, cues the brain to stay awake.It doesn’t help that your mind will likelybe aroused by what you’ve been readingor watching, adding another barrier tosleep.

Your first line of defense should beto organize your day in a way that’sconducive to helping you slow down in

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the evening. Take care of all thecomputer and phone work you need todo earlier in the day, and if you have tohave any stressful conversations, makesure you have them well before it’s timefor bed. Also, create a schedule foryourself that ensures that you don’t eatdinner or exercise too close to lights-out(I’ll talk more about these in a minute).

Then get into the habit of quietingdown in the evening. Dim the lights asthe night wears on and give yourself apre-bed ritual. It might involvestraightening up a bit, setting aside thingsyou’ll need in the morning, brushing yourteeth, flossing, and going through yourskin care routine (Dr. Lancer’s polish-

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cleanse-nourish method!). If you havethe time and inclination, take a warmbath—it’s been shown to help hurrysleep onset. Adding a lavender scent tothe water has been proven to berelaxing, too. Reading in bed is anothergood way to get your brain to ease intosleep. Many people find this to be a verysoothing activity, especially if thematerial isn’t too exciting. When you gothrough the same routine every night, it’sgoing to signal your brain that it’s timefor sleep. If you have difficulty falling orstaying asleep, consider reading in aroom other than your bedroom using alow-watt light.

Only use your bed or bedroom forsleep (the exception, as just noted, being

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reading if it helps you drift off to sleep).If it doesn’t lead to a persistent state ofarousal, sex is okay, too. Pavlovconditioned dogs to hear a bell andsalivate because they associated the bellwith food. Our brains react similarly tosuggestion. If you condition your brain tosee your bed as a place for sleep, assoon as you walk into the bedroombiochemical changes are going to occurthat increase the likelihood that you’llfall asleep. Conversely, if you watchTV, work on the computer (or your smartphone), or have upsetting phoneconversations with your mother-in-lawin the bedroom, your brain is going toassociate your bedroom with

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stimulation. For most people, sex canlead to a state of deep relaxation andhelp ease you into sleep. But there aresome people who have trouble fallingasleep after sex. Coordinate the timingof intimacy with your partner so that youcan both get a good night’s sleep.

3. Empty Your Mind

Stress and anxiety can prevent you fromfalling asleep by making it hard to slipinto that relaxed-brain mode I was justtalking about. They can also wake youup in the middle of the night, as anyonewho’s found himself panicking aboutmortgage payments at four in the morningcan tell you. Before you go to bed (or

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after you’ve gone to bed but cannot sleepbecause your mind’s on overdrive), sitquietly in a room other than yourbedroom and write down all of thethings you need to attend to the next day.Realize, too, that these are things youcan’t work on right now. You can’t callthe mortgage company. You can’t talk toyour boss right now (and don’t eventhink about sending her an e-mail!). Youcan’t discuss the washing machineproblem with your soundly sleepingspouse. So write it all down—that willgive you some peace of mind, becausenow you’re not going to forget anythingtomorrow. Leave the piece of paper inthe other room and go to bed.

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4. Not Before Bed: Alcohol,Caffeine, Nicotine, a Big Meal

If you need another reason not to smokebesides that it’s the absolute worst thingyou can do for your health, consider thatsmoking also interferes with sleep:Nicotine’s stimulating effect can keepyou up at night. What’s more, researchsuggests that smokers take in less oxygenwhile they sleep, which may lead to avariety of conditions that can causepremature death.

Caffeine, as you probably alreadyknow, is also a stimulant, but what youmay not know is that it can stay in yourbody for as long as fourteen hours. Ifyou’re very sensitive to caffeine, avoid

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coffee, tea, chocolate, and caffeinatedsodas for ten or twelve hours beforebedtime. It’s also a good idea to avoidalcohol in the late afternoon and eveningif you typically have trouble sleeping(moderate drinking is okay if it doesn’tseem to bother you). Though it initiallyacts as a sedative, as alcohol ismetabolized it has a stimulating effect onthe body that may make it hard to fallasleep or may wake you up. Alcoholalso exacerbates snoring and sleepapnea. If you must have a nightcap, makeit something soothing, such aschamomile tea, or a beverage thatcontains calcium, such as milk or ayogurt drink. Calcium works as a naturalsedative for some people.

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Like alcohol, a big meal might makeyou sleepy at first, but you will suffer forit later. If you try to go to sleep after abig meal, your body is going to be toobusy digesting the food to sufficientlymove into relaxation mode. Likewise,eating anything high in fat or proteinclose to bedtime may keep you awake(they take longer to digest thancarbohydrates). If you’re prone to reflux(see here), you also run the risk ofending up with an insomnia-inducingcase of heartburn.

To Nap or Not toNap?

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A lot, both pro and con, has been saidabout napping, so let me clear it up foryou. A thirty-minute nap can be veryenergizing and refreshing and, if youhave the time, it’s a good way torecharge. Earlier I mentioned that it’scommon to have an afternoon dip inenergy. That dip is going to feel likethe Grand Canyon if you’re not gettinghigh-quality sleep at night. For somepeople, a power nap is the perfectremedy.

Discovering whether or not apower nap works for you may takesome trial and error. And there aresome caveats. If you have insomnia, Idon’t recommend napping, because itdiminishes your sleep drive. When youtry to fall asleep later that night, it’sgoing to be rough going. Even if youdon’t suffer from insomnia, make sureyou don’t nap too close to dinnertimeor for longer than thirty minutes. Along nap or a nap just before or after

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dinner will probably make it hard foryou to drift off to sleep at bedtime.

It’s also important to realize thatnaps are not a substitute for a goodnight’s sleep. A thirty-minute nap isn’tenough to give you the deep sleepyou need to repair your body andrefresh your mind. So while a nap canhelp you make up some lost sleep, itcan’t replace healthy nighttime sleep.

5. Exercise Often and at the RightTime of Day

Exercise, and cardiovascular exercise inparticular, is probably the best naturalsleep aid you can find. Regularly gettingyour heart rate up triggers the release ofendorphins and may have a positiveeffect on serotonin levels, both of which

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help relieve stress and promote deep,restorative sleep. For those samereasons, exercise also helps lower therisk of depression and one of its sideeffects: insomnia. Yet to get the sleepbenefits of exercise, timing iseverything. Vigorous physical activitycauses the release of adrenaline, puttingyour body in an excited state that makesit hard for you to drop off. It alsoelevates body temperature, anotherobstacle to falling asleep. Try to getyour workout in earlier in the day, or atthe latest no closer than three hoursbefore bed. If, however, you’re game todo some gentle stretching or a strollaround the block before bed, I’drecommend it. Any movements that help

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you relax without raising your bodytemperature can help send you off intodreamland. Just make sure that prior tostarting a vigorous exercise program youcheck with your physician to make sureit is safe to do so. For more on exercise,check out chapter 2.

6. Block Out Stimuli

This is an especially important part ofsleep hygiene for anyone in midlife andolder. Now that you spend longeramounts of time in the light sleep stagesand your deep sleep isn’t as deep as itused to be, you need to anticipate noise,movement, and other disruptions that canjolt you awake. Close the drapes, shut

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your bedroom door, turn off or removeany electronics giving off ambient light—you might even go as far as installingsoundproof windows or blackoutcurtains. An eye mask, earplugs, andsome kind of noise-blocking machinewith soothing sounds can also help. Onepatient of mine has lights with a motionsensor in her backyard. Any time aneighborhood cat or her own dog is outthere prowling around in the middle ofthe night, the lights flick on, oftenawakening her. This is the kind ofsituation in which a mask can help. Andspeaking of animals, just say no to dogsand cats sleeping on your bed. Not onlycan their propensity to hog space andmove around at their leisure be

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disturbing, but they can also leavebehind hair and dander that stir upallergies and asthma. Love your pet, butget him his own bed. The importance ofdarkness, quiet, and the absence ofmovement in your bedroom can’t beoverstated.

7. Seek a Solution for Snoring

Snoring can be a sign of sleep apnea,which I discuss here, as well asphysiological irregularities (such aslarge tonsils) that cause breathing tovibrate the soft palate in the back of themouth. It’s always wise to have yourdoctor evaluate you to determine theunderlying cause of your snoring, even if

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it’s not disturbing your sleep. Somepeople snore loudly and don’t wakethemselves up (although their bedpartners aren’t always so fortunate).

If your snoring isn’t associated with ahealth problem such as obstructive sleepapnea and you’re just seeking ways tolessen your bed partner’s sleepdisruption, there are a few remedies youcan try. One is to nix alcohol at night,which can exacerbate snoring. Anotheris to lose weight if needed: Overweightpeople tend to be more susceptible tosnoring (and sleep apnea). You mightalso try sleeping on your stomach or side(sleeping on your stomach does makeyour face more prone to wrinkles, but itcan also decrease snoring). If you can’t

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seem to stay off your back, try sleepingin a T-shirt with a tennis ball sewn intoa pocket between your shoulder blades.Nasal strips have also been shown tohelp diminish snoring by increasingairflow through the nostrils. Forstubborn cases, there are surgicaloptions. Some ear, nose, and throatspecialists even offer “snoreplasty,” aprocedure that involves injecting astiffening agent into the soft palate.

8. Arm Yourself with a GoodMattress and Pillow

Comfort is key to a good night’s sleep.Pillows are a personal preference—some people like hard, flat ones; others

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like them soft and fluffy—but make surethat you buy one that won’t aggravateallergies or asthma if you have either.Look for pillows without feathers orthose billed as “hypoallergenic.” Youcan also purchase pillow casings thatblock out dust mites, which can lead toallergy or asthma reactions, too. If youhave arthritis in your neck, check outcervical pillows, specially made curvedsupports for the neck.

Like pillows, mattresses too are apersonal preference. However,whatever kind you choose, be certainthat it allows your head and spine to bealigned when you lie down (your hipsshouldn’t sink). Consider a memoryfoam mattress. It is designed to mold to

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the curves of your body. This can putless stress on your bones and musclesand decrease orthopedic-related achesand pains that develop with age. Anadded benefit to memory foam is thatyou won’t disrupt your bed partner’ssleep as you change positions throughthe night.

When you shop for a mattress, test itout by lying down in your typical sleepposition, then before you buy make surethe mattress has a thirty-day warranty.That way if it turns out to be not socomfortable after all, you can exchangeit for another.

Help! It’s Three A.M.

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and I Can’t Sleep

“I wake up at three in the morning. Ilie in bed and can’t get back to sleep.”I hear that complaint in my office justabout every day, especially amongpatients over the ages of forty andfifty who are just beginning to feel theeffects of the age-related downturn instage 3 sleep. So what is to be done?

Don’t just lie in bed looking at theclock—in fact, don’t look at the clock atall. That will only make you anxious(“I have to get up in three hours!”),and anxiety is the enemy of sleepbecause it leads to the production ofarousing chemicals in the body.Worrying about not being able tosleep makes it a self-fulfillingprophecy. Get out of bed—you don’twant your bed to become a place youassociate with sleeplessness. Sitquietly in another room with a dim

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light, open up a magazine or book(preferably something a little boring),and when you begin to feel sleepy,turn off the light and go back to bed. Ifit happens again, repeat.

There are all kinds of reasons youmay wake up in the middle of thenight or very early in the morning,including disturbing sounds or lights,having to go to the bathroom, hotflashes, pain from arthritis or otherconditions. Wakefulness is also acommon symptom of depression, so ifyou’re constantly battling insomnia,think about what other symptoms youmight have. Prolonged bouts ofsadness, frequent crying, feelings ofworthlessness, and finding that youdon’t enjoy life are all signs ofdepression (and the risk of depression,we know, increases with age). Seekhelp if you have any of thesesymptoms, and seek help immediatelyif you’re having thoughts of harming

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yourself.

9. Try a Sleep Aid

Sleeping pills can be very helpful as ashort-term treatment for insomnia.Sometimes an emotional event—sayyou’ve lost a spouse or are gettingmarried—can trigger acute insomnia;once you’ve gotten over the worst partof grieving or the excitement of awedding, the bad sleeping habits youdeveloped may remain and lead to achronic problem with insomnia. Manymodern sleeping pills are effective andnonaddictive, and they can be just thething to get your sleep back on track ifyou’re going through a rough patch.

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Sleeping pills, though, shouldn’t bethe first thing you try when you’re havingchronic trouble sleeping—make sure youhave all the other sleep hygiene habits inplace first. Another option is to considerseveral thirty-minute sessions ofcognitive behavioral therapy (CBT).Psychiatrists, psychologists, and othertrained counselors often use CBT to treatinsomnia related to anxiety and distortedthinking (i.e., you tend to blow smallproblems out of proportion). It can bevery helpful and may end your need forsleeping pills altogether.

If sleeping pills remain aconsideration, it’s worth consulting yourdoctor about benzodiazepine-like

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hypnotics (such as Ambien, Sonata, andLunesta) and benzodiazepines (such asRestoril, Ativan, and Klonopin).Benzodiazepines have multiple uses—they’re also prescribed as musclerelaxants and anti-anxiety drugs—andthey can be especially helpful if besidesinsomnia you have restless legssyndrome or another disorder calledperiodic limb movements, in which yourlegs move rhythmically at night. They’rea good choice if you also suffer fromanxiety, but shouldn’t be used if youhave sleep apnea (they can suppressrespiration).

While both types of drugs can cause adependency, benzodiazepine-likehypnotics cause fewer withdrawal

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symptoms. Bear in mind that both typesof drugs can have side effects such asresidual drowsiness during the day, adecrease in hand-eye coordination, andsleepwalking (and even sleep eating,cooking, and driving). You might alsotalk to your doctor about using othernon-sleeping-pill medications to helpyou sleep. Antidepressants, other typesof muscle relaxants, and antihistaminescan all be useful for insomnia (althoughsome antidepressants can have theopposite effect).

Melatonin supplements work forsome people, too. Melatonin is ahormone naturally secreted by the bodythat plays a role in establishing the

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sleep-wake cycle and that declines withage. Whereas light tells the body towake up, melatonin tells the body to goto sleep. If you’re going to try melatoninsupplements, do so with caution,because melatonin can disturb yourcircadian rhythm more than you’d like.Start with a low dose (1.5 mg), thenslowly increase the dosage if you findyou need more. Don’t exceed 6 mg aday, and never take it if you’re pregnantor have a serious medical condition.

Valerian is another alternative sleepaid you might talk to your doctor about.It seems to have Valium-like effects inmost people, but be aware that some findit stimulating. Be cautious; start with adose lower than that recommended on

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the label (it comes in extract, tablet, andcapsule form), and see how it goesbefore increasing your dosage.

10. Minimize Jet Lag

If you cross time zones, you can end upwith a temporary circadian rhythmdisorder (jet lag). What happens is thatyour body stays in the time zone you justleft even though there are cues aroundyou (such as daylight or darkness)indicating that you’re now on a differentschedule. As a result, you can end upoverly sleepy or unable to sleep. Youmay even have gastrointestinalproblems. To reduce jet lag when you’reflying east, once you reach your

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destination, seek exposure to light in themorning; this will help your circadianrhythm catch up. If you’re flying west,seek exposure to light (even artificiallight) in the evening. Using a sleep aid tomake it easier to get some shut-eyewhile you’re flying or to deal with thetime change once you’ve arrived canalso be helpful.

You can further help yourself pushpast jet lag by making sure youraccommodations are conducive to agood night’s sleep. Call in advance toask for a hotel room that’s quiet—noelevators, workout rooms, or icemachines next door, no windowsoverlooking the pool or flashing neonsigns. In a city, ask to be on a high floor

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(farther away from traffic) and in a roomthat doesn’t face a busy street. Then, asmuch as possible, treat your hotel roomas you do your own bedroom. Gothrough the same before-bed rituals youdo at home.

11. Play Catch Up

As I said earlier, consistency is key inovercoming sleep obstacles. But onoccasions when it’s impossible tomaintain your regular habits, you canstill catch up on sleep. This is known aspaying your sleep debt. Sleeping longeron weekends or napping (see here) willlet you make up for some of the hoursyou’ve lost; however, be aware that

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either can throw you off schedule again.Work on getting back into your regularroutine and try to avoid the need to playcatch up very often.

Remember, a good night’s sleep issomething you can’t afford to take forgranted. Deep, refreshing sleep is vitalto your health and sense of well-being.It’s integral to fighting the effects ofaging, including the risk of diseases thatare more likely to crop up as you getolder. Inadequate sleep can definitelyshorten your life.

If you’re not motivated by the fear ofa life-threatening disease, at least

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consider how much better you feel whenyou’re well rested. Sleep improves thequality of your life in every way. Thebrightness and resiliency of your skin.Your memory and ability to concentrate.Your mood. Your level of get-up-and-go. How well you eat. How much energyyou have for exercise.

Use the suggestions in this chapter tohelp you develop good habits beforedifficulties arise. Just like all the otherpillars of anti-aging in this book,effective sleep habits require disciplineand commitment. You need topurposefully manage your day andevening, and you may even have to giveup certain cherished rituals to get theresults you need. But give yourself the

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gift of a good night’s sleep and you’resure to improve your health and theoverall quality of your life.

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CHAPTER 6

The Art of AgingGracefully

None are so old as those who haveoutlived enthusiasm.

—Henry David Thoreau

THE PHRASE “AGING GRACEFULLY” getstossed around a lot. But what does aginggracefully really mean? Images from thebig screen may leap to mind. There aremany actors and actresses—Cary Grant,

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Paul Newman, Katharine Hepburn,Sophia Loren, Raquel Welch, MerylStreep, Diane Keaton, Sidney Poitier,Sean Connery, to name a few—whoselooks and demeanor remained, andremain, vibrant with age. But whatstrikes me most about people who havetranscended their chronological age isthat they exude a certain joie de vivre—joy of living. Aging gracefully to memeans continuing to be enthusiasticabout life and all that it has to offer. Themost compelling reason to hang on toyour health, maintain strength andenergy, and, yes, even look your best, isthat it helps you stay positive and behappy, active, excited, and in love withlife.

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Youth has many blessings, so ofcourse we try to stay young. But age hasits rewards, too, and they are oftenoverlooked or, at best, viewed as sort ofa consolation prize. Yet the experience,knowledge, and judgment you gain asyou grow older are wonderful gifts. AndI’m not just talking about the proverbialwisdom of the wizened ninety-year-old.These are things that you begin to layclaim to as you move into your forties,fifties, and beyond. When you’reyounger, a lot of your energy goes intodefining yourself. You’re learning aboutyourself and what you want from life. Inthe later stages of life, you will havehopefully figured out who you are, and

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that allows you to focus your energy onthe things that make you feel happy andsatisfied.

It’s easy to lament the things we didor didn’t do in our earlier years, andeven to still feel stuck—maybe younever lost the weight you wanted to,never attained the professional heightsyou desired, are still in a toxicrelationship, or have never found theright significant other. But it’s never toolate to change your life: to improve yourhealth, break with someone who ismaking you unhappy, or continue to meetnew people. You can even change yourcareer path, or perhaps go back toschool to expand your interests andknowledge. Part of aging gracefully is

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zeroing in on not only what is importantto you, but who is truly important to you,and letting the rest fall by the wayside.Nurturing meaningful relationships isparticularly critical: those relationshipscan help you live longer—and certainlybetter.

THE BENEFIT OF FRIENDS

Certainly, one of the most significantrelationships, if not the most significantrelationship, you can have is therelationship with yourself. That means,among other things, to be aware of yourown thoughts and feelings and to begiving to (and forgiving of) yourself.

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Having a good relationship with yourselfnot only makes you a psychologicallyhealthier person, but helps open the doorto good relationships with other peopleas well. And that’s essential: The love,friendship, and companionship of othersis integral to aging gracefully. It’s wellknown that isolation or perceivedloneliness is associated with conditionsthat age the body and put it at greaterrisk of age-related diseases. Loneliness,for instance, has been found to raiseblood pressure, affect sleep quality, andincrease the production of the stresshormone cortisol. On the other hand,friendship (even more than familyrelationships) has been associated with

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decreases in depression, increases inself-esteem, and better coping withstress.

Data from the AustralianLongitudinal Study of Aging has shownthat people age seventy and older whohave an active social life live 22 percentlonger than those with a less activesocial life. And in 2008, researchers atHarvard’s School of Public Healthfound that socially active seniors had aslower rate of memory decline than theirmore isolated peers.

Make Your BrainMore Age-Resistant

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Taking care of your mental well-beingby reducing stress, finding sources ofhappiness in everyday life, andadjusting your perceptions of agingare all important ways to keep yourbrain healthy. Many of the things youdo for overall health—exercising,eating well, getting adequate sleep—can help, too. But there are practicalstrategies that can protect your brainfrom decline. Here are some that havebeen shown to help.

Learn something new. There’s beensome suggestion that mentallychallenging or stimulating activitiessuch as puzzles keep the brain sharp.Sorry, crossword fans. “There’s noevidence that people who docrossword puzzles regularly havebetter cognitive function,” says DenisePark, PhD, director of the Center forVital Longevity in Dallas. “It may bethat this type of activity doesn’t

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involve creating new knowledge—you’re passively entering in definitionsof words you already know.”However, when you learn somethingcompletely new, you can create newpathways or neural circuits in the brain—almost like scaffolding around thebrain. What might work? Learning anew language, a new instrument, anew computer program—check outyour local adult education campus tosee all the possibilities.

Be safe. Anything that puts strain orstress on your head can, over time,damage your brain. This includes theobvious dangers—skiing or bikingwithout a helmet or driving without aseatbelt, for instance—as well as themore unexpected ones, for example,heading a soccer ball. “It’s important tobe conscious of activities that mayseem to have nothing to do with thebrain but can cause damage that

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aggregates over a lifetime. Keep inmind that even minimal blows to thehead can cause trouble,” says Park.

Be active. I’ll repeat what I said inmore detail in chapter 2 (see here):People who exercise have betterblood flow to the brain, they producesubstances that foster the growth ofnew brain cells, and they’re at a lowerrisk for Alzheimer’s.

Get your fill of omega-3 fats. Yourbrain is surrounded by a flexible, fluidmembrane that’s made up of omega-3fatty acids. When you don’t getenough of these healthy fats from yourdiet, your body uses omega-6 fats,which are less pliable and slowreactions in the brain. For more onomega-3s, see here.

These studies looked at people who

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were elderly, but they point out theimportance of cultivating relationshipsand staying socially active right now.Every chapter in this book has beendevoted not only to helping you shaveyears off your present physiological agebut to helping you develop healthy habitsthat will hold you in good stead in thefuture. Tending to your relationships ispart of that and just as important asexercising and eating right.

Take this as your cue to continuewidening your circle of friends as theyears go by. Anything that keeps yousocially active now—joining a bookclub or walking group, taking classes ata local high school or community center,meeting up regularly with friends or

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colleagues—will pay off later.Personally, I’ve seen the value of havinga diverse group of friends, some youngerthan I am and some older than I am. Asmy parents have gotten older, I’vewatched as many of their friends havepassed away. So from a practicalstandpoint, having friends from differentgenerations ensures you’ll have companyand support well into your later years.But there’s another perk. In a way,youthfulness is contagious. When youbond with people younger than yourself,they keep you up to date on changestaking place in the world—newtechnology, say, or the latest in art, oreven changes in the English language. I

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think a reluctance to try new thingscontributes to more rapid aging. Whenyou have younger friends, it broadensyour horizons. You don’t just look back—you look forward, and that helps tokeep you interested in life.

ATTITUDE AND AGING

Though age can help you become morecertain about your character,individuality, spirituality—your overallplace and purpose in this world—it canalso make you feel out of themainstream. So much in our culturecelebrates and idealizes youth whileoften reducing older people to a punch

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line, sometimes even infantilizing thosein their later years. It’s so important toresist the stereotypes that equate agingwith a loss of relevance.

One person who has writteneloquently about the role of self-perception in aging is Sherwin B.Nuland, MD, a surgeon and author. “Ifthere is a single factor that is thefoundation stone for all successful aging,a factor that allows every other element,encourages every other element, andnurtures every other element, that factormust surely be a healthy self-image,” Dr.Nuland wrote in The Art of Aging. “Weneed to approve of ourselves, to takepride in what we have become, to feel avibrancy in our moral sense—we must,

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quite simply, be happy with what weare.”

Thinking that you’re “past yourprime” or that you’re edging towardbeing “over the hill” even as you’re justmoving out of your forties has thepotential to become a self-fulfillingprophecy. Evidence suggests that howyou view aging significantly affects yourability to stay healthy, active, and on theball. It may even affect how long youlive.

A great example of how attitudeinfluences actuality is a well-knownexperiment called the CounterclockwiseStudy. In 1979, the psychologist EllenLanger and her students at Harvard

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University devised a study that involvedhaving frail, elderly men spend a weekliving in a monastery outfitted to look asthough it were still the year 1959. Thefurnishings and everything the menexperienced, from the televisionprograms they watched and the musicthey heard to the newspapers they readand daily discussions they had fit into atwenty-year time warp.

The men were split into two groups,and the first group was instructed notjust to act like it was 1959, but as muchas possible to be who they were in1959. To set the stage, they were askedto write a biography of themselves in thepresent tense as if it were twenty yearsearlier. A week later, the second group

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of participants took their turn in the retroenvironment, but instead of living as if itwere 1959, they were told to live in thepresent and simply reminisce about thepast. They also wrote bios about whothey were in 1959, but in the past tense.Despite being extremely dependent onrelatives prior to the study, at the study’send, both sets of seniors were able tofunction independently. Having to liveon their own, being treated with respectand engaging in lively discussions hadhad an obvious effect on them. Bothgroups also improved their hearing andmemory after the week’s retreat. But thegroup who lived as if they were twentyyears younger reaped even more

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benefits: They had more joint flexibility,scored better on intelligence tests, andhad better posture and gait. By manymeasures, they actually got younger. “Itis not primarily our physical selves thatlimit us but rather our mindset about ourphysical limits,” concluded Langer.

Since Langer weighed in with theCounterclockwise Study, otherresearchers have shown that attitude canhave considerable power over how wellsomeone ages. For instance, ThomasHess, PhD, a professor in the graduateprogram on Lifespan DevelopmentalPsychology in the Department ofPsychology at North Carolina StateUniversity, and his team had two groupsof older folks read bogus newspaper

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articles about aging and memory to see ifit had any influence on their ownmemories. One group read about ascientific paper that found people have alot of control over memory as they age,while the other group read an articlestating that memory declines as you getolder and there’s not much you can doabout it. After completing their reading,both groups were given a list of thirtywords to study for two minutes, thenwere asked to recall as many words asthey could. The group that read thepositive article recalled 10 to 15 percentmore words than the group who read thenegative article. If this study is anyindication, believing that it’s possible to

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retain brain power as you age can makeit a reality—but believing the oppositecan cause your mental aptitude todiminish. “What’s more, one thing that’semerging is how important it is tomaintain an engaged lifestyle andexercise cognitive skills,” says Dr.Hess. “If you fall prey to negativestereotypes, you may remove yourselffrom situations that require these skills,and this would exacerbate any normalcognitive changes you’d see.”

There’s one more study I want to tellyou about because it illustrates howimportant it is not to buy in to the notionthat it’s all downhill once you’re pastmiddle age. Recently, Becca Levy, PhD,an associate professor of epidemiology

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and psychology at Yale University,followed up on some data collectedback in the 1970s by a gerontologist inOxford, Ohio. The gerontologistsurveyed more than one thousand peopleages fifty and older in the town and hadthem answer a variety of questionsregarding their health, work, andlifestyle. One of the questions includedin the survey was what the townspeoplethought of aging. Many years later, Levyand her team looked at their answers tothis question, then tracked downmortality information about the people tosee if there was any correlation betweenattitude and life span. What they foundwas that people who believed that aging

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was a positive experience tended to liveseven and a half years longer. Thissuggests that there really is a connectionbetween attitude and longevity.

THE HAPPINESS FACTOR

If I had to boil down all of thesociopsychological factors that help youage gracefully into one word, that wordwould be happiness. It’s happiness—that joie de vivre I mentioned earlier—that makes all the difference.

The good news is that many peopleactually are happier as they get older.When researchers at the Centers forDisease Control and Prevention (CDC)

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surveyed different age groups abouthappiness, they found that people in theirearly twenties reported feeling sad on anaverage of 3.4 days per month, whilepeople aged sixty-five to seventy-fourfelt sad 2.3 days. There are probably alot of reasons for the difference. Whenyou’re older you’re generally freed fromchild rearing and the stress of buildingand maintaining a career. You also tendto have more coping skills at yourdisposal—you’ve been through stressfulexperiences before and know how tohandle them. Experience also teachesyou that life is cyclical. Things may getbad, but they usually get better again.When you’re young and haven’t livedthrough so many ups and downs, you’re

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not as likely to see the sun on thehorizon.

We instinctively know that happinessis healthier for us, but there is also hardevidence that it can slow the effects ofaging. For instance, happiness can helpstrengthen your immune system.Researchers at Rush University MedicalCenter in Chicago, now conducting oneof the largest ongoing studies onAlzheimer’s and aging, have found thatpeople who reported having a greatersense of purpose and direction in life (tome that’s longhand for happiness) alsohave a lower risk for Alzheimer’sdisease and cognitive deterioration.Happy people are also at a much lower

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risk of premature death, according to astudy published in the Journal of HealthPsychology. “I think we underestimatethe importance of being happy. There’snot a lot of research on happiness andbrain functioning right now, but I expectwe’ll soon learn that there are realrelationships between high lifesatisfaction and brain health,” saysDenise Park.

One thing is for sure: People whosuffer from depression experience animpairment in concentration andattention—it’s as if their brain is aging.“In fact, depression can sometimes firstappear as a memory problem, like apseudo dementia,” says Cynthia Green,PhD, a brain health expert and assistant

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clinical professor of psychiatry at MountSinai School of Medicine in New YorkCity. And depression also seems to beconnected to real dementia. Someresearch shows that women who aredepressed are more likely to sufferdementia later in life.

While it’s good news that the CDCsurvey found that older people have ahigher rate of happy days, happiness isnot something you want to save for yoursenior years. It’s important to pursue itnow. Aside from the fact that it simplyfeels better to be happy, it’s going tohelp you retain your health and continueto function at a high level. If you don’tfeel happy, examining your life to

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discover why is just as important ananti-aging strategy as anything elsewe’ve recommended in this book. Youmay find that you need to make bigchanges in your life (changes, forinstance, in a relationship or your job),but you may also find that you simplyneed to take more time to experiencejoy, to add more elements of surpriseand adventure to your life, or to livemore purposefully or compassionately.There are a lot of keys to happiness;determine the key to yours.

ACTIVELY PARTICIPATINGIN LIFE

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Recently, I’ve read about a couple ofteachers who are still in the classroomeven though they are in their nineties. Tome this is another strategy for agingwell: continuing to be an activeparticipant in life. This doesn’tnecessarily mean you have to keepworking until you’re in your nineties; itsimply means being engaged with theworld. Taking yourself off autopilot.Many people go through the daysomewhat unaware of what’s going onaround them. They may commute to workhardly noticing the other cars or thepeople riding next to them on the bus ortrain. They might sit in a meeting withoutever really paying attention to who’s

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around them or what they’re wearing.Think about it: What color is the carpetin your office? Who lives on the cornerof your street? Who is yourcongressional representative? Thesethings might seem inconsequential, but ifyou’re unaware of them, it shows justhow passive and disconnected you canbecome.

And yet living a more engaged lifecan really pay off when it comes tolongevity and vitality. “If people areengaged in life, they’re more likely tomaintain their cognitive skills,” explainsThomas Hess. “Studies funded by theNational Institute on Aging show thatwhat people do in midlife—their jobs,their leisure activities—has a pretty

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strong effect on cognitive changes lateron.” Anything that calls for you to useyour brain and make decisions can helpyou maintain your cognitive abilities.

There’s a deep connection betweenwhat I’ve been talking about in thischapter—staying positive, not giving into negative stereotypes about aging,seeking happiness and companionship—and everything else in this book. Whenyou are physically fit, eating andsleeping well, and looking your best,you simply function at a higher level andfor that reason you feel good. That inturn makes you ten thousand times morelikely to graciously accept growingolder, to even welcome it in many ways.

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There’s no question that staving offthe effects of aging takes work andpossibly changing some ingrained habits.The truth is, many people passively letphysical and psychological declineinvade their lives as they grow older.When you put in the time and energy tostay strong, healthy, and enthusiastic, itcan transform you in profound physicaland emotional ways. When your body isstrong and you feel your best, youbecome more engaged in the world andappreciative of the people around you.Life simply seems more beautiful.

One thing many people don’t realizewhen they’re younger—but whichbecomes crystal clear with age—is that

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life is incredibly precious. Everymoment counts. You have it within youto live each of those moments to thefullest. If you make the decision to keepyour body and mind in the best possibleshape, it’s going to help ensure that yourtime on this earth is not only long but,most important, well lived.

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PART II

THE 20 YEARS YOUNGER LIFESTYLE

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CHAPTER 7

Meal Plans andRecipes

MUCH OF WHAT RESEARCH HAS TOLD USabout what helps stave off the agingprocess is incorporated into thefollowing two-week eating plan. Thinkof it as your introduction to an easy,effective, and terrific-tasting way to turnback the clock. After the two weeks areover, you can repeat the meal plans

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again, or simply use them as a templateto create your own healthy plan. If youchoose to do the latter, use theguidelines here and below as well as thelist of superfoods in chapter 3 to helpyou continue eating for longevity andoptimal energy.

Most of the meals on the plan takebetween three and twenty minutes toprepare, and all the ingredients areeasily found in your local supermarket.Here’s how it works.

Pick a daily calorie level: 1,500,1,700, 2,000, or 2,500. For helpfiguring out the right calorie level,turn to here.

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You can swap one meal for another aslong as they’re equivalent, e.g. thebreakfast in Day 1 for the breakfast inDay 7. Same goes for the othermeals, snacks, and treats. A day’splan might include Day 1’s breakfast,Day 5’s lunch, Day 6’s dinner, asnack from Day 11, and a treat fromDay 14. This way, you keep creatingnew meal plans, allowing you tostretch out these menus for months.

Check my website20YearsYounger.com for moresupport, recipes, and meal ideas.

It’s okay to substitute foods that aresimilar for one another. For instance,

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you can have almonds in place ofwalnuts, chicken for lamb, greenpeppers for broccoli. This will giveyour diet more variety.

Soy milk, nonfat (skim) milk and 1%milk are interchangeable—so ifthere’s soy milk in a meal and you’drather have nonfat or 1% milk, goahead and make the swap.

If you need more salt, add it sparinglyto the food on your plate, not to theentire dish. This will give yousaltiness without as much sodium. Nomatter how you swap and combinemeals, this plan is designed to maxout at 2,300 mg sodium. Remember,

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for each teaspoon of salt you add,you’re adding 290 mg more sodium.Take out a measuring spoon, measureout teaspoon and put it in your handso you know what that amount lookslike. Then get rid of half of it. What’sleft is the amount you should add toyour meal—even less if possible.

If you want to design your own meals,use the calorie guide in the chartbelow. Each day, make sure to haveseveral servings of fruits orvegetables, a serving or two ofwhole grains, and two servings ofnonfat or 1% milk or soy milk (orthree if you’re on 2,500calories/day). Stick to lean sources

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of protein and healthy fats as well.

Calories Per Meal/Snack/Treat

CaloriesPer Day

Breakfast Lunch Dinner Snack1

Snack2

1,500 400 425 525 150 None

1,700 440 430 525 155 None

2,000 440 565 645 150 None

2,500 440 660 750 150 250

If you find through trial and error thatyour ideal daily calorie level is onewe don’t offer (for instance 1,800calories or 3,000 calories), followthe closest lower calorie level andadd foods from the list below.Here’s an example of how to makethe appropriate adjustments. If youthink you need 1,800 calories per

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day, follow the 1,700 calories/dayplan and add 100 more caloriesthrough foods from the list. If youneed 3,000 calories per day, makethe 2,500 calories/day your base andbolster it with 500 more dailycalories. One easy way to do this isto simply double up on the twosnacks offered on the plan—one is150 calories, the other 250, so thatgives you 400 extra calories—thenadd another 100 calories from the listbelow.

Healthful Ways to Bulk Up on

Calories

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FRUIT

(60 calories per serving)

A serving is…

Apple—1 mediumApricots—4 fresh or 8 dried halvesBanana—½Berries (blackberries, blueberries,

strawberries, raspberries)—1 cupCantaloupe—1 cup choppedCherries—14Dates—3Figs—2 medium fresh or 1½ driedFruit salad—1 cup choppedGrapefruit—½

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Grapes—½ cupKiwi—1½Orange—1 smallMango—½ or ½ cup slicesPeach—1 mediumPear—1 smallPineapple—¾ cup cubes

VEGETABLES

(25 calories per serving)

A serving is…

Asparagus—8 spearsBean sprouts—¾ cupBeets—½ cup cooked

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Broccoli—1 cup raw or ½ cup cookedCabbage—1½ cups raw shredded or ¾

cup cookedCarrot—1 medium or ½ cup choppedCauliflower—1 cup raw or cookedCelery—4 medium stalksCucumber—1½ cups slicedEggplant—1 cup cookedGreens (such as collard, kale, spinach,

turnip greens)—½ cup cookedLettuce (such as arugula, mixed greens,

romaine)—3 cupsString beans—½ cup cookedTomato—1 medium, ¾ cup chopped or

1 cup cherry tomatoes

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Tomato sauce (plain)— cup

WHOLE GRAINS/STARCHY VEGETABLES

(80 calories per serving)

A serving is…

Bagel, whole wheat—¼ of a largebagel or ½ a medium

Beans (legumes, such as black beans,pinto beans, white beans,garbanzos, lentils)— cup cookedor canned

Bread, 100% whole grain—1 slicewith at least 2 grams fiber

Bulgur wheat—½ cup cookedCereal, flaky type—about ¾ cup (at

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least 4 grams fiber per 100calories)

Corn—½ cup or 5-inch earCouscous, whole wheat (such as

Fantastic Foods or Casbah)—½cup cooked

Crispbread, whole grain—80 calories’worth and no more than 2 grams fat

English muffin, whole wheat—½Grits—½ cup cookedMuesli—¼ cupMuffin, bran or whole grain—¼ large

muffin, or ½ of a 2.75 x 2-inch-diameter muffin

Oatmeal, plain (or other unsweetenedwhole-grain hot cereal)—½ cup

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cookedPancake, whole grain—2 pancakes

with a 4-inch diameterPasta, whole grain—½ cup cookedPeas—¾ cupPita bread, whole wheat—½ of a 6-

inch roundPolenta— cup cookedPopcorn—3 cups (air popped or no

more than 3 grams fat)Potato or sweet potato—½ medium, or

heaping ½ cup cooked with no fatadded

Roll, whole wheat—1 small (1 ounce)or ½ of a 65-gram (2.3 ounces)

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hamburger rollRice, brown or wild— cup cookedTortilla—1 tortilla (7 inches)Waffles, whole grain—one small

frozen waffle or four ½-inchsquares

LEAN PROTEIN

(about 60 calories per serving)

A serving is…

Beef, lean (such as sirloin, tenderloin,and 95 percent lean ground)—1ounce cooked

Cheese, reduced-fat hard (such asreduced-fat cheddar, jack, or

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Swiss)—1 ounce (no more than 3grams of saturated fat per ounce)

Chicken, skinless—1½ ounces or ¼cup diced broiled, or 1 ounce or 3tablespoons diced stewed

Egg—1 largeEggs, liquid (such as Better’n Eggs)—

½ cupFish, white-fleshed (such as grouper,

flounder, or snapper)—2 ouncescooked

Fish, oily (such as salmon, trout, orbluefish)—1 ounce cooked

Peanut butter (such as Smart Balance)—1 tablespoon (also counts as 1fat serving)

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Pork tenderloin—1 ounceSalmon, canned, packed in water,

drained—2 ouncesSeitan (wheat protein)—2 ouncesTempeh (fermented soy)—1¼ ouncesTofu—2 to 4 ounces (check label as

calories vary)Tuna, canned, light, packed in water,

drained—2 ouncesVegetable burger, soy based—½ patty

(check label as products differ;ideally, the entire burger shouldhave at least 12 grams of proteinand no more than 9 grams ofcarbohydrate, which you mustcount toward your grain/starchy

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vegetable servings)

HEALTHY FATS

(45 calories per serving)

A serving is…

Avocado— of a whole avocadoMargarine—1 teaspoon (with no

partially hydrogenated oil, such asBestlife buttery spread)

Margarine, light—1 tablespoon (withno partially hydrogenated oil)

Mayonnaise, reduced fat—1tablespoon

Nuts, any kind—1 tablespoonNut butter—1½ teaspoons

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Oil (such as olive oil or canola oil)—1 teaspoon

Ricotta cheese—1½ tablespoonsRicotta cheese, part skim—2

tablespoonsSalad dressing—2 teaspoons to 1

tablespoonSalad dressing, reduced fat—1 to 2

tablespoons (check label forcalorie counts)

MENUS

Day 1

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Breakfast

1,700, 2,000, AND 2,500 CALORIES/DAY:

Acai Almond Butter Smoothie: In ablender, combine until smooth 1package (100 grams) frozen acai, ½cup frozen unsweetened raspberries,1 tablespoon almond butter, 2teaspoons honey, 1 cup skim milk,and 1 tablespoon ground flaxseed.

Sprinkle ¼ cup whole grain cerealsuch as Kashi Good Friends on top ofsmoothie.

1,500 CALORIES/DAY: Omit the cereal.

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Lunch

1,500 AND 1,700 CALORIES/DAY:

Sardine Salad: 3 cups shreddedromaine lettuce, 2 ounces sardinespacked in olive oil and drained,tossed with 2 teaspoons lemon juice,1 tablespoon finely chopped redonion, and 2 tablespoons finelychopped Italian parsley.

A 1-ounce whole wheat roll (about73 calories), torn and dipped in 2teaspoons olive oil.

Serve with ¾ cup grapes and 2medium fresh or dried figs.

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2,000 CALORIES/DAY: Serve Sardine Saladwith 1½ ounce whole wheat roll (about109 calories), torn and dipped in 1tablespoon olive oil. Serve with 1½cup grapes and 3 medium fresh or driedfigs.

2,500 CALORIES/DAY: Serve Sardine Saladwith 1½ ounce whole wheat roll (about109 calories), torn and dipped in 1tablespoon olive oil. Serve with 1½cup grapes, 3 medium fresh or driedfigs, and 1½ tablespoons choppedpecans.

Dinner

1,500 AND 1,700 CALORIES/DAY:

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1 serving Baked Eggplant and GroundTurkey (here).

½ cup cooked cracked wheat (bulgur)with 2 teaspoons olive oil, a pinch ofsalt, black pepper to taste, and 1tablespoon finely chopped freshbasil.

2 cups baby spinach dressed with 1teaspoon olive oil, ½ teaspoonbalsamic vinegar, and black pepperto taste.

¾ cup chopped cantaloupe.

2,000 CALORIES/DAY: 1 serving BakedEggplant and Ground Turkey with ½

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cup cooked cracked wheat (bulgur)tossed with 1 tablespoon olive oil, apinch of salt, black pepper to taste, and1 tablespoon finely chopped freshbasil. Serve with spinach salad andcantaloupe as noted above.

2,500 CALORIES/DAY: 1 serving BakedEggplant and Ground Turkey with ¾cup cooked cracked wheat (bulgur)with 1 tablespoon olive oil, a pinch ofsalt, black pepper to taste, and 1tablespoon finely chopped fresh basil.Serve with spinach salad andcantaloupe as noted above.

Snack

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ALL CALORIE LEVELS:

Fresh Mint Tea: 2 tablespoons freshmint steeped in 1¼ cups hot soy milkand then strained (can also be chilledfor iced tea). Sweeten with 1teaspoon honey.

2,500 CALORIES/DAY EXTRA SNACK: 1medium apple sliced and spread with 2tablespoons sunflower seed butter.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

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Graham Cracker with Banana andWalnuts: Top 1 graham cracker (2squares) with ½ sliced banana and 1tablespoon chopped walnuts.

2,000 CALORIES/DAY: Top 2 grahamcrackers with ½ sliced banana and 2teaspoons chopped walnuts.

2,500 CALORIES/DAY: Top 2 grahamcrackers with ½ sliced banana and 1tablespoon plus 2 teaspoons choppedwalnuts.

Day 2

Breakfast

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1,500 CALORIES/DAY:

1 serving Muesli (here) served with 1cup skim milk and topped with ½ cupfresh blackberries.

1,700, 2,000, AND 2,500 CALORIES/DAY:

1 serving Muesli served with 1 cupskim milk and topped with ½ cupfresh blackberries and 1½tablespoons chopped almonds.

Lunch

1,500 AND 1,700 CALORIES/DAY:

Chicken, Grapefruit, and ArugulaSalad: Combine 2 ounces dark meat

Page 740: 20 Years Younger Look Younger, Feel Younger, Be Younger!

or 3 ounces light meat rotisseriechicken, bones and skin removed,and cut into strips, 3 cups arugula,sections from 1 grapefruit, skin andpith removed, 1½ teaspoons oliveoil, 1 teaspoon cider vinegar, andblack pepper to taste.

2 Wasa multigrain crispbreads toppedwith 1 teaspoon Bestlife spread.

2,000 CALORIES/DAY: Make salad as abovebut with 2.75 ounces dark meat or 4ounces of light meat rotisserie chickenand topped with 1 tablespoon cashewhalves. Serve with 2 Wasa multigraincrispbreads spread with 1 teaspoonBestlife spread.

Page 741: 20 Years Younger Look Younger, Feel Younger, Be Younger!

2,500 CALORIES/DAY: Make salad as abovebut with 2.75 ounces dark meat or 4ounces light meat rotisserie chickenand topped with 2 tablespoons cashewhalves and 2½ tablespoons goldenraisins. Serve with 2 Wasa multigraincrispbreads prepared as above.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Poached Trout with Tomatoand Basil (here).

Spicy Farro or Barley with Mint andParsley: Dress 1 cup grain cookedaccording to package directions with

Page 742: 20 Years Younger Look Younger, Feel Younger, Be Younger!

2 teaspoons olive oil, ¼ cup cookedshiitake mushrooms, a large pinch ofcayenne pepper, a pinch of salt, 2tablespoons finely chopped freshmint, and 2 tablespoons finelychopped curly parsley.

1 cup fresh sliced strawberries.

2,000 CALORIES/DAY: 1 serving PoachedTrout with Tomato and Basil with 1½cups cooked farro or barley tossedwith 2½ teaspoons olive oil, ¼ cupcooked shiitake mushrooms, a largepinch of cayenne pepper, a pinch ofsalt, 3 tablespoons finely chopped freshmint, and 3 tablespoons finely choppedcurly parsley. Serve with 1 cup fresh

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sliced strawberries.

2,500 CALORIES/DAY: 1 serving PoachedTrout with Tomato and Basil with 1¾cups cooked farro or barley tossedwith 1 tablespoon olive oil, ¼ cupcooked shiitake mushrooms, a largepinch of cayenne pepper, a pinch ofsalt, 3 tablespoons finely chopped freshmint, and 3 tablespoons finely choppedcurly parsley. Serve with 1½ cupsfresh sliced strawberries.

Snack

ALL CALORIE LEVELS:

Pomegranate Freeze: In a blender,

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blend until smooth (about 30seconds) ¼ cup frozen 100%pomegranate juice (freeze in ice cubetray or paper cup) and 1¼ cups plainsoy milk.

2,500 CALORIES/DAY EXTRA SNACK: 1 small4-inch whole wheat pita bread spreadwith 1 tablespoon plus 2 teaspoons no-salt-added almond butter.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

1 serving Zucchini Olive Oil Cake

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(here).

2,000 CALORIES/DAY: 1 serving ZucchiniOlive Oil Cake with ¼ cup plus 2tablespoons unsweetened applesauce.

2,500 CALORIES/DAY: 1 serving ZucchiniOlive Oil Cake with 1 cupunsweetened applesauce.

Day 3

Breakfast

1,500 CALORIES/DAY:

¾ cup shredded wheat topped with 1tablespoon ground flaxseed, 1½tablespoons chopped walnuts, ¾ cup

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sliced strawberries, and 1 cup plainsoy milk.

1,700, 2,000, AND 2,500 CALORIES/DAY: 1 cupshredded wheat topped with 1tablespoon ground flaxseed, 2tablespoons chopped walnuts, ¾ cupsliced strawberries, and 1 cup plainsoy milk.

Lunch

1,500 AND 1,700 CALORIES/DAY:

Edamame Dip: 1 cup cooked shellededamame pureed in a food processorwith 2 teaspoons sesame oil, 1tablespoon rice wine vinegar, ¼

Page 747: 20 Years Younger Look Younger, Feel Younger, Be Younger!

teaspoon grated fresh ginger, and teaspoon salt.

Two small 2-to-3-inch diameterbrown rice cakes.

Cabbage Salad: 1 cup shreddedcabbage dressed with a dressingmade of 1 teaspoon miso, 1 teaspoonrice wine vinegar, and ¼ teaspoonhoney.

¾ cup diced honeydew melon.

2,000 CALORIES/DAY: Make Edamame Dipwith 1¼ cup cooked shelled edamame,2½ teaspoons sesame oil, 1 tablespoonrice wine vinegar, ¼ teaspoon grated

Page 748: 20 Years Younger Look Younger, Feel Younger, Be Younger!

fresh ginger, and a pinch salt. Servewith four small 2-to-3-inch diameterbrown rice cakes, Cabbage Salad, and1 cup diced honeydew melon.

2,500 CALORIES/DAY: Serve Edamame Dip,rice cakes, and Cabbage Salad from2,000 calories/day with 1½ cups dicedhoneydew melon with 1 tablespoonslivered almonds.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Braised Chicken Legs inRed Wine with Lentils, Fennel, andKale (here).

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2 cups mixed greens and ¾ cup slicedraw white button mushrooms dressedwith 1½ teaspoons olive oil, 1tablespoon lemon juice, and 2tablespoons fresh chives.

1¼ cups blueberries.

2,000 CALORIES/DAY: 1 serving BraisedChicken Legs in Red Wine withLentils, Fennel, and Kale and mixedgreens from above with a 1-ouncewhole wheat roll and 1¾ cupsblueberries.

2,500 CALORIES/DAY: 1 serving BraisedChicken Legs in Red Wine withLentils, Fennel, and Kale and mixed

Page 750: 20 Years Younger Look Younger, Feel Younger, Be Younger!

greens from above using 2 teaspoonsolive oil in dressing with two 1-ouncecrusty whole wheat rolls and 1¾ cupsblueberries.

Snack

ALL CALORIE LEVELS:

1 Acai Popsicle (here).

2,500 CALORIES/DAY EXTRA SNACK: Trailmix: 1 ounce whole wheat crackers(about 19 reduced-fat Wheat Thins), 1tablespoon plus 2 teaspoons choppedpecans, and 1 tablespoon darkchocolate chips.

Page 751: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

3½ cups air-popped popcorn with 1teaspoon olive oil, three spritzes ofolive oil cooking spray, a dash ofsalt, and a dash of cayenne pepper.

2,000 CALORIES/DAY: 5 cups air-poppedpopcorn with 1 teaspoon olive oil, fivespritzes of olive oil cooking spray, adash of salt, and a dash of cayennepepper.

2,500 CALORIES/DAY: 6 cups air-poppedpopcorn with 1½ teaspoons olive oil,

Page 752: 20 Years Younger Look Younger, Feel Younger, Be Younger!

five spritzes of olive oil cooking spray,a dash of salt, and a dash of cayennepepper.

Day 4

Breakfast

1,500 CALORIES/DAY:

6 tablespoons Irish oatmeal cookedwith water and topped with 1tablespoon dried apricots and 1tablespoon almonds.

1 cup skim milk.

1,700, 2,000, AND 2,500 CALORIES/DAY: 6tablespoons Irish oatmeal cooked with

Page 753: 20 Years Younger Look Younger, Feel Younger, Be Younger!

water and topped with 2 tablespoonsdried apricots, 1½ tablespoonsalmonds, and 1 cup skim milk.

Lunch

1,500 AND 1,700 CALORIES/DAY:

6 pieces store- or restaurant-boughtsalmon and avocado sushi roll.

¾ cup fresh pineapple chunks toppedwith 1 tablespoon plus 1 teaspoonchopped walnuts.

2,000 CALORIES/DAY: 9 pieces store- orrestaurant-bought salmon and avocadosushi roll served with ¾ cup fresh

Page 754: 20 Years Younger Look Younger, Feel Younger, Be Younger!

pineapple chunks topped with 1tablespoon plus 1 teaspoon choppedwalnuts.

2,500 CALORIES/DAY: 9 pieces salmon andavocado sushi roll served with 1 cupfresh pineapple chunks topped with 2½tablespoons chopped walnuts.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Slow-Cooked Lamb withTomato, Cauliflower, and Chard(here).

Whole Grain Crostini: Brush two

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medium slices of whole grain bread(150 calories’ worth or 1.6 ouncestotal) with 2 teaspoons olive oil.Place in a warm oven or toaster ovenuntil slightly browned and crispy.

1 large orange

2,000 CALORIES/DAY: 1 serving Lambserved with Whole Grain Crostini and1 large orange, sectioned and mixedwith 1 cup blueberries and 2 teaspoonsmacadamia nuts.

2,500 CALORIES/DAY: 1 serving Lambserved with Whole Grain Crostiniprepared with 1 tablespoon olive oil,plus 1 large orange, sectioned and

Page 756: 20 Years Younger Look Younger, Feel Younger, Be Younger!

mixed with 1½ cups blueberries and 1tablespoon macadamia nuts.

Snack

ALL CALORIE LEVELS:

½ cup nonfat plain yogurt with ½ cupraspberries and 1 teaspoon cashewsmixed in and ½ graham cracker (onesquare) crumbled on top.

2,500 CALORIES/DAY EXTRA SNACK: 2 Wasamultigrain crispbreads, sprinkled with1½ tablespoons reduced-fat mozzarellacheese and 2 tablespoons choppedtomato. Heat in the toaster oven untilcheese melts, about 1 minute. Serve

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with ¾ cup grapes.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

1 large banana sliced and topped with12 regular-size dark chocolate chipsand 1 teaspoon pine nuts.

2,000 CALORIES/DAY: ½ medium banana,sliced, and ¾ cup pear slices toppedwith 36 regular-size dark chocolatechips and 2 teaspoons pine nuts.

2,500 CALORIES/DAY: ½ medium banana,

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sliced, and 1 cup pear slices toppedwith 36 regular-size dark chocolatechips and 1 tablespoon plus 1 teaspoonpine nuts.

Day 5

Breakfast

1,500 CALORIES/DAY:

Blackberry Smoothie: In a blender,puree until smooth 1 cup frozenblackberries, ½ medium frozenbanana (peel banana, place in asealed plastic bag, and freeze), 1½tablespoons peanut butter, and ¾ cupplain nonfat yogurt.

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1,700, 2,000, AND 2,500 CALORIES/DAY: MakeBlackberry Smoothie with 1 cup frozenblackberries, ½ large frozen banana,1½ tablespoons peanut butter, and 1cup plain nonfat yogurt.

Lunch

1,500 AND 1,700 CALORIES/DAY:

1½ cups canned lentil soup (no morethan 300 mg sodium per 1½ cupserving, such as Health ValleyOrganic no salt added lentil soup).Add 2 cups baby spinach and 2teaspoons Parmesan cheese to soupwhile heating.

Page 760: 20 Years Younger Look Younger, Feel Younger, Be Younger!

1 Wasa multigrain crispbread spreadwith 1 teaspoon Bestlife spread.

½ grapefruit, sectioned and toppedwith 2 tablespoons pistachios.

2,000 CALORIES/DAY: Serve 2 cups lentilsoup with 2 cups baby spinach and 2teaspoons Parmesan cheese added tosoup while heating, one Wasamultigrain crispbread spread with 1teaspoon Bestlife spread, and onegrapefruit, sectioned and topped with 3tablespoons pistachios.

2,500 CALORIES/DAY: Serve 2 cups cannedlentil soup with 2 cups baby spinachand 2 teaspoons Parmesan cheese

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added to soup while heating, two Wasamultigrain crispbreads each spreadwith 1 teaspoon Bestlife spread, andone grapefruit, sectioned and drizzledwith ½ teaspoon honey and 2½tablespoons pistachios.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Spiced Cod (here).

Cracked Wheat Salad: cup cookedcracked wheat (bulgur) preparedaccording to package directions,combined with teaspoon salt, ¼cup fresh pomegranate seeds

Page 762: 20 Years Younger Look Younger, Feel Younger, Be Younger!

(substitute 1 cup orange sections forpomegranate seeds if not available),1 tablespoon olive oil, 2 tablespoonschopped mint, and 2 tablespoonschopped parsley.

2,000 CALORIES/DAY: 1 serving SpicedCod served with Cracked Wheat Saladprepared with 1 cup plus 2 tablespoonscooked cracked wheat (bulgur)combined with teaspoon salt, 5tablespoons fresh pomegranate seeds,or 1½ cups orange sections, 1tablespoon olive oil, 2 tablespoonschopped mint, and 2 tablespoonschopped parsley.

2,500 CALORIES/DAY: 1 serving Spiced

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Cod served with Cracked Wheat Saladprepared with 1¼ cups cooked crackedwheat combined with teaspoon salt,6 tablespoons fresh pomegranate seedsor 1½ cups orange sections, 1tablespoon plus 1 teaspoon olive oil, 2tablespoons chopped mint, and 2tablespoons chopped parsley.

Snack

ALL CALORIE LEVELS:

1 Acai Popsicle (here).

2,500 CALORIES/DAY EXTRA SNACK: 1 small,4-inch whole wheat pita, spread with 2tablespoons sunflower seed butter.

Page 764: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

Pretzels, Golden Raisins, and DarkChocolate Trail Mix: 50 calories’worth or about ½ ounce pretzelscombined with 2½ tablespoonsgolden raisins and 2 teaspoons orabout 15 regular-size dark chocolatechips.

2,000 CALORIES/DAY: Pretzels, GoldenRaisins, and Dark Chocolate Trail Mixprepared with 50 calories’ worth orabout ½ ounce pretzels with 3

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tablespoons golden raisins and 1tablespoon plus 1 teaspoon or about 30regular-size dark chocolate chips.

2,500 CALORIES/DAY: Pretzels, GoldenRaisins, and Dark Chocolate Trail Mixprepared with 75 calories’ worth orabout ¾ ounce pretzels with 4tablespoons golden raisins and 1tablespoon plus 1 teaspoon or about 30regular-size dark chocolate chips.

Day 6

Breakfast

1,500 CALORIES/DAY:

Yogurt Parfait: In a medium-size

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bowl, combine cup plain nonfatyogurt, 2 crushed Wasa multigraincrispbreads, ½ banana, sliced, ¾ cupblueberries, and 2 tablespoonsroughly chopped walnuts. Let sitovernight or serve immediately.

1,700, 2,000, AND 2,500 CALORIES/DAY: YogurtParfait prepared with ¾ cup plainnonfat yogurt, 2 crushed Wasamultigrain crispbreads, 2 teaspoonshoney, ½ banana, sliced, ¾ cupblueberries, and 2 tablespoons roughlychopped walnuts.

Lunch

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1,500 AND 1,700 CALORIES/DAY:

Cannellini Bean Spread on WholeGrain Pita: In a food processor,combine until smooth ¾ cupcannellini beans (cooked or canned,no salt added, drained and rinsed),2½ teaspoons olive oil, a dash ofsalt, 2 tablespoons fresh basil, and 2tablespoons water. Spread mixture ina small (4-inch diameter) wholegrain pita bread and add a slice oftomato.

Arugula Salad: 2 cups of aruguladressed with ½ teaspoon olive oiland fresh lemon juice to taste.

½ cup cubed honeydew melon.

Page 768: 20 Years Younger Look Younger, Feel Younger, Be Younger!

2,000 CALORIES/DAY: Cannellini BeanSpread on Whole Grain Pita preparedwith 1 cup cannellini beans, 1tablespoon olive oil, a dash of salt, 2tablespoons fresh basil, and 2tablespoons water. Spread in a small(4-inch diameter) whole grain pitabread with a slice of tomato. Servewith Arugula Salad and ¾ cup cubedhoneydew topped with 1 tablespoonpistachios.

2,500 CALORIES/DAY: Cannellini BeanSpread on Whole Grain Pita withTomato and Arugula Salad as preparedin 2,000 calories/day, and served with1 cups cubed honeydew topped with2 tablespoons pistachios.

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Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Sweet Potato and TurkeyShepherd’s Pie (here).

Cole Slaw with Mustard Vinaigrette:1 cup sliced cabbage with a dressingmade of 2 teaspoons cider vinegar, 2teaspoons olive oil, ¼ teaspoonmustard powder, 1 teaspoon honey, apinch of salt, and cayenne pepper ifdesired.

1-ounce (about 73 calories) wholewheat roll served with 1 teaspoonolive oil mixed with 2 teaspoons ofchopped basil for dipping.

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¾ cup raspberries.

2,000 CALORIES/DAY: 1 serving SweetPotato and Turkey Shepherd’s Pieserved with Cole Slaw and a 1-ouncewhole wheat roll served with 2½teaspoons olive oil mixed with 2teaspoons chopped basil for dipping.Serve with 1½ cups raspberries,drizzled with ½ teaspoon honey and 1teaspoon pomegranate seeds.

2,500 CALORIES/DAY: 1 serving SweetPotato and Turkey Shepherd’s Pieserved with Cole Slaw and a 1-ouncewhole wheat roll served with 2½teaspoons olive oil mixed with 2teaspoons chopped basil for dipping.

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Serve with 1½ cups raspberries,drizzled with 2 teaspoons honey and 1tablespoon pomegranate seeds.

Snack

ALL CALORIE LEVELS:

Strawberry Milk: 1¼ cups coldvanilla-flavored soy milk blendeduntil smooth with ½ cup sliced freshstrawberries.

2,500 CALORIES/DAY EXTRA SNACK: 1 smallsliced pear spread with 1 tablespoonplus 2 teaspoons almond butter.

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Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

1 serving Baked Apple (here).

2,000 CALORIES/DAY: 1 serving BakedApple topped with ½ ounce or 1tablespoon low-fat caramel sauce and½ teaspoon pecans.

2,500 CALORIES/DAY: 1 serving BakedApple topped with ½ ounce or 1tablespoon low-fat caramel sauce and1 tablespoon pecans.

Day 7

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Breakfast

1,500 CALORIES/DAY:

Banana Spice Smoothie: In a blendercombine until smooth 1 mediumfrozen banana (peel banana, place ina sealed plastic bag, and freeze), 1tablespoon ground flaxseed, ½ cupsilken tofu, pinch of cinnamon, pinchof nutmeg, and 1¼ cups soy milk.

1 Wasa multigrain crispbread.

1,700, 2,000, AND 2,500 CALORIES/DAY: BananaSpice Smoothie as above; spread 2teaspoons peanut butter on the Wasamultigrain crispbread.

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Lunch

1,500 AND 1,700 CALORIES/DAY:

Goat Cheese Sandwich: Spread onetoasted 1-ounce slice of whole grainbread with ½ ounce goat cheese,layer with 2 large slices tomato and½ cup chopped purslane (if youcannot find purslane, use watercressor arugula).

Citrus Salad: 1 cup orange and 1 cupgrapefruit sections with 3tablespoons sunflower seeds.

2,000 CALORIES/DAY: Prepare Goat CheeseSandwich with two toasted 1-ounceslices of whole grain bread and the

Page 775: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Citrus Salad from above with cupgrapes added.

2,500 CALORIES/DAY: Goat CheeseSandwich as prepared for 2,000calories/day and the Citrus Salad with1 cup grapes and 2 teaspoons of maplesyrup added.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Trout Gumbo (here).

Mixed Baby Green Salad: 2 cupsgreens with 1 teaspoon olive oil, adash of salt, and a splash of lemon

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juice.

¾ cup raspberries.

2,000 CALORIES/DAY: 1 serving TroutGumbo with the Mixed Baby GreenSalad, cup cooked brown riceprepared according to packagedirections seasoned with 1 teaspoonolive oil, a dash of salt, and 2tablespoons finely chopped freshparsley, and ¾ cup raspberries.

2,500 CALORIES/DAY: 1 serving TroutGumbo with the Mixed Baby GreenSalad, ¾ cup cooked brown riceseasoned with 1 teaspoon olive oil, adash of salt, and 2 tablespoons finely

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chopped fresh parsley, and ¾ cupraspberries.

Snack

ALL CALORIE LEVELS:

Cucumber with Yogurt Dip: In asmall bowl thoroughly combine ¾cup nonfat plain yogurt, ½ teaspoonolive oil, 1 teaspoon fresh-squeezedlemon juice, and ¼ teaspoon finelychopped chives. Serve with 1 cupcucumber slices.

2,500 CALORIES/DAY EXTRA SNACK: Spread1½ tablespoons peanut butter on twoWasa multigrain crispbreads and

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sprinkle with 1 tablespoon thinly slicedcelery and ½ teaspoon honey.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

½ cup plus 2 tablespoons darkchocolate sorbet.

2,000 CALORIES/DAY: Top the sorbet with2 teaspoons chopped pecans.

2,500 CALORIES/DAY: Top the sorbet with1½ tablespoons chopped pecans.

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Day 8

Breakfast

1,500 CALORIES/DAY:

Yogurt Pomegranate Parfait: cupnonfat plain yogurt with 2tablespoons pomegranate seeds(substitute 2½ tablespoons driedapricots, chopped, or ¾ cupraspberries if pomegranate is notavailable), ½ cup blackberries, and 1tablespoon chopped walnuts mixedin.

1 whole wheat English muffin toastedand spread with 2 teaspoons Bestlifespread.

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1,700, 2,000, AND 2,500 CALORIES/DAY: Prepareparfait with 2 tablespoons walnuts.Serve with English muffin prepared asabove.

Lunch

1,500 AND 1,700 CALORIES/DAY:

Couscous Peach Salad: 1 cup cookedwhole wheat couscous tossed with ½cup sliced peaches, ¼ cup chickpeasfrom a can, drained and rinsed, and 1tablespoon pine nuts, dressed with 1teaspoon olive oil, 2 teaspoonssherry vinegar, a dash of salt, andblack pepper to taste.

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Quick Roasted Kale: Heat oven to350 degrees. Place 2 cups thinlysliced kale on a tray and lightly coatwith vegetable oil spray, a dash ofsalt, and black pepper. Cook for 5minutes, stirring often. After 5minutes add 1 tablespoon balsamicvinegar, return to oven, and cook foran additional 2 minutes.

2,000 CALORIES/DAY: Prepare CouscousPeach Salad with 1 cup whole wheatcouscous tossed with 1 cup slicedpeaches, cup chickpeas and 1tablespoon pine nuts, dressed with 1tablespoon olive oil, 2 teaspoonssherry vinegar, a dash of salt, and black

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pepper to taste. Serve with QuickRoasted Kale.

2,500 CALORIES/DAY: Prepare CouscousPeach Salad from 2,000 calories/daylunch with 2 tablespoons of pine nuts,and add 1 teaspoon olive oil to theQuick Roasted Kale.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Creamy Mac and NoCheese (here).

Tomato Salad: 1 large tomato cut intowedges with ¼ cup very thinly sliced

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red onion, dressed with 2 teaspoonsolive oil and a splash red winevinegar.

Steamed Broccoli with Garlic: Place1 cup of broccoli florets and 1 cloveof finely minced garlic in a smallsaucepan. Add ¼ cup of water,cover, and cook until broccoli istender, about 3 minutes. Drain anddress with 1 teaspoon olive oil and teaspoon salt.

2,000 CALORIES/DAY: 1 serving CreamyMac and No Cheese, Tomato Salad,and Steamed Broccoli with Garlicprepared with 1 tablespoon olive oil.

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2,500 CALORIES/DAY: 1 serving CreamyMac and No Cheese, Tomato Saladwith the addition of ½ of a choppedavocado, and Steamed Broccoli withGarlic prepared the same way as the2,000 calories/day.

Snack

ALL CALORIE LEVELS:

Grape, Cardamom, and YogurtParfait: ¾ cup nonfat plain yogurtwith cup grapes, 2 teaspoonspumpkin seeds, and ½ teaspooncardamom.

2,500 CALORIES/DAY EXTRA

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SNACK: 2 Wasa multigraincrispbreads each spread with 2½teaspoons tahini and topped with 1tablespoon shredded carrot.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

1 serving Chocolate Sesame Biscotti(here).

2,000 CALORIES/DAY: Chocolate SesameBiscotti spread with 2 teaspoonsalmond butter.

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2,500 CALORIES/DAY: Chocolate SesameBiscotti spread with 1 tablespoonalmond butter.

Day 9

Breakfast

1,500 CALORIES/DAY:

Tofu Scramble: Heat a heavy-bottomskillet over medium heat and add 2teaspoons olive oil. Add 1tablespoon of finely chopped onion,then crumble 6 ounces firm tofu (ifpossible, buy tofu with a label thatnotes it’s been processed withcalcium sulfate) into the pan. Cook,

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stirring often, for 5 minutes. Seasonwith teaspoon salt. Serve rolled inan 8-inch diameter whole graintortilla with ½ cup diced tomato andminced fresh hot pepper to taste.

½ cup sliced fresh mango and ½ cupblackberries.

1,700, 2,000, AND 2,500 CALORIES/DAY: PrepareTofu Scramble using 1 tablespoon ofolive oil. Serve with mango andblackberries as above.

Lunch

1,500 AND 1,700 CALORIES/DAY:

Page 788: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Open-Face Almond Butter Sandwich:Spread one 1-ounce slice wholewheat bread with 1 tablespoonalmond butter and top with ¼ cuproughly chopped dried figs and cuproughly chopped grapes.

Celery Salad: 1½ cups sliced celerydressed with 2½ teaspoons olive oil,½ teaspoon fresh lemon juice, and ½teaspoon Dijon mustard.

2,000 CALORIES/DAY: Prepare AlmondButter Sandwiches with two 1-ounceslices of whole wheat bread spreadwith 1 tablespoon plus 2 teaspoonsalmond butter and topped with ¼ cuproughly chopped dried figs and ½ cup

Page 789: 20 Years Younger Look Younger, Feel Younger, Be Younger!

roughly chopped grapes. Serve withCelery Salad.

2,500 CALORIES/DAY: Prepare AlmondButter Sandwiches with two 1-ounceslices of whole wheat bread spreadwith 2 tablespoons almond butter andtopped with cup roughly choppeddried figs and cup roughly choppedgrapes. Serve with Celery Salad.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Salmon Salad withAvocado, Hijiki, Cucumber, andMushrooms (here).

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cup black rice (use brown if blacknot available) cooked according topackage directions and seasonedwith 1 teaspoon sesame oil, teaspoon salt, and 2 tablespoonschopped fresh cilantro.

½ grapefruit and ½ cup raspberries.

2,000 CALORIES/DAY: 1 serving SalmonSalad and cup black rice seasonedwith 1 teaspoon sesame oil, teaspoonsalt, and 2 tablespoons chopped freshcilantro. Serve with a whole grapefruitsprinkled with 2 teaspoons choppedwalnuts.

2,500 CALORIES/DAY: 1 serving Salmon

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Salad and 1 cup black rice seasonedwith 1 teaspoon sesame oil, teaspoonsalt, and 2 tablespoons chopped freshcilantro. Serve with a whole grapefruitsprinkled with 1 tablespoon choppedwalnuts.

Snack

ALL CALORIE LEVELS:

1 green tea bag steeped in 1½ cupshot soy milk.

2,500 CALORIES/DAY EXTRA SNACK: 1 largebanana sliced lengthwise and spreadwith 1½ tablespoons sunflower seedbutter.

Page 792: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

Poached Pear: Peel pear, slice inhalf, and core. In a saucepan deepenough to accommodate the pear,bring 2 cups of water and 2tablespoons of sugar to a boil. Add 1tablespoon of lemon zest, a wholevanilla bean cut in half lengthwise,and the pear. Reduce heat to simmerand cook until tender, 20–30 minutesdepending on variety of the pear.Serve drizzled with 2 tablespoonsnonfat sour cream, 1 teaspoon honey,

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and 2 tablespoons of the poachingliquid.

2,000 CALORIES/DAY: Poached Pear servedwith 1 tablespoon chopped pecans.

2,500 CALORIES/DAY: Poached Pear servedwith 2 tablespoons chopped pecans.

Day 10

Breakfast

1,500 CALORIES/DAY:

Egg White and Spinach Omelet:Prepared with 2 egg whites, 1tablespoon reduced-fat feta cheese,and 2 cups spinach. Use 2½

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teaspoons olive oil for cooking.

1 Wasa multigrain crispbread.

1 cup blackberries drizzled with 1teaspoon honey.

1 cup skim milk.

1,700, 2,000, AND 2,500 CALORIES/DAY: EggWhite and Spinach Omelet served withone Wasa multigrain crispbread, 1½cups blackberries drizzled with 2teaspoons honey, and 1 cup skim milk.

Lunch

1,500 AND 1,700 CALORIES/DAY:

Page 795: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Portobello Sandwich: 1 portobellomushroom rubbed with 1 teaspoonolive oil and baked in a 350-degreeoven until tender, about 20 minutes,served on a 1½-ounce whole grainbun with 1 slice of red onion and aslice of tomato.

1 sliced plum tossed with 1 teaspoonolive oil, a splash of red wine, and1½ tablespoons roughly choppedpistachios.

10 baby carrots dipped into 2teaspoons tahini.

2,000 CALORIES/DAY: Portobello Sandwichprepared as above using 1½ teaspoons

Page 796: 20 Years Younger Look Younger, Feel Younger, Be Younger!

olive oil, served with 1 sliced plumtossed with 1 teaspoon olive oil, asplash of red wine, and 3 tablespoonsroughly chopped pistachios, and 15baby carrots dipped into 4 teaspoonstahini.

2,500 CALORIES/DAY: Portobello Sandwichprepared as above using 2 teaspoonsolive oil, served with 1 sliced plumtossed with 1 teaspoon olive oil, asplash of red wine, and 3 tablespoonsroughly chopped pistachios, and 25baby carrots dipped into 1½tablespoons tahini.

Dinner

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1,500 AND 1,700 CALORIES/DAY:

1 serving Tofu Vegetable Soup withKombu (here).

1 serving Whole Grain Thin Spaghettiwith Peanut Sauce (here).

1 large orange.

2,000 CALORIES/DAY: 1 servingTofu Vegetable Soup with Kombu andWhole Grain Thin Spaghetti withPeanut Sauce served with 1 largeorange and 2 Wasa multigraincrispbreads spread with 1 teaspooneach Bestlife spread.

2,500 CALORIES/DAY: 1 serving Tofu

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Vegetable Soup with Kombu andWhole Grain Thin Spaghetti withPeanut Sauce served with 1 largeorange and ¾ cup sliced strawberriesand 3 Wasa multigrain crispbreadsspread with 1 teaspoon each Bestlifespread.

Snack

ALL CALORIE LEVELS:

Chocolate Ginger Latte: Steep 1ginger tea bag in 1 cup of soy milk,then whisk in 2 teaspoons cocoapowder and 2 teaspoons sugar.

2,500 CALORIES/DAY EXTRA SNACK: Trail

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mix: 3 tablespoons toasted pine nutsand 15 reduced-fat Wheat Thins or 90calories of your favorite whole graincracker.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

Orange with Spices and Pecans: Tosssections of one medium orange, peeland pith removed, with a pinch ofcinnamon, cardamom, and powderedginger. Top with 1½ tablespoonschopped pecans.

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2,000 CALORIES/DAY: Orange with Spicesand Pecans prepared with 2tablespoons plus 2 teaspoons choppedpecans.

2,500 CALORIES/DAY: Orange with Spicesand Pecans prepared with 3tablespoons chopped pecans.

Day 11

Breakfast

1,500 CALORIES/DAY:

Whole Grain Cream of Wheat: 3tablespoons Healthy Grain InstantOriginal Cream of Wheat cookedaccording to package instructions

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with 1 medium apple, shredded, ¼teaspoon cinnamon, ½ cupraspberries, 2 teaspoons groundflaxseed, and 1½ tablespoonschopped walnuts.

1 cup skim milk.

1,700, 2,000, AND 2,500 CALORIES/DAY: HealthyGrain Instant Original Cream of Wheatprepared as above served with ¾ cupraspberries, 1 tablespoon groundflaxseed, and 2 tablespoons choppedwalnuts. Serve with 1 cup skim milk.

Lunch

1,500 AND 1,700 CALORIES/DAY:

Page 802: 20 Years Younger Look Younger, Feel Younger, Be Younger!

1 serving Sesame Shrimp Salad withNapa Cabbage and Bean Sprouts(here).

1 cup blueberries topped with 2tablespoons nonfat plain yogurt.

2,000 CALORIES/DAY: 1 serving SesameShrimp Salad served with 1 brown ricecake spread with ¼ avocado, mashed,and 1 cup blueberries topped with 2tablespoons nonfat plain yogurt.

2,500 CALORIES/DAY: 1 serving SesameShrimp Salad served with 2 brown ricecakes spread with avocado, mashed,and 1 cup blueberries topped with 2

Page 803: 20 Years Younger Look Younger, Feel Younger, Be Younger!

tablespoons nonfat plain yogurt.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Veggie Chili with Kale(here).

1 serving Polenta (here).

2,000 CALORIES/DAY: 1 serving VeggieChili with Kale and Polenta with 2tablespoons (½ ounce) reduced-fatcheddar cheese melted on the polenta.Add salad of 2 cups mixed baby greenswith ½ cup sliced white buttonmushrooms, 1 medium tomato,

Page 804: 20 Years Younger Look Younger, Feel Younger, Be Younger!

chopped, 1 teaspoon olive oil, and asplash of red wine vinegar.

2,500 CALORIES/DAY: 1 serving VeggieChili with Kale and Polenta preparedas for 2,000 calories/day. Prepare thesalad with 2 teaspoons olive oil.

Snack

ALL CALORIE LEVELS:

Grape, Cinnamon, and Yogurt Parfait: cup plain nonfat yogurt with ½ cup

grapes and ¼ teaspoon groundcinnamon.

2,500 CALORIES/DAY EXTRA SNACK: 3½

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tablespoons sunflower seeds with ¼cup pomegranate seeds.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

Dark Chocolate with FreshStrawberries: 1¼ cups wholestrawberries with 12 regular-sizedark chocolate chips and 1tablespoon plus 1 teaspoon choppedpecans.

2,000 CALORIES/DAY: Prepare DarkChocolate with Fresh Strawberries

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with 1¼ cups whole strawberries and36 regular-size dark chocolate chipsand 1 tablespoon plus 2 teaspoonschopped pecans.

2,500 CALORIES/DAY: Prepare DarkChocolate with Fresh Strawberrieswith 1 cup whole strawberries with 48regular-size dark chocolate chips and 3tablespoons chopped pecans.

Day 12

Breakfast

1,500 CALORIES/DAY:

¼ cup dry steel-cut oats cookedaccording to package directions in 1

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cup soy milk with 1 vanilla beansliced lengthwise or teaspoonvanilla extract, and topped with ¾cup chopped fresh strawberries and 2tablespoons slivered almonds.

1,700, 2,000, AND 2,500 CALORIES/DAY: ¼ cupdry steel-cut oats cooked according topackage directions in 1 cup soy milkwith 1 vanilla bean sliced lengthwiseor teaspoon vanilla extract, andtopped with ¾ cup chopped freshstrawberries and 3 tablespoonsslivered almonds.

Lunch

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1,500 AND 1,700 CALORIES/DAY:

Tempeh, Lettuce and TomatoSandwich: Preheat oven to broil. In afood processor combine ¼ avocado,a pinch of salt, and 1 tablespoonsilken tofu. Set aside. Place a 4-ounce slice of tempeh in the oven andcook on each side for 3 minutes.Toast two 1-ounce slices of wholegrain bread and spread each with ½of the avocado mixture, top withtempeh, a slice of tomato, and twoleaves of romaine lettuce.

2,000 CALORIES/DAY: Prepare sandwich asabove using ½ avocado, a pinch of salt,and 2 tablespoons silken tofu, a 4½-

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ounce slice of tempeh, two 1-ounceslices of whole grain bread, a slice oftomato, and two leaves of romainelettuce. Serve with a salad of 2 cupsspinach leaves topped with a splash ofbalsamic vinegar and ½ teaspoon oliveoil.

2,500 CALORIES/DAY: Prepare sandwichand spinach salad as 2,000calories/day. Serve with 1¼ cupssliced peaches.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Poached Chicken Curry

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(here) garnished with 1 tablespoonreduced-fat sour cream.

¼ cup cooked brown rice seasonedwith 1 teaspoon olive oil and a dashof salt.

2,000 CALORIES/DAY: 1 serving PoachedChicken Curry garnished with 1tablespoon reduced-fat sour cream andserved with cup cooked brown riceseasoned with 2½ teaspoons olive oil,a dash of salt, and Spicy Mango Relish:

cup mango cubes combined withchopped fresh hot pepper to taste, 2tablespoons chopped fresh cilantro,and a pinch of salt.

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2,500 CALORIES/DAY: 1 serving PoachedChicken Curry garnished with 1tablespoon reduced-fat sour cream andserved with cup cooked brown riceseasoned with 2½ teaspoons olive oiland a dash of salt. Prepare SpicyMango Relish with ½ cup mangocubes.

Snack

ALL CALORIE LEVELS:

Cucumber with Ricotta Dip: cupplus 2 tablespoons nonfat ricottacheese mixed with a pinch ofpaprika, 1 tablespoon plus 1teaspoon cashews, and teaspoon

Page 812: 20 Years Younger Look Younger, Feel Younger, Be Younger!

fresh lemon juice with 1 cup slicedcucumber for dipping.

2,500 CALORIES/DAY EXTRA SNACK: 6ounces nonfat Greek yogurt with 3tablespoons peanuts and 24 regular-size dark chocolate chips.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

1 Carrot Oatmeal Cookie (here)

2,000 CALORIES/DAY: 1 Carrot OatmealCookie spread with 1½ teaspoons

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almond butter.

2,500 CALORIES/DAY: 1 Carrot OatmealCookie spread with 2½ teaspoonsalmond butter and topped with 1teaspoon almonds.

Day 13

Breakfast

1,500 CALORIES/DAY:

¾ cup whole grain flake cereal (suchas Arrowhead Mills Oat BranFlakes, Nature’s Path Flax Plus, orKashi-7 Whole Grain Flakes) mixedwith ½ cup Shredded Wheat.

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2 teaspoons sunflower seeds.

¾ cup blackberries.

1 cup soy milk.

1,700, 2,000, AND 2,500 CALORIES/DAY: 1 cupwhole grain flake cereal mixed with ½cup Shredded Wheat, 1 tablespoonsunflower seeds, ¾ cup blackberries,and 1 cup soy milk.

Lunch

1,500 AND 1,700 CALORIES/DAY:

Tuna Salad: In a large bowl combine4 ounces low-sodium chunk light tuna

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packed in water, drained, with 1teaspoon capers, 1 medium tomato,diced, 1 teaspoon Dijon mustard, ½cup sliced cucumbers, ½ cup slicedcelery, 1 cup arugula, 2 teaspoonsolive oil, and 1 teaspoon fresh lemonjuice.

1 Wasa multigrain crispbread.

1 cup sliced strawberries.

2,000 CALORIES/DAY: Prepare Tuna Saladwith 5 ounces tuna, 1 teaspoon capers,1 medium tomato, diced, 1 teaspoonsesame seeds, 1 teaspoon Dijonmustard, ½ cup sliced cucumbers, ½cup sliced celery, 1 cup arugula, 1

Page 816: 20 Years Younger Look Younger, Feel Younger, Be Younger!

tablespoon olive oil, and 1 teaspoonfresh lemon juice. Serve with a 1-ounce whole wheat roll and 1 cupsliced strawberries.

2,500 CALORIES/DAY: Prepare Tuna Saladas for 2,000 calories/day. Serve withtwo 1-ounce whole wheat rolls and 1cup sliced strawberries.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Pork Tenderloin withTurnips, Apples, and Onions (here).

1 cup barley cooked according to

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package directions and combinedwith 2 teaspoons olive oil, 1 cup ofarugula, one dash of salt, and blackpepper to taste.

2,000 CALORIES/DAY: 1 serving PorkTenderloin with Turnips, Apples, andOnions served with 1¼ cups barleycombined with 1 tablespoon olive oil,2 teaspoons chopped pecans, 1 cup ofarugula, one dash of salt, and blackpepper to taste.

2,500 CALORIES/DAY: 1 serving PorkTenderloin with Turnips, Apples, andOnions served with 1½ cups barleycombined with 1 tablespoon olive oil,1 tablespoon plus 1 teaspoon chopped

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pecans, 1 cup of arugula, a dash of salt,and black pepper to taste.

Snack

ALL CALORIE LEVELS:

Mango Smoothie: Combine in ablender until smooth ½ cup slicedfresh mango and 1 cup calcium-enriched soy milk.

2,500 CALORIES/DAY EXTRA SNACK: 10 ricecrackers (about 115 calories’ worth)dipped in 1 tablespoon plus 1 teaspoontahini mixed with 1 tablespoonpomegranate seeds.

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Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

1 serving Stuffed Baked Peach (here).

2,000 CALORIES/DAY: 1 serving StuffedBaked Peach and ½ cup plain nonfatGreek yogurt.

2,500 CALORIES/DAY: 1 servingStuffed Baked Peach and ¾ cup plainnonfat Greek yogurt topped with 1teaspoon almonds.

Day 14

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Breakfast

1,500 CALORIES/DAY:

1 serving Blueberry OatmealPancakes with ¼ cup reservedblueberries included in recipe (here).

cup calcium-fortified orange juice.

1,700, 2,000, AND 2,500 CALORIES/DAY: 1serving Blueberry Oatmeal Pancakestopped with ¼ cup reservedblueberries included in recipe and 2teaspoons chopped walnuts. Serve with¾ cup calcium-fortified orange juice.

Lunch

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1,500 AND 1,700 CALORIES/DAY:

Black Bean Salad: Toss 1 cupshredded cabbage with ½ cup cookedor canned (no salt, drained andrinsed) black beans, ½ cup slicedcucumber, 1 tablespoon finelychopped red onion, ¼ avocadosliced, 1 tablespoon fresh lime juice,1½ teaspoons olive oil, teaspoonsalt, and black pepper to taste.

Garlic Toast: Rub a 1-ounce slice ofwhole grain bread with ½ teaspoonolive oil and teaspoon mincedgarlic, and toast under the broileruntil golden brown.

1 orange.

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2,000 CALORIES/DAY: Prepare Black BeanSalad as above but with 1 cup blackbeans. Serve with Garlic Toast andorange.

2,500 CALORIES/DAY: Prepare Black BeanSalad as 2,000 calories/day, and addone Wasa multigrain crispbread spreadwith 1½ teaspoons Bestlife spread.Serve with Garlic Toast and orange.

Dinner

1,500 AND 1,700 CALORIES/DAY:

1 serving Baked Penne Pasta withShrimp (here).

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Arugula and Fennel Salad: 1 cuparugula and 1 cup finely shavedfennel dressed with 2 teaspoonsolive oil, 1 teaspoon balsamicvinegar, a small pinch of salt, andblack pepper to taste.

2,000 CALORIES/DAY: 1 serving BakedPenne Pasta with Shrimp and Arugulaand Fennel Salad prepared with 2 cupsarugula, 1 cup finely shaved fennel, ¼cup grated carrot dressed with 1tablespoon olive oil, 2 teaspoonsbalsamic vinegar, 1 tablespoon plus 1teaspoon pine nuts, a small pinch ofsalt, and black pepper to taste.

2,500 CALORIES/DAY: 1 serving Baked

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Penne Pasta with Shrimp and Arugulaand Fennel Salad prepared as for 2,000calories/day. Serve with ¾ cup slicedapple drizzled with 2 teaspoons honey.

Snack

ALL CALORIE LEVELS:

Carrots with Spiced Yogurt Dip: In asmall bowl thoroughly combine ¾cup nonfat plain yogurt, 1 teaspoonolive oil, a pinch of ground cumin, apinch of cayenne pepper, ¼ teaspoonfennel seeds, and a pinch of salt.Serve with 6 medium carrot slices.

2,500 CALORIES/DAY EXTRA SNACK: 1 cup

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sliced green or yellow summer squashdipped into 6 tablespoons hummusmixed with 1 tablespoon plus 1teaspoon toasted sesame seeds.

Treat

1,500 CALORIES/DAY: Omit the treat.

1,700 CALORIES/DAY:

Trail mix: 2 teaspoons almonds, 3tablespoons chopped dried figs, and1 tablespoon cocoa nibs.

2,000 CALORIES/DAY: Prepare trailmix with 1 tablespoon almonds, 4tablespoons chopped dried figs, and 1

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tablespoon plus 1 teaspoon cocoa nibs.

2,500 CALORIES/DAY: Trail mix asprepared for 2,000 calories/day,served with 10 reduced-fat WheatThins or 60 calories of another wholewheat cracker.

20 YEARS YOUNGERRECIPES

Think of it as the best of both worlds:This collection of twenty-five recipesoffers the anti-aging benefits of theOkinawan diet as well as those ofMediterranean traditions, with the

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distinctive flavors of each. Each recipealso contains one or more of thesuperfoods listed in chapter 3. Overall,they give you a lot of health rewards foryour cooking efforts—and those effortswon’t sap your energy: No recipe takesmore than twenty minutes of preparationtime. Enjoy!

Breakfast

MUESLI

Serves 4 Prep time: 5 minutes Total

time: 5 minutes

1½ cups rolled oats

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¼ cup chopped dried fruits, such as apricots,prunes, or raisins (raisins can be leftwhole)

¼ cup chopped almonds

3 tablespoons raw pumpkin seeds

2 tablespoons ground flaxseed

½ teaspoon very finely chopped orangerind

1. Combine all ingredients in a mediumbowl. Store any extra servings in anairtight container.

Per serving: 264 calories; 1.6 g saturated fat; 5 mgsodium; 6 g fiber

BLUEBERRY OATMEAL PANCAKES

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Serves 4 Prep time: 5 minutes

Total time: 15 minutes

¾ cup spelt flour

cup plus 2 tablespoons wheat bran

cup plus 2 tablespoons oatmeal

½ teaspoon baking soda

½ cup egg substitute

1¾ cup buttermilk (more if batter is toothick)

1½ tablespoons canola oil

2 tablespoons Bestlife spread, melted

2 cups blueberries

Vegetable oil spray

1. Heat a heavy-bottom skillet over

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1. Heat a heavy-bottom skillet overmedium heat.

2. Mix spelt flour, bran, oatmeal,baking soda, egg substitute,buttermilk, oil, and Bestlife spreaduntil just combined but a fewlumps are still present. Do notovermix. Gently fold in 1 cup ofthe blueberries.

3. Spray hot skillet with cooking oilspray and drop batter onto skilletmaking 4 large or 8 smallpancakes. When bubbles appearon the surface of the pancake,about 3 minutes, flip, and cookthe other side for another 2minutes.

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4. Garnish with the remainingblueberries.

Per serving: 337 calories; 2.4 g saturated fat; 377 mgsodium; 8 g fiber

Lunch

SESAME SHRIMP SALAD WITH NAPA

CABBAGE AND BEAN SPROUTS

Serves 4 Prep time: 10 minutes

Total time: 10 minutes

¼ cup sesame paste (tahini)

2 tablespoons rice wine vinegar

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1 tablespoon water

¼ teaspoon salt

Hot pepper flakes, to taste

4 cups julienned Napa cabbage

1 cup bean sprouts

1 cup shredded carrots

1 pound shrimp, cooked and shelled

2 teaspoons sesame oil

Juice of 1 lemon

1. In a large bowl combine untilsmooth sesame paste, rice winevinegar, water, salt, and hotpepper flakes. Add cabbage, beansprouts, and carrots, and tossuntil thoroughly incorporated.

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2. In a small bowl toss shrimp withsesame oil and lemon juice.

3. To serve, make a bed of cabbagemixture and top with the shrimp.

Per serving: 321 calories; 2 g saturated fat; 385 mgsodium; 4 g fiber

Dinner

BRAISED CHICKEN LEGS IN RED WINE

WITH LENTILS, FENNEL, AND KALE

Serves 4 Prep time: 10 minutes

Total time: 1 hour

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2 teaspoons olive oil

4 chicken legs, skin removed

1 medium onion, finely chopped

2 cloves garlic, finely chopped

1 cup red wine

1 cup water

1 large sprig rosemary

½ cup lentils

1 cup sliced fennel

2 cups chopped kale

¼ teaspoon salt

1. Preheat oven to 325 degrees.

2. Heat a large ovenproof heavy-bottom pot with a lid overmedium heat. Pour in olive oil and

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place legs in pot in a single layerand cook, turning once, untilbrowned, about 10 minutes.

3. Remove legs and add onion andgarlic to the pot. Cook, stirringoften, for 3 minutes. Add wine,water, rosemary, and lentils, bringto a boil, then reduce heat andsimmer for 5 minutes. Addchicken legs, fennel, and kale.

4. Cover pot and place in oven. Cookfor 1 hour. Remove from oven,take out rosemary sprig, add salt,and serve.

Per serving: 331 calories; 3.8 g saturated fat; 255 mg

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sodium; 9 g fiber

POACHED CHICKEN CURRY

Serves 4 Prep time: 15 minutes

Total time: 45 minutes

1 tablespoon olive oil

1 onion, sliced

1 teaspoon cumin

1 teaspoon mustard powder

1 tablespoon minced fresh ginger

2 cloves garlic, minced

¼ teaspoon cayenne pepper, or to taste

2 large tomatoes, sliced, or 2 cups canned, nosalt added

4 cups water ¼ teaspoon salt

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Pepper, to taste

1 teaspoon turmeric

1 cup cooked garbanzo beans, dry orcanned, no salt added, drained andrinsed

2 cups diced sweet potatoes

4 cups julienned collard greens

1 cup fresh or frozen peas

1 pound skinless, boneless chicken breasts,cut into ½-inch strips

1. Heat a heavy-bottom stockpotwith a lid over medium heat. Addolive oil and onion to the pot.Cook, stirring often, for 5 minutes.Add cumin, mustard powder,ginger, garlic, and cayenne. Cook

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for 2 more minutes, stirringconstantly.

2. Add tomatoes, water, salt,pepper, turmeric, garbanzo beans,sweet potatoes, and collardgreens to the pot and bring to aboil. Reduce heat to a simmer andcook until the sweet potatoes aretender, about 20 minutes.

3. Add peas and chicken. Cover andsimmer for 5 minutes, or untilchicken is cooked through. Serve.

Per serving: 397 calories; 1.1 g saturated fat; 277 mgsodium; 11 g fiber

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BAKED EGGPLANT AND GROUND TURKEY

Serves 4 Prep time: 20 minutes

Total time: 1 hour

4 cups thinly sliced eggplant

1 onion, thinly sliced

2 cloves garlic, minced

Vegetable oil cooking spray

12 ounces ground turkey

1 tablespoon oregano

½ teaspoon cinnamon

½ teaspoon cumin

teaspoon salt

Pepper to taste

1 cup tomato sauce

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½ cup water

1. Preheat oven to 375 degrees.Heat a large heavy-bottom skilletover medium heat.

2. Coat eggplant, onion, and garlicwith cooking spray. Place on abaking sheet and roast in oven for15 minutes.

3. Spray turkey with cooking sprayand cook in skillet, stirring often,until browned, about 5 minutes.Stir in oregano, cinnamon, cumin,salt, and pepper to taste.

4. Coat a 9×9-inch baking pan with

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cooking spray. Pour in ½ cup ofthe tomato sauce and top withhalf of the eggplant mixture, halfof the turkey mixture, remainingeggplant mixture, remainingturkey mixture, and top withremaining tomato sauce. Pour thewater around the edges.

5. Bake for 40 minutes. Serve hot.

Per serving: 206 calories; 2 g saturated fat; 387 mgsodium; 5 g fiber

SWEET POTATO AND TURKEY

SHEPHERD’S PIE

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Serves 4 Prep time: 20 minutes

Total time: 60 minutes

POTATOES

2 medium sweet potatoes

2 teaspoons olive oil

2 tablespoons skim milk

teaspoon salt

TURKEY

Vegetable oil cooking spray

2 large carrots, shredded

1 onion, chopped

1 pound boneless turkey tenderloin,chopped into 1-inch pieces

1 teaspoon fresh thyme

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3 cups spinach

POTATOES

1. Preheat oven to 375 degrees. Cutpotatoes in half lengthwise, placecut-side down in a baking pan,and bake in the oven until tenderwhen tested with a fork, about 30minutes.

2. Remove potatoes from the oven(leave the oven on), and scoopout the flesh. Place the flesh in alarge bowl and add olive oil, milk,and salt and mash with a woodenspoon until smooth.

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TURKEY MIXTURE (prepare while potatoesare cooking)

1. Heat a heavy-bottom skillet overmedium heat.

2. Lightly coat skillet with cookingspray. Add carrots and onion andcook until slightly browned, about4 minutes, stirring often.

3. Add turkey and thyme, cook untilgolden brown, about 5 minutes.Mix in spinach.

TO ASSEMBLE

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1. In a 9×9-inch baking pan or fourindividual 4-or 5-inch ramekins,place turkey mixture on thebottom and cover with sweetpotatoes.

2. Bake in a 375-degree oven for 15minutes if using warmingredients. (If you assembledpies earlier and refrigerated, bakeabout 25 minutes.)

3. After baking pies, turn oven tobroil and broil 6 to 9 inches fromheat source until tops of potatoesare browned, about 5 minutes.Serve hot.

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Per serving: 239 calories; 1 g saturated fat; 212 mgsodium; 4 g fiber

SLOW-COOKED LAMB WITH TOMATO,CAULIFLOWER, AND CHARD

Serves 4 Prep time: 20 minutes

Total time: 2 hours

½ teaspoon cumin

teaspoon cayenne

¼ teaspoon turmeric

½ teaspoon cinnamon

1 pound boneless leg of lamb, cut into cubes

Vegetable oil cooking spray

2 cups water

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1 onion, chopped

2 cloves of garlic, finely minced

2 large tomatoes, chopped

1 cup chopped cauliflower

4 cups chard (or spinach if not available)

¼ teaspoon salt

1. In a large mixing bowl combinethe cumin, cayenne, turmeric, andcinnamon. Add the lamb and tossuntil coated. Set aside.

2. Heat a large heavy-bottom potwith a lid over medium heat.Spray with vegetable oil and addhalf of the lamb, browning, about3 minutes on each side. Remove

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the first batch of lamb and repeatwith the remaining half. Removethe second batch of lamb and setaside.

3. Add the water and scrape thebottom of the pot to incorporatethe spices stuck to the pot. Addthe lamb, onion, garlic, andtomatoes.

4. Bring to a boil, reduce the heat tolow, cover, and simmer for 1½hours, stirring occasionally. Addthe cauliflower and chard andcook for an additional 10 minutes.Add salt. Serve hot.

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Per serving: 205 calories; 2.7 g saturated fat; 329 mgsodium; 3 g fiber

PORK TENDERLOIN WITH TURNIPS,APPLES, AND ONIONS

Serves 4 Prep time: 10 minutes

Total time: 2 hours

2 tablespoons paprika

1½ tablespoons olive oil

1 teaspoon ground cumin

1 tablespoon brown sugar

1 tablespoon cocoa powder

1 tablespoon fresh oregano

½ teaspoon salt

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4 cloves garlic, minced

1 pound pork tenderloin

1 cup 1-inch cubes of turnip

1 cup 1-inch cubes of apple

1 onion, diced

1. Preheat oven to 325 degrees.

2. Blend paprika, 1 tablespoon of theoil, cumin, brown sugar, cocoapowder, oregano, salt, garlic, and1 teaspoon water in foodprocessor until it becomes apaste, about 1 minute.

3. Rub pork with mixture and allowto marinate in the refrigerator for

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1 hour or up to 24 hours.

4. Place turnip, apple, and onion in abowl and toss with remainingolive oil.

5. Place pork in baking pan andsurround with turnip, apple, andonion. Bake until the internaltemperature reaches 150 degrees(the temperature will rise while itis resting), about 45 minutes. Letrest for at least 10 minutes beforeslicing.

Per serving: 248 calories; 2 g saturated fat; 359 mgsodium; 4 g fiber

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POACHED TROUT WITH TOMATO AND

BASIL

Serves 4 Prep time: 10 minutes

Total time: 20 minutes

½ cup white wine

1 large tomato, skin* and seeds removed,chopped

1 cup water

2 tablespoons finely diced onion

¼ cup basil leaves

1 pound trout fillet, divided into 4 portions

teaspoon salt

1. Place wine, tomato, water, onion,

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and basil in a heavy-bottom skillet(just large enough to fit fish sopieces do not overlap) and bringto a boil.

2. Reduce heat and let simmer for 5minutes.

3. Add the trout, cover, and cook foran additional 5 minutes. Add salt.

4. Serve the fish in shallow bowlswith the broth spooned on top.

* To remove the skin of a tomato,dip it into boiling water for tenseconds, then place in a bowl of

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cold water. The skin should easilypeel off.

Per serving: 150 calories; .8 g saturated fat; 112 mgsodium; 1 g fiber

SPICED COD

Serves 4 Prep time: 10 minutes

Total time: 25 minutes

1 tablespoon olive oil

2 cloves garlic, minced

¼ teaspoon cumin

¼ teaspoon turmeric

¼ teaspoon cinnamon

Crushed red pepper, to taste

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4 large tomatoes, cores removed, andchopped

2 cups water

1 pound cod, cut into 4 portions

¼ teaspoon salt

1 lemon, cut into 4 wedges

1. Heat a large heavy-bottom skilletwith a lid over medium heat. Addolive oil and garlic and cook,stirring constantly, for 1 minute.

2. Add cumin, turmeric, andcinnamon and cook for anadditional 30 seconds, stirringconstantly. Add red pepper,tomatoes, and water. Bring to a

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boil, then reduce heat to asimmer and cook for 10 minutes.

3. Add fish to spice broth, then coverand cook until fish flakes easilywith a fork, about 4 minutes.Season with salt.

4. Serve fish with the spice brothand lemon wedges.

Per serving: 164 calories; .7 g saturated fat; 219 mgsodium; 3 g dietary fiber

TROUT GUMBO

Serves 4 Prep time: 15 minutes

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Total time: 55 minutes

1½ tablespoons olive oil

2 tablespoons all-purpose flour

1 tablespoon minced garlic

4 cups low-sodium vegetable broth

1 cup water

1 bottle beer

3 large tomatoes, chopped

1 onion, finely chopped

Fresh chili peppers, finely chopped, to taste

1 tablespoon Cajun seasoning

2 cups sliced okra (fresh or frozen)

1½ pounds trout fillet cut into 1-inch pieces

teaspoon salt

1. Heat a heavy-bottom pot over

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1. Heat a heavy-bottom pot overmedium heat. Add oil and flourand whisk together until smooth.Cook, stirring constantly untilbrowned and bubbly, about 5minutes. Mix in garlic and cook for1 minute.

2. Gradually add the vegetablebroth, water, and beer, andcombine thoroughly. Bring to aboil and mix in tomatoes, onion,chili peppers, Cajun seasoning,and okra. Reduce heat to asimmer, then cover and cook for30 minutes, stirring often.

3. Add trout to soup and return to a

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simmer. Cover and cook until fishis flaky, about 5 minutes. Add saltand serve.

Per serving: 422 calories; 2.7 g saturated fat; 360 mgsodium; 5 g fiber

SALMON SALAD WITH AVOCADO, HIJIKI,CUCUMBER, AND MUSHROOMS

Serves 4 Prep time: 15 minutes

Total time: 45 minutes

1 cup hijiki seaweed (if not available,substitute a green such as spinach,arugula, or watercress)

1½ pounds skinless center-cut salmon fillet

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(wild-caught, if possible)

¼ teaspoon salt

3 teaspoons sesame oil

1 lemon, halved

2 tablespoons rice wine vinegar

2 tablespoons finely chopped green onion

1 cup peeled, seeded and diced cucumber

1 cup sliced white button mushrooms

1 avocado, sliced

1. In a medium-size bowl pourenough warm water over the hijikito cover and let stand for 30minutes. (If using a green, skipthis step.)

2. While the seaweed is soaking, cut

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the salmon in half lengthwise,then slice each piece crosswiseinto ¼-inch slices.

3. Fill a deep 10-inch skillet withenough water to cover salmonand bring to a boil. Reduce theheat to a simmer. Place six slicesof salmon in the pan and poachfor 30 seconds; remove with aslotted spoon and transfer to aplate with a paper towel to drain.Repeat until all the salmon iscooked.

4. Place fish slices on a dry plate in asingle layer and season them with teaspoon of the salt and 1

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teaspoon of the sesame oil.Squeeze half the lemon over theslices.

5. After the seaweed is finishedsoaking, drain and toss withvinegar, the remaining sesameoil, green onion, cucumber, andmushrooms.

6. Dress avocado with juice from theremaining half lemon andremaining teaspoon salt.

7. To serve, top the seaweed saladwith the salmon and avocadoslices.

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Per serving: 394 calories; 3.6 g saturated fat; 247 mgsodium; 3 g fiber

BAKED PENNE PASTA WITH SHRIMP

Serves 4 Prep time: 15 minutes

Total time: 1 hour 5 minutes

2 cups whole grain penne pasta (about 5.32ounces)

Vegetable oil cooking spray

1 large onion, finely sliced

4 cloves garlic, finely minced

2 sweet red peppers, sliced

½ teaspoon salt

3 tomatoes, chopped

2 cups chopped chard

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2 tablespoons chopped fresh oregano

1 tablespoon chopped fresh rosemary

1 tablespoon olive oil

1½ pounds shrimp, shelled and deveined

1. Preheat oven to 375 degrees.

2. Prepare the pasta according topackage directions.

3. Heat a large ovenproof skilletover medium heat. Spray withcooking oil spray and add onionand half the garlic to skillet. Cook,stirring regularly, for 3 minutes.Add red peppers and cook for 5more minutes. Remove from heat.

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4. In a large bowl combine salt,tomatoes, chard, oregano,rosemary, red pepper mixture,olive oil and the cooked pasta.

5. Place in a baking dish, cover withfoil, and bake for 20 minutes.Remove foil and bake for anadditional 10 minutes.

6. During the last 10 minutes of thepasta baking, toss shrimp in abowl with the remaining garlic.Coat with vegetable oil spray.Place the shrimp on a baking trayand bake in the oven until justpink, about 6 minutes.

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7. To serve, divide pasta into 4portions and top each portion witha quarter of the shrimp.

Per serving: 406 calories; 1.2 g saturated fat; 590 mgsodium; 8 g fiber

CREAMY MAC AND NO CHEESE

Serves 4 Prep time: 10 minutes

Total time: 45 minutes

½ pound whole grain macaroni

1½ cups chopped cauliflower

1 cup roasted winter squash (fresh orfrozen)

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3 tablespoons chopped cashews

1 tablespoon Bestlife spread ½ teaspoonmustard powder

½ teaspoon paprika

¼ teaspoon salt

Black pepper, to taste

3 Wasa whole grain crispbreads, pulverized

1. Preheat oven to 375 degrees.

2. Cook macaroni according topackage directions. Drain and setaside in a large mixing bowl.

3. Place cauliflower in a medium-sizepot. Cover with water and bring toa boil. Reduce to a simmer and

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cook until tender, about 10minutes.

4. Drain cauliflower, reserving ½ cupof cooking water. Pureecauliflower, squash, cashews,Bestlife spread, reserved cookingwater, mustard powder, paprika,and salt in a blender until verysmooth, about 1 minute.

5. Combine the macaroni andcauliflower mixture and mix well.Transfer the mixture to a 9-inchovenproof skillet. Top with blackpepper and pulverizedcrispbreads.

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6. Bake for 10 minutes. Turn oven toa broil and cook until top isbrowned, about 5 minutes. Serveimmediately.

Per serving: 319 calories; 1.2 g saturated fat; 243 mgsodium; 10 g fiber

TOFU VEGETABLE SOUP WITH KOMBU

Serves 4 Prep time: 15 minutes

Total time: 50 minutes

Vegetable oil cooking spray

3 cloves garlic, minced

1 onion, finely sliced

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1 teaspoon grated fresh ginger

1 tablespoon miso paste

6 cups water

1 teaspoon low-sodium soy sauce

1 ounce kombu

16 ounces firm tofu, cut into cubes

Leaves of 1 small head or ½ large head bokchoy

1 cup sliced shiitake mushrooms

1. Heat a heavy-bottom soup potover medium heat. Spray withvegetable oil spray, add garlic,onion, and ginger. Stir constantlyfor 3 minutes. Add miso andslowly add water, taking care todissolve the miso. Once the miso

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is dissolved, add the remainingwater, soy sauce, and kombu.

2. Bring soup to a boil, reduce heat,and simmer for 20 minutes. Addtofu, bok choy, and shiitakemushrooms, then simmer for anadditional 10 minutes. Serve hot.

Per serving: 284 calories; 1.7 g saturated fat; 408 mgsodium; 8 g fiber

WHOLE GRAIN THIN SPAGHETTI WITH

PEANUT SAUCE

Serves 4 Prep time: 5 minutes

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Total time: 15 minutes

2 tablespoons peanut butter

1 tablespoon white vinegar

1 tablespoon water

4 ounces thin whole grain spaghetti cookedaccording to package directions

1 cup shredded carrots

¼ cup fresh cilantro

1. In a large bowl, combine peanutbutter, vinegar, and water untilsmooth.

2. Add spaghetti, carrots, andcilantro to peanut butter mixture,toss, and serve.

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Per serving: 158 calories; .9 g saturated fat; 59 mgsodium; 1 g fiber

VEGGIE CHILI WITH KALE

Serves 4 Prep time: 10 minutes

Total time: 50 minutes (plus at least 3

hours for tofu to freeze and then thaw)

Vegetable oil spray

1 large onion, chopped

3 cloves garlic, minced

8 ounces firm or very firm tofu, drainedthoroughly, frozen solid and defrosted

6 cups water

3 tomatoes, chopped, or 3 cups canned, nosalt added, chopped

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2 sweet red peppers, seeds removed, finelychopped

2 carrots, chopped

teaspoon cayenne, or more to taste

2 tablespoons chili powder

1½ cups cooked red kidney beans (dried orcanned, no salt added, drained andrinsed)

2 cups finely chopped kale

¼ teaspoon salt

1. Heat large heavy-bottom stockpotover medium heat. Coat withvegetable oil spray, add onionand garlic, and cook until brown,stirring regularly, about 5minutes.

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2. Crumble thawed tofu, which willbe similar to the consistency ofground beef. Add to the onionmixture. Continue cooking, stirringregularly, for 5 minutes.

3. Add water, tomatoes, redpeppers, carrots, cayenne, chilipowder, kidney beans, and kale.Stir and bring to a boil.

4. Reduce heat and simmer for 30minutes. Stir in salt. Serve hot.

Per serving: 324 calories; 1.6 g saturated fat; 434 mgsodium; 18 g fiber

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POLENTA

Serves 4 Prep time: 5 minutes

Total time: 25 minutes

Vegetable oil spray

3 cups water

1 cup cornmeal

1½ tablespoons olive oil

One large pinch salt

1. Preheat oven to 350 degrees.Spray a 9 x 9-inch baking panwith vegetable oil spray.

2. Bring water to a boil in a medium-

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size pan. Slowly add cornmeal,stirring continuously to avoidlumps.

3. Reduce heat to medium andcontinue to cook, stirring, for 5minutes. Remove from heat andstir in olive oil and salt.

4. Pour cornmeal mixture into bakingpan and cook for 10 minutes. Turnoven to broil and cook until top isbrowned, about 5 more minutes.

Per serving: 202 calories; 1.2 g saturated fat; 42 mgsodium; 4 g fiber

Snack

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ACAI POPSICLE

Serves 4 Prep time: 5 minutes

Total time: 3 hours (includes freezing

time)

1 cup frozen acai puree, defrosted

5 cups skim milk

2 tablespoons honey

1. Place all the ingredients into ablender and blend until smooth,about 1 minute.

2. Pour the mixture into four

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Popsicle molds or paper cups.Place a popsicle stick or chopstickin the middle of each cup andfreeze for 3 hours or until solid.

3. To serve, remove from molds orpeel away the paper cup. Extrapopsicles can be stored in thefreezer for future snacks.

Per serving: 155 calories; .5 g saturated fat; 132 mgsodium; 1 g fiber

Treat

ZUCCHINI OLIVE OIL CAKE

Serves 8 Prep time: 10 minutes

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Total time: 30 minutes

1 egg

¼ cup olive oil

½ cup sugar

¼ cup whole wheat flour

½ teaspoon baking soda

½ teaspoon low-sodium baking powder

½ teaspoon cinnamon

Pinch ground cloves

Pinch ground ginger

Pinch grated nutmeg

½ cup shredded zucchini

6 tablespoons chopped walnuts

Vegetable oil cooking spray

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1. Preheat oven to 350 degrees.Combine all the ingredientsexcept vegetable oil spray in amixer and mix until just fullyincorporated.

2. Spray a 9-inch pie plate withvegetable oil spray. Pour batterinto pie plate and spread toevenly coat the plate.

3. Bake until the cake is slightlyspringy to the touch and testsclean with a knife, about 20minutes. Slice and serve. Extraportions can be frozen for futuretreats.

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Per serving: 155 calories; 1.5 g saturated fat; 89 mgsodium; 1 g fiber

BAKED APPLE

Serves 4 Prep time: 5 minutes

Total time: 25 minutes

Vegetable oil cooking spray

4 apples, halved, core removed

4 teaspoons olive oil

2 tablespoons brown sugar

½ teaspoon ground cinnamon

2 tablespoons low-fat sour cream

1. Preheat oven to 325 degrees.

Page 883: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Spray a baking dish withvegetable oil.

2. In a large bowl, toss apples witholive oil, brown sugar, andcinnamon.

3. Place apples in the baking dishskin-side up. Top the apples withany sugar that remains in thebowl. Bake until tender, about 20minutes. Serve warm, roomtemperature, or cold topped withsour cream.

Per serving: 153 calories; 1.3 g saturated fat; 9 mgsodium; 3 g fiber

Page 884: 20 Years Younger Look Younger, Feel Younger, Be Younger!

CHOCOLATE SESAME BISCOTTI

Serves 6 Prep time: 10 minutes

Total time: 30 minutes

3 tablespoons pureed silken tofu

¼ cup sugar plus 1 teaspoon for rolling

1 teaspoon baking powder

2 tablespoons sesame oil

¼ cup plus 2 tablespoons flour

2 tablespoons cocoa powder

¼ cup whole wheat flour

2 tablespoons sesame seeds

1. Preheat oven to 375 degrees.

Page 885: 20 Years Younger Look Younger, Feel Younger, Be Younger!

2. In food processor combine all theingredients except the teaspoonsugar, and process for 1 minute.

3. Remove dough, sprinkle with theteaspoon sugar, and roll into a log1 inch in diameter. Place onbaking sheet and bake for 10minutes. Remove from oven, letcool for 5 minutes, and slice into½-inch slices (there should beabout 12 large or 18 smallcookies). Return slices to pan andplace them in the oven. Turn theoven off and let biscotti dry for 15minutes or overnight beforeserving. The longer you drybiscotti, the harder the cookies

Page 886: 20 Years Younger Look Younger, Feel Younger, Be Younger!

will be.

Per serving: 149 calories; 1 g saturated fat; 84 mgsodium; 2 g fiber

CARROT OATMEAL COOKIE

Serves 6 Prep time: 5 minutes

Total time: 15 minutes

1 cup rolled oats

2 tablespoons olive oil

2 tablespoons soy or skim milk

1 tablespoon sugar

1 tablespoon honey

¼ cup shredded carrot

Page 887: 20 Years Younger Look Younger, Feel Younger, Be Younger!

1 tablespoon currants

¼ cup chopped walnuts

½ teaspoon baking powder

Pinch salt

Vegetable oil cooking spray

1. Preheat oven to 350 degrees.

2. Combine all but the oil spray;process for 2 minutes.

3. Spray a cookie sheet with oilspray. Divide batter into 6cookies. Flatten and bake tillgolden, about 7 minutes.

Per serving: 150 calories; 1.1 g saturated fat; 73 mg

Page 888: 20 Years Younger Look Younger, Feel Younger, Be Younger!

sodium; 2 g fiber

STUFFED BAKED PEACH

Serves 1 Prep time: 5 minutes

Total time: 20 minutes

2 tablespoons nonfat ricotta

1 teaspoon honey

Dash of vanilla extract

1 peach, pit removed, halved

1 teaspoon finely chopped almonds

1. Preheat oven to 375 degrees.

2. In a small bowl combine ricotta,

Page 889: 20 Years Younger Look Younger, Feel Younger, Be Younger!

honey, and vanilla. Stuff peachhalves with ricotta mixture andplace on a baking sheet.

3. Bake for 15 minutes. Top withalmonds and serve warm or cool.

Per serving: 148 calories; .5 g saturated fat; 75 mgsodium; 3 g fiber

Page 890: 20 Years Younger Look Younger, Feel Younger, Be Younger!

CHAPTER 8

Putting It AllTogether

TO MAKE HEALTHY EXERCISE, eating, skincare, and sleep habits part of your liferequires organization and efficiency. Forexample, below is a week in the lives offour different people. One hasn’tcommitted to much physical activity(Pre–Level I) and is eating 1,500calories; the others are a Level I

Page 891: 20 Years Younger Look Younger, Feel Younger, Be Younger!

exerciser eating 1,700 calories; a LevelII exerciser eating 2,000 calories; and aLevel III exerciser eating 2,500 calories.

Note: In many cases, breakfast islisted after exercise. If you find you gettoo hungry during your workout, havehalf of your breakfast before youexercise.

PRE-LEVEL I, 1,500CALORIES

This schedule isn’t difficult to followand leaves plenty of room for moreexercise, should you decide to step upyour physical activity.

Page 892: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Monday

7:00 A.M.

Wake up

7:15 A.M.

Physical activity: Stretches and corestrengtheners

7:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:45 A.M.

Breakfast: Yogurt PomegranateParfait; English muffin with Bestlifespread

Page 893: 20 Years Younger Look Younger, Feel Younger, Be Younger!

12:30 P.M.

Lunch: Couscous Peach Salad; QuickRoasted Kale

3:00 P.M.

Snack: Grape, Cardamom, and YogurtParfait

6:30 P.M.

Dinner: Creamy Mac and No Cheese;Tomato Salad; Steamed Broccoli withGarlic

10:45 P.M.

Skin care: Polish, cleanse, nourish

11:00 P.M.

Page 894: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Sleep

Tuesday

7:00 A.M.

Wake up

7:15 A.M.

Physical activity: Stretches and corestrengtheners

7:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:45 A.M.

Breakfast: Tofu Scramble; mango and

Page 895: 20 Years Younger Look Younger, Feel Younger, Be Younger!

blackberries

12:30 P.M.

Lunch: Open Face Almond ButterSandwich; Celery Salad

3:00 P.M.

Snack: Green tea with soy milk

6:30 P.M.

Dinner: Salmon Salad with Avocado,Hijiki, Cucumber, and Mushrooms;black rice; grapefruit and raspberries

10:45 P.M.

Skin care: Polish, cleanse, nourish

Page 896: 20 Years Younger Look Younger, Feel Younger, Be Younger!

11:00 P.M.

Sleep

Wednesday

7:00 A.M.

Wake up

7:15 A.M.

Physical activity: Stretches and corestrengtheners

7:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:45 A.M.

Page 897: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Breakfast: Egg White and SpinachOmelet; Wasa multigrain crispbread;blackberries and honey; skim milk

12:30 P.M.

Lunch: Portobello Sandwich; plumsalad with pistachios; baby carrots andtahini

3:00 P.M.

Snack: Chocolate Ginger Latte

6:30 P.M.

Dinner: Tofu Vegetable Soup withKombu; Whole Grain Thin Spaghettiwith Peanut Sauce; orange

Page 898: 20 Years Younger Look Younger, Feel Younger, Be Younger!

10:45 P.M.

Skin care: Polish, cleanse, nourish

11:00 P.M.

Sleep

Thursday

7:00 A.M.

Wake up

7:15 A.M.

Physical activity: Stretches and corestrengtheners

7:30 A.M.

Page 899: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Skin care: Cleanse, nourish, sunscreen

7:45 A.M.

Breakfast: Whole Grain Cream ofWheat; skim milk

12:30 P.M.

Lunch: Sesame Shrimp Salad withNapa Cabbage and Bean Sprouts;blueberries and nonfat plain yogurt

3:00 P.M.

Snack: Grape, Cinnamon, and YogurtParfait

6:30 P.M.

Page 900: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Dinner: Veggie Chili; Polenta

10:45 P.M.

Skin care: Polish, cleanse, nourish

11:00 P.M.

Sleep

Friday

7:00 A.M.

Wake up

7:15 A.M.

Physical activity: Stretches and corestrengtheners

Page 901: 20 Years Younger Look Younger, Feel Younger, Be Younger!

7:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:45 A.M.

Breakfast: Oatmeal with soy milk,strawberries, and slivered almonds

12:30 P.M.

Lunch: Tempeh, Lettuce, and TomatoSandwich

3:00 P.M.

Snack: Cucumber with Ricotta Dip

6:30 P.M.

Dinner: Poached Chicken Curry;

Page 902: 20 Years Younger Look Younger, Feel Younger, Be Younger!

brown rice

10:45 P.M.

Skin care: Polish, cleanse, nourish

12:00 A.M.

Sleep

Saturday

8:00 A.M.

Wake up

8:15 A.M.

Physical activity:Stretches and core strengtheners

Page 903: 20 Years Younger Look Younger, Feel Younger, Be Younger!

20-minute walk

9:00 A.M.

Skin care: Cleanse, nourish, sunscreen

9:15 A.M.

Breakfast: Whole grain flake cereal,sunflower seeds, blackberries, and soymilk

1:00 P.M.

Lunch: Tuna Salad; strawberries;Wasa multigrain crispbread

4:00 P.M.

Snack: Mango Smoothie

Page 904: 20 Years Younger Look Younger, Feel Younger, Be Younger!

7:30 P.M.

Dinner: Pork Loin with Turnips,Apples, and Onions; barley andarugula

11:45 P.M.

Skin care: Polish, cleanse, nourish

12:00 A.M.

Sleep

Sunday

8:00 A.M.

Wake up

8:15 A.M.

Page 905: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Physical activity:Stretches and core strengtheners20-minute walk

9:00 A.M.

Skin care: Cleanse, nourish, sunscreen

9:15 A.M.

Breakfast: Blueberry OatmealPancakes; calcium-fortified orangejuice

1:00 P.M.

Lunch: Black Bean Salad; GarlicToast; orange

Page 906: 20 Years Younger Look Younger, Feel Younger, Be Younger!

3:00 P.M.

Snack: Carrots with Spiced YogurtDip

6:30 P.M.

Dinner: Baked Penne Pasta withShrimp; Arugula and Fennel Salad

10:45 P.M.

Skin care: Polish, cleanse, nourish

11:00 P.M.

Sleep

LEVEL I, 1,700 CALORIES

Page 907: 20 Years Younger Look Younger, Feel Younger, Be Younger!

This is the perfect schedule for anyonewith a busy week. You can get most ofyour cardio in on the weekends.

Monday

6:00 A.M.

Wake up

6:15 A.M.

Physical activity:Stretches and core strengthenersStrength training

6:45 A.M.

Skin care: Cleanse, nourish, sunscreen

Page 908: 20 Years Younger Look Younger, Feel Younger, Be Younger!

7:00 A.M.

Breakfast: Acai Almond ButterSmoothie with whole grain cereal

12:30 P.M.

Lunch: Sardine Salad; whole wheatroll with olive oil; grapes and figs

1:00 P.M.

Physical activity: 20-minute walk

3:00 P.M.

Snack: Fresh Mint Tea with honey

6:30 P.M.

Dinner: Baked Eggplant with Ground

Page 909: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Turkey; cracked wheat; baby spinach;cantaloupeTreat: Graham Cracker with Bananaand Walnuts

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

Tuesday

6:00 A.M.

Wake up

6:15 A.M.

Page 910: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Physical activity: Stretches and corestrengtheners

6:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:00 A.M.

Breakfast: Muesli with skim milk,blackberries, and almonds

12:30 P.M.

Lunch: Chicken, Grapefruit, andArugula Salad; two Wasa multigraincrispbreads with Bestlife spread

1:00 P.M.

Page 911: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Physical activity: 20-minute walk

3:00 P.M.

Snack: Pomegranate Freeze

6:30 P.M.

Dinner: Poached Trout with Tomatoand Basil; Spicy Farro with Mint andParsley; strawberriesTreat: Zucchini Olive Oil Cake

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

Page 912: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Wednesday

6:00 A.M.

Wake up

6:15 A.M.

Physical activity:Stretches and core strengthenersStrength training

6:45 A.M.

Skin care: Cleanse, nourish, sunscreen

7:00 A.M.

Breakfast: Shredded wheat withflaxseed, walnuts, strawberries, and

Page 913: 20 Years Younger Look Younger, Feel Younger, Be Younger!

soy milk

12:30 P.M.

Lunch: Edamame Dip; brown ricecakes; Cabbage Salad; honeydewmelon

3:00 P.M.

Snack: Acai Popsicle

6:30 P.M.

Dinner: Braised Chicken Legs in RedWine with Lentils, Fennel, and Kale;mixed greens with mushrooms andolive oil–lemon dressing; blueberriesTreat: Air-popped popcorn

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9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

Thursday

6:00 A.M.

Wake up

6:15 A.M.

Physical activity: Stretches and corestrengtheners

6:30 A.M.

Page 915: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Skin care: Cleanse, nourish, sunscreen

7:00 A.M.

Breakfast: Irish oatmeal with driedapricots, almonds, and skim milk

12:30 P.M.

Lunch: Salmon and avocado sushi roll;pineapple and walnuts

1:00 P.M.

Physical activity: 20-minute walk

3:00 P.M.

Snack: Nonfat yogurt with raspberries,cashews, and graham cracker

Page 916: 20 Years Younger Look Younger, Feel Younger, Be Younger!

6:30 P.M.

Dinner: Slow Cooked Lamb withTomato, Cauliflower, and Chard;Whole Grain Crostini; orangeTreat: Banana with dark chocolatechips and pine nuts

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

Friday

6:00 A.M.

Page 917: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Wake up

6:15 A.M.

Physical activity:Stretches and core strengthenersStrength training

6:45 A.M.

Skin care: Cleanse, nourish, sunscreen

7:00 A.M.

Breakfast: Blackberry Smoothie

12:30 P.M.

Lunch: Lentil soup with Parmesancheese and baby spinach; Wasa

Page 918: 20 Years Younger Look Younger, Feel Younger, Be Younger!

multigrain crispbread; grapefruit andpistachios

1:00 P.M.

Physical activity: 20-minute walk

3:00 P.M.

Snack: Acai Popsicle

6:30 P.M.

Dinner: Spiced Cod; Cracked WheatSaladTreat: Pretzels, Golden Raisins, andDark Chocolate Trail Mix

10:45 P.M.

Page 919: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Skin care: Polish, cleanse, nourish

11:00 P.M.

Sleep

Saturday

7:00 A.M.

Wake up

7:15 A.M.

Physical activity:Stretches and core strengtheners1-hour walk

8:30 A.M.

Page 920: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Skin care: Cleanse, nourish, sunscreen

8:45 A.M.

Breakfast: Yogurt Parfait

1:00 P.M.

Lunch: Cannellini Bean Spread onWhole Grain Pita; Arugula Salad;honeydew melon

3:00 P.M.

Physical activity: Tennis

4:00 P.M.

Snack: Strawberry Milk

7:30 P.M.

Page 921: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Dinner: Sweet Potato and TurkeyShepherd’s Pie; Coleslaw withMustard Vinaigrette; whole wheat rollwith olive oil; raspberriesTreat: Baked Apple

10:45 P.M.

Skin care: Polish, cleanse, nourish

11:00 P.M.

Sleep

Sunday

7:00 A.M.

Wake up

Page 922: 20 Years Younger Look Younger, Feel Younger, Be Younger!

7:15 A.M.

Physical activity:Stretches and core strengtheners1-hour walk

8:30 A.M.

Skin care: Cleanse, nourish, sunscreen

8:45 A.M.

Breakfast: Banana Spice Smoothie;Wasa multigrain crispbread and peanutbutter

1:00 P.M.

Lunch: Goat Cheese Sandwich; CitrusSalad

Page 923: 20 Years Younger Look Younger, Feel Younger, Be Younger!

3:00 P.M.

Snack: Cucumber with Yogurt Dip

6:30 P.M.

Dinner: Trout Gumbo; Mixed BabyGreen Salad; raspberriesTreat: Dark chocolate sorbet

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

LEVEL II, 2,000 CALORIES

Page 924: 20 Years Younger Look Younger, Feel Younger, Be Younger!

If you prefer to get your cardio in atnight, this is a good plan for you.

Monday

6:00 A.M.

Wake up

6:30 A.M.

Physical activity: Stretches and corestrengtheners

6:45 A.M.

Skin care: Cleanse, nourish, sunscreen

7:30 A.M.

Page 925: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Breakfast: Yogurt PomegranateParfait; English muffin with Bestlifespread

12:30 P.M.

Lunch: Couscous Peach Salad; QuickRoasted Kale

3:00 P.M.

Snack: Grape, Cardamom, and YogurtParfait

5:00 P.M.

Physical activity:45 minutes on the elliptical trainerStrength training

Page 926: 20 Years Younger Look Younger, Feel Younger, Be Younger!

6:30 P.M.

Dinner: Creamy Mac and No Cheese;Tomato Salad; Steamed Broccoli withGarlic and olive oilTreat: Chocolate Sesame Biscotti withalmond butter

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

Tuesday

6:00 A.M.

Page 927: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Wake up

6:15 A.M.

Physical activity: Stretches and corestrengtheners

6:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:30 A.M.

Breakfast: Tofu Scramble; mango andblackberries

12:30 P.M.

Lunch: Almond Butter Sandwich;Celery Salad

Page 928: 20 Years Younger Look Younger, Feel Younger, Be Younger!

3:00 P.M.

Snack: Green tea with soy milk

5:00 P.M.

45-minute walk

6:30 P.M.

Dinner: Salmon Salad with Avocado,Hijiki, Cucumber, and Mushrooms;black rice; grapefruit and walnutsTreat: Poached Pear with pecans

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Page 929: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Sleep

Wednesday

6:00 A.M.

Wake up

6:15 A.M.

Physical activity:Stretches and core strengthenersStrength training

7:00 A.M.

Skin care: Cleanse, nourish, sunscreen

7:30 A.M.

Page 930: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Breakfast: Egg White and SpinachOmelet; Wasa multigrain crispbread;blackberries and honey; skim milk

12:30 P.M.

Lunch: Portobello Sandwich; plumsalad with pistachios; baby carrots andtahini

3:00 P.M.

Snack: Chocolate Ginger Latte

6:30 P.M.

Dinner: Tofu Vegetable Soup withKombu; Whole Grain Thin Spaghettiwith Peanut Sauce; orange; Wasamultigrain crispbreads with Bestlife

Page 931: 20 Years Younger Look Younger, Feel Younger, Be Younger!

spreadTreat: Orange with Spices and Pecans

8:00 P.M.

Physical activity: Darts

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

Thursday

6:00 A.M.

Wake up

Page 932: 20 Years Younger Look Younger, Feel Younger, Be Younger!

6:15 A.M.

Physical activity: Stretches and corestrengtheners

6:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:30 A.M.

Breakfast: Whole Grain Cream ofWheat; skim milk

12:30 P.M.

Lunch: Sesame Shrimp Salad withNapa Cabbage and Bean Sprouts;brown rice cakes with avocado;blueberries and nonfat plain yogurt

Page 933: 20 Years Younger Look Younger, Feel Younger, Be Younger!

3:00 P.M.

Snack: Grape, Cinnamon, and YogurtParfait

5:00 P.M.

Physical activity: 45-minute walk

6:30 P.M.

Dinner: Veggie Chili; Polenta withreduced-fat cheddar cheese; mixedbaby greens saladTreat: Dark chocolate with freshstrawberries and pecans

9:45 P.M.

Skin care: Polish, cleanse, nourish

Page 934: 20 Years Younger Look Younger, Feel Younger, Be Younger!

10:00 P.M.

Sleep

Friday

6:00 A.M.

Wake up

6:15 A.M.

Physical activity: Stretches and corestrengtheners

6:30 A.M.

Skin care: Cleanse, nourish, sunscreen

7:30 A.M.

Page 935: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Breakfast: Oatmeal with soy milk,strawberries, and slivered almonds

12:30 P.M.

Lunch: Tempeh, Lettuce, and TomatoSandwich; spinach salad

3:00 P.M.

Snack: Cucumber with Ricotta Dip

5:00 P.M.

Physical activity:45 minutes on the elliptical trainerStrength training

6:30 P.M.

Page 936: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Dinner: Poached Chicken Curry;brown rice; Spicy Mango RelishTreat: Carrot Oatmeal Cookie withalmond butter

10:45 P.M.

Skin care: Polish, cleanse, nourish

11:00 P.M.

Sleep

Saturday

7:00 A.M.

Wake up

7:15 A.M.

Page 937: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Physical activity:Stretches and core strengtheners1 hour cycling

8:45 A.M.

Skin care: Cleanse, nourish, sunscreen

9:00 A.M.

Breakfast: Whole grain flake cerealand shredded wheat, sunflower seeds,blackberries, and soy milk

1:00 P.M.

Lunch: Tuna Salad; whole wheat roll;strawberries

Page 938: 20 Years Younger Look Younger, Feel Younger, Be Younger!

3:00 P.M.

Physical activity: In-line skating

4:00 P.M.

Snack: Mango Smoothie

7:30 P.M.

Dinner: Pork Loin with Turnips,Apples, and Onions; barley, pecans,and arugulaTreat: Stuffed Baked Peach and nonfatGreek yogurt

10:45 P.M.

Skin care: Polish, cleanse, nourish

Page 939: 20 Years Younger Look Younger, Feel Younger, Be Younger!

11:00 P.M.

Sleep

Sunday

7:00 A.M.

Wake up

7:15 A.M.

Physical activity:Stretches and core strengtheners1 hour cycling

8:45 A.M.

Skin care: Cleanse, nourish, sunscreen

Page 940: 20 Years Younger Look Younger, Feel Younger, Be Younger!

9:00 A.M.

Breakfast: Blueberry OatmealPancakes topped with blueberries andwalnuts; calcium-fortified orange juice

1:00 P.M.

Lunch: Black Bean Salad; GarlicToast; orange

3:00 P.M.

Snack: Carrots with Spiced YogurtDip

6:30 P.M.

Dinner: Baked Penne Pasta withShrimp; Arugula and Fennel Salad

Page 941: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Treat: Trail mix

9:45 P.M.

Skin care: Polish, cleanse, nourish

10:00 P.M.

Sleep

LEVEL III, 2,500 CALORIES

This is just one example of how to get asubstantial amount of exercise in eachday. Most people find that they have toget up pretty early to reach their dailygoal.

Page 942: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Monday

5:30 A.M.

Wake up

5:45 A.M.

Physical activity:Stretches and core strengtheners1-hour run

7:00 A.M.

Skin care: Cleanse, nourish, sunscreen

7:15 A.M.

Breakfast: Acai Almond ButterSmoothie with whole grain cereal

Page 943: 20 Years Younger Look Younger, Feel Younger, Be Younger!

10 A.M.

Snack: Apple with sunflower seedbutter

12:30 P.M.

Lunch: Sardine Salad; whole wheatroll with olive oil; grapes, figs, andpecans

3:00 P.M.

Snack: Fresh Mint Tea

6:30 P.M.

Dinner: Baked Eggplant with GroundTurkey; cracked wheat; baby spinach;and cantaloupe

Page 944: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Treat: Graham Cracker with Bananaand Walnuts

9:15 P.M.

Skin care: Polish, cleanse, nourish

9:30 P.M.

Sleep

Tuesday

5:30 A.M.

Wake up

5:45 A.M.

Physical activity:

Page 945: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Stretches and core strengthenersStrength training1-hour swim

7:45 A.M.

Skin care: Cleanse, nourish, sunscreen

8:00 A.M.

Breakfast: Muesli with skim milk,blackberries, and almonds

10 A.M.

Snack: Whole wheat pita with almondbutter

12:30 P.M.

Page 946: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Lunch: Chicken, Grapefruit andArugula Salad; 2 Wasa multigraincrackers with Bestlife spread

3:00 P.M.

Snack: Pomegranate Freeze

6:30 P.M.

Dinner: Poached Trout with Tomatoand Basil; Spicy Farro with Mint andParsley; strawberriesTreat: Zucchini Olive Oil Cake withapplesauce

9:15 P.M.

Skin care: Polish, cleanse, nourish

Page 947: 20 Years Younger Look Younger, Feel Younger, Be Younger!

9:30 P.M.

Sleep

Wednesday

5:30 A.M.

Wake up

5:45 A.M.

Physical activity: Stretches and corestrengtheners

6:00 A.M.

Skin care: Cleanse, nourish, sunscreen

6:15 A.M.

Page 948: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Breakfast: Shredded wheat withflaxseed, walnuts, strawberries, andsoy milk

10:00 A.M.

Snack: Trail mix

12:30 P.M.

Lunch: Edamame Dip; brown ricecakes; Cabbage Salad; honeydewmelon and slivered almonds

3:00 P.M.

Snack: Acai Popsicle

5:00 P.M.

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Physical activity: Squash

6:30 P.M.

Dinner: Braised Chicken Legs in RedWine with Lentils, Fennel, and Kale;mixed greens with mushrooms andolive oil-lemon dressing; whole wheatrolls; blueberriesTreat: Air-popped popcorn

9:15 P.M.

Skin care: Polish, cleanse, nourish

9:30 P.M.

Sleep

Page 950: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Thursday

5:30 A.M.

Wake up

5:45 A.M.

Physical activity:Stretches and core strengthenersStrength training1-hour run

7:45 A.M.

Skin care: Cleanse, nourish, sunscreen

8:00 A.M.

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Breakfast: Irish oatmeal with driedapricots, almonds, and skim milk

10:00 A.M.

Snack: 2 Wasa multigrain crispbreadswith mozzarella and tomato; grapes

12:30 P.M.

Lunch: Salmon and avocado sushi roll;pineapple and walnuts

3:00 P.M.

Snack: Nonfat yogurt with raspberries,cashews, and graham cracker

6:30 P.M.

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Dinner: Slow Cooked Lamb withTomato, Cauliflower, and Chard;Whole Grain Crostini; orange,blueberries, and macadamia nutsTreat: Banana and pear with darkchocolate chips and pine nuts

9:15 P.M.

Skin care: Polish, cleanse, nourish

9:30 P.M.

Sleep

Friday

5:30 A.M.

Page 953: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Wake up

5:45 A.M.

Physical activity:Stretches and core strengtheners1-hour swim

7:00 A.M.

Skin care: Cleanse, nourish, sunscreen

7:15 A.M.

Breakfast: Blackberry Smoothie

10:00 A.M.

Snack: Whole wheat pita withsunflower seed butter

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12:30 P.M.

Lunch: Lentil Soup with Parmesancheese and baby spinach; Wasamultigrain crispbreads; grapefruit,honey, and pistachios

3:00 P.M.

Snack: Acai Popsicle

6:30 P.M.

Dinner: Spiced Cod; Cracked WheatSaladTreat: Pretzels, Golden Raisins, andDark Chocolate Trail Mix

10:15 P.M.

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Skin care: Polish, cleanse, nourish

10:30 P.M.

Sleep

Saturday

6:30 A.M.

Wake up

6:45 A.M.

Physical activity:Stretches and core strengthenersHalf of the strength training routine80-minute run

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8:45 A.M.

Skin care: Cleanse, nourish, sunscreen

9:00 A.M.

Breakfast: Yogurt Parfait

11:00 A.M.

Snack: Pear with almond butter

1:00 P.M.

Lunch: Cannellini Bean Spread onWhole Grain Pita; Arugula Salad;honeydew melon and pistachios

3:00 P.M.

Physical activity: Tennis

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4:00 P.M.

Snack: Strawberry Milk

7:30 P.M.

Dinner: Sweet Potato and TurkeyShepherd’s Pie; Coleslaw withMustard Vinaigrette; whole wheat rollwith olive oil; raspberries with honeyand pomegranate seeds.Treat: Baked Apple with low-fatcaramel sauce and pecans

10:45 P.M.

Skin care: Polish, cleanse, nourish

11:00 P.M.

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Sleep

Sunday

6:30 A.M.

Wake up

6:45 A.M.

Physical activity:Stretches and core strengthenersOther half of the strength trainingroutine80 minutes of cycling

8:45 A.M.

Skin care: Cleanse, nourish, sunscreen

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9:00 A.M.

Breakfast: Banana Spice Smoothie;Wasa multigrain crispbread and peanutbutter

11:00 A.M.

Snack: Wasa multigrain crispbreadswith peanut butter, celery, and honey

1:00 P.M.

Lunch: Goat Cheese Sandwich; CitrusSalad with grapes and maple syrup

3:00 P.M.

Physical activity: Ping-Pong

4:00 P.M.

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Snack: Cucumber with Yogurt Dip

6:30 P.M.

Dinner: Trout Gumbo; Mixed BabyGreen Salad; brown rice; raspberriesTreat: Dark chocolate sorbet withpecans

9:15 P.M.

Skin care: Polish, cleanse, nourish

9:30 P.M.

Sleep

Page 961: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Acknowledgments

WITH SPECIAL THANKS to Daryn Eller,Janis Jibrin, RD, Donna Fennessy, SidraForman, Molly Borman-Pullen, MichelleKennedy, and Tracy Gensler for theirexcellent contributions to this book.Thanks, too, to Angeli Lacson forhelping to facilitate this project. We’realso very grateful for the insights fromall of the researchers quoted throughoutthis book.

Page 962: 20 Years Younger Look Younger, Feel Younger, Be Younger!

ALSO BY BOB GREENE

The Life You Want: Get Motivated,Lose Weight, and Be Happy

The Best Life DietBob Greene’s Total Body Makeover

Get With the Program!Make the Connection: Ten Steps to a

Better Body—and a Better LifeKeep the Connection: Choices for a

Better Body and a Better Life20 Years Younger Daily Journal: Your

Day-by-Day Companion

Page 963: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Bob Greene is an exercise physiologistand certified personal trainer. He is thebestselling author of The Best Life Diet,Bob Greene’s Total Body Makeover,and Get With the Program! and thecoauthor of Make the Connection. He isalso a contributing writer and editor forO, The Oprah Magazine and writesarticles on health and fitness forOprah.com. Harold A. Lancer, MD, is aBeverly Hills dermatologist. Ronald L.Kotler, MD, is cofounder of thePennsylvania Hospital Sleep DisordersCenter. Diane L. McKay, PhD, is anutrition research scientist and assistantprofessor at Tufts University.

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* Especially good for hand-eyecoordination

Page 965: 20 Years Younger Look Younger, Feel Younger, Be Younger!

† Especially good for balance

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Contents

Welcome

Reverse the effects of aging withthe 20 Years Younger program

Introduction

PART I

THE ART AND SCIENCE OFAGING

CHAPTER 1: The Science of Aging

CHAPTER 2: The Ultimate Anti-AgingWeapon: Exercise

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CHAPTER 3: Lifelong, Life-Lengthening Eating

CHAPTER 4: Recapturing Your Skin’sYouth

CHAPTER 5: Rejuvenating Sleep

CHAPTER 6: The Art of AgingGracefully

PART II

THE 20 YEARS YOUNGERLIFESTYLE

CHAPTER 7: Meal Plans and Recipes

CHAPTER 8: Putting It All Together

Acknowledgments

Page 968: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Also by Bob Greene

Copyright

Page 969: 20 Years Younger Look Younger, Feel Younger, Be Younger!

Copyright

Copyright © 2011 by Bob GreeneEnterprises, Inc.Cover design by Mario J. Pulice; Coverphotographs © Getty ImagesCover copyright © 2012 by HachetteBook Group, Inc.

All rights reserved. In accordance withthe U.S. Copyright Act of 1976, thescanning, uploading, and electronicsharing of any part of this book withoutthe permission of the publisher constituteunlawful piracy and theft of the author’sintellectual property. If you would like

Page 970: 20 Years Younger Look Younger, Feel Younger, Be Younger!

to use material from the book (other thanfor review purposes), prior writtenpermission must be obtained bycontacting the publisher [email protected]. Thank youfor your support of the author’s rights.

Little, Brown and CompanyHachette Book Group237 Park Avenue, New York, NY 10017www.hachettebookgroup.comwww.twitter.com/littlebrown

First e-book edition: April 2011

The publisher is not responsible forwebsites (or their content) that are notowned by the publisher.

Page 971: 20 Years Younger Look Younger, Feel Younger, Be Younger!

This book is intended to supplement, notreplace, the advice of a trained healthprofessional. Before starting a diet plan,or beginning or modifying an exerciseprogram, check with your physician tomake sure that the changes areappropriate for you. If you know orsuspect that you have a health problem,you should consult a health professional.The author and publisher specificallydisclaim any liability, loss, or risk,personal or otherwise, which is incurredas a consequence, directly or indirectly,of the use and application of any of thecontents of this book.

Illustrations by Molly Borman-Pullen

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ISBN 978-0-316-18377-2