The food pyramid almost crushed Elaine Monarch. She'd always enjoyed whole-wheat bread and the other healthy carbohydrates that form the pyramid's foundation, but her resolve to eat plenty of grains grew even stronger after she went to her doctor complaining of bloating and diarrhea. "He told me I needed more fiber in my diet," she says. "That advice practically killed me."
Monarch, it turns out, has celiac disease: Her immune system attacks the gluten from grains, damaging her small intestine in the process. The founder of the Celiac Disease Foundation, she is still diligent about consuming enough fiber — but these days she gets it from fruit, nuts and supplements instead of grains.
Americans are constantly bombarded with expert health advice, and many of the messages are unquestionably right for everyone. No one will ever get sick from avoiding cigarettes or trans fats. But some of the most commonly repeated pieces of advice actually aren't meant for everyone. After all, the USDA couldn't equip its pyramid with a section just for people with celiac disease. Health recommendations are sometimes based on studies that didn't include a good cross section of the general public. And even when broadly representative studies trumpet a 94% success rate, that still leaves 6 people out of 100 looking for answers.
"What's good for the population as a whole is not necessarily good for a given individual," says Dan Roden, M.D., assistant vice-chancellor for personalized medicine at Vanderbilt University.
So we took a look at some pieces of conventional wisdom that are truly wise — for most people. Then we asked the experts what you ought to do, just in case you're not completely average in every way. Feeling kind of special? This is for you.
Your Fitness Routine
Smart advice: Vigorous workouts do more for you than moderate ones.
Tailor it if you're sedentary and your main goal is weight loss. If you work too hard — and tire too quickly — you may not burn enough calories to make a real dent in your weight. A 2003 study of 184 women found that walking at a moderate pace for at least 150 minutes each week for a year was just as slimming as working out more intensely for shorter periods of time. In fact, women assigned to long sessions of moderate exercise lost about the same amount as women who worked harder for shorter bursts — 15 to 18 pounds, on average. To drop weight, exercise most days of the week at a pace that you can sustain for 30 to 40 minutes. You should be able to talk without gasping for air.
Smart advice: Walking is the simplest way to get exercise — all you need are sneakers and a sidewalk.
Tailor it if you have heart disease and it's a smoggy day. Studies show that the tiny particles in the air during a high-smog day can increase the risk of heart attack. Move your workout indoors on smoggy days (check airnow.gov for local air quality), and flick on the air conditioner — it can cut indoor pollutant levels by up to 50%.
Smart advice: Every little bit of exercise gets you fitter — even housework or gardening.
Tailor it if you're trying to prevent or treat heart disease. True, any activity is better than none — but sweeping or pulling weeds probably won't work your heart hard or long enough to significantly reduce the odds of clogged arteries, heart attack or stroke. Instead, do 30 minutes of moderately vigorous exercise four or five times a week to dramatically lower your heart risk. A study of nearly 40,000 women found that briskly walking at least 2 hours each week halved the risk of heart disease.
Smart advice: Swimming is an ideal low-impact aerobic exercise.
Tailor it if you have asthma. The chlorine in a pool — even if it's outdoors — can trigger an attack. In children, it may even raise the odds of developing the disorder in the first place. To be on the safe side, find a different form of exercise if you have asthma that flares up poolside, experts say; if you have a child under age 7 with allergies, don't take him to a pool with a strong smell of chlorine (and if you're trying to slim down, here's another argument for a land-based workout: Most swimmers don't burn enough calories to shed many pounds).
Your Food and Drink
Smart advice: Eat plenty of leafy green vegetables.
Tailor it if you take the blood thinner warfarin (Coumadin). This drug prevents dangerous blood clots by blocking the action of vitamin K, which is needed to make clot-building compounds in the blood — but too much K in your diet can overwhelm your protection. The nutrient is especially abundant in dark green, leafy vegetables such as spinach, Swiss chard and kale, so don't have more than one serving of any of these in a day.
Smart advice: Drink at least 8 glasses of water every day.
Tailor it if you have bladder control problems. You might be able to avoid leaks by cutting back a bit on fluids. Ask your doctor how much you should drink each day — and don't worry if it doesn't come close to the magical "8 glass" rule. Nearly 20% of your water intake comes from food anyway, according to the National Health and Nutrition Examination Survey. If you're peeing at least every 8 hours and your urine is light colored, you're likely drinking enough.
Your Medications
Smart advice: When it comes to blood pressure, lower is better.
Tailor it if you have coronary artery disease (CAD). Getting your blood pressure down — to about 120/80 — can help you avoid a heart attack or stroke, but don't go much lower. You need a little extra pressure to push blood through your narrowed vessels. A study of more than 22,000 people with CAD found that cutting diastolic pressure (the bottom number) to less than 70 more than doubled the risk of a heart attack or death. One exception: Low blood pressure didn't seem risky for CAD sufferers who'd had angioplasty to clear obstructed vessels or bypass surgery to reroute blood through a healthy new vessel.
Smart advice: Acetaminophen is one of the safest pain relievers and a first-line choice for arthritis relief.
Tailor it if you have a glass of wine (or any alcohol) daily. There's already a warning on bottles of acetaminophen for people who have three or more drinks every day, noting that the combo can damage the liver. But even light drinking can prime the liver for trouble, says Donald Jensen, M.D., a board member of the American Liver Foundation. Although 4 g of acetaminophen is the recommended maximum daily dose, he says, you shouldn't exceed 2 g of acetaminophen on any day you have even one drink.
Smart advice: Get your nutrients from whole foods, not pills.
Tailor it if you're a strict vegetarian. If you don't eat eggs or drink milk, you may need supplements to get enough vitamins B12 and D. Try 6 mcg of B12 (the amount in a typical multi). The current recommendation for vitamin D is 200 to 600 IU, depending on your age, but researchers say that needs an update: 1,000 to 2,000 IU is optimal and safe to take. And although you can get plenty of iron through a vegetarian diet, it takes planning. Get a blood test to check your iron levels if you fatigue easily.
Smart advice: If you have chronic pain, you'll get safe, effective help from a nonsteroidal anti-inflammatory drug, such as ibuprofen or a prescription-only variety such as Indocin.
Tailor it if you're age 65 or older. The main risk with NSAIDs is that they can cause stomach ulcers and internal bleeding — and that danger rises substantially with age. In fact, almost all deaths from NSAID-related bleeding occur in the elderly, experts say. If you're over 65 and need relief from chronic pain, talk with your doctor: Other options include acetaminophen (which isn't an NSAID) and corticosteroids — and even narcotics like Demerol, as long as you follow your doctor's instructions to reduce the chances of dependence or side effects.