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Belly Fat Predicts a Heart Attack

You are at high risk for a premature death if you can pinch more than three inches in your belly. Even people who are not overweight are at high risk for a heart attack and diabetes if they store most of their fat in the belly instead of in the buttocks, hips and thighs (Annals of Internal Medicine, November 10, 2015). Having extra belly fat is associated with high cholesterol, high blood pressure, high blood sugar, inflammation, arteriosclerosis (plaques in your arteries), heart disease, strokes, kidney damage, diabetes, dementia, impotence, peripheral nerve damage and some types of cancers. More than 40 percent of North Americans already have high blood sugar levels that damage every cell in their bodies (JAMA, Sept 8, 2015;314(10):1021-1029).

What Excess Belly Fat Means
Storing fat primarily in your belly is a strong indicator that you also have fat stored in your liver. Your liver is supposed to prevent blood sugar levels from rising too high. When a healthy person eats,
• blood sugar rises,
• the pancreas responds by releasing insulin into the bloodstream, and
• insulin lowers blood sugar by driving sugar from your bloodstream primarily into your liver.

However, if you have a lot of fat stored in your liver,
• your liver cannot accept the extra sugar,
• blood sugar levels remain high, and
• this causes sugar molecules to attach to the outer cell membranes.

Once sugar is stuck on the outside surface membrane of a cell, it can never get off. It is converted by a series of chemical reactions from glucose to fructose and eventually to sorbitol that destroys the cell. This process causes all of the horrible side effects of diabetes.

If you can pinch three or more inches of fat on your belly, you probably have high blood sugar levels. Check with your doctor, who will do tests for the markers of diabetes:
• fasting blood sugar greater than 97,
• blood sugar two hours after eating greater than 120,
• triglycerides greater than 150,
• good HDL cholesterol less than 40,
• HBA1C (sugar stuck on cells) greater than 5.5,
• sonogram test showing extra fat in the liver.

Lifestyle Changes Are More Important than Drugs
Lose weight: If you have any of these risk factors for diabetes, or if you are already diabetic, you should immediately work to lose weight until you are down to one inch or less of fat over your belly. A seven percent reduction in body weight reduces diabetes risk by almost 60 percent (Diabetes Care, Dec, 2002;25(12): 2165–2171). I recommend that you try intermittent fasting to lose weight and keep it off.

Avoid Sugar-Added Foods: Sugar-added foods cause much higher rises in blood sugar than the sugar in fruits and vegetables. Even moderate doses of sugar added to foods can raise blood pressure and increase risk for diabetes, heart attacks, and premature death (British Medical Journal, December 10, 2014). Epidemiological studies in humans and experimental trials in animals show that added sugars increase blood pressure, blood pressure variability, heart rate, the heart’s needs for oxygen, inflammation, insulin resistance and high blood sugar levels.

Avoid Drinks with Sugar: Sugared drinks, including fruit juices, cause the highest rises in blood sugar levels. When you take sugar in a drink, it passes directly from the stomach into the intestines where it is absorbed almost immediately. People who drink fruit juice daily have higher blood pressures than those who drink it only occasionally (Appetite, January 2015; 84(1):68–72). Quench your thirst with water or other non-sweetened beverages.

Eat Lots of Plants: Fruits and vegetables contain antioxidants that help to prevent the inflammation that can cause insulin resistance.

Restrict Refined Carbohydrates; Eat WHOLE Grains: Whole grains are seeds of grass that have a tough outer coating like a capsule. When you grind grains into flour, you destroy the capsule and create a powder that can be quickly digested and absorbed, so foods made from flour cause high rises in blood sugar. Restrict bakery products, pastas and refined breakfast cereals and eat whole (unground) grains instead. My favorite whole grain food is long-cooking oatmeal (rolled oats or steel-cut oats). Other whole grains that are widely available are barley, wild rice, brown rice and quinoa. More at Eat Whole Grains, Not Flour

Eat Nuts: Eating nuts is associated with a reduced risk for diabetes and heart attacks (Coron Artery Dis, May 2016;27(3):227-320) and premature death (Br J Nutr, Jan 28, 2016;115(2):212-25 and JAMA Intern Med, May 2015;175(5):755-66). Nuts are rich in fat, but the fat in nuts is inside cells and you lack the enzymes to break down the fat cells in nuts. Most of the fat in nuts passes to your colon where bacteria have these enzymes, so you absorb some of the fat there while the rest passes out undigested.

Avoid Red Meat and Processed Meats: Meat is a rich source of nitrites and nitrates which block insulin receptors. Processed meats have even higher levels of nitrates because they are added as preservatives. Red meat contains high levels of extremely absorbable heme iron that can damage the beta cells that produce insulin. North Americans who eat red meat are at increased risk for diabetes (Am. J. Clinx Nutr, 2011;94:1088–1096). In one study, eating red meat daily increased risk of diabetes by 19 percent and eating processed meat (such as a hot dog or two slices of bacon) daily increased risk by more than 50 percent, while substituting other protein sources for red meat markedly reduced diabetes risk (Am. J. Clin. Nutr, October 2011). A diet high in meat and low in fruits and vegetables markedly increased risk for diabetes (Clin Nutr, April 2016;35(2):453-9). Meat-eating adults are four times more likely to develop diabetes than vegetarians in just two years of follow-up (Nutrition, Metabolism & Cardiovascular Diseases, published online October 10, 2011). Women who eat red meat daily are at increased risk for diabetes and weight gain (Diabetes Care, September 2001;24(9):1528-1535 and Arch. Intern. Med, 2004;164:2235–2240).

Avoid Fried Foods: Fried foods are associated with increased risk for diabetes (Am J Clin Nutr, June 18, 2014). Cooking without water causes sugar to bind to proteins to form Advanced Glycation End products (AGEs) that increase risk for diabetes, heart attacks and cancers. Fried potatoes in particular are associated with increased risk for diabetes (Am. J. Clin. Nutr, 2006;83:284–290).

Try to Exercise Every Day: Any muscle movement, even when muscles are moved passively on a motor-driven stationary bicycle, lowers blood sugar and increase insulin sensitivity (Med Sci Sports Exerc, published online April 6, 2016). Exercise helps to prevent high rises in blood sugar and increases insulin sensitivity, which helps to cure diabetes and prevent heart attacks. Contracting muscles lower blood sugar by drawing large amounts of sugar from the bloodstream. Exercise empties the liver and muscles of their stored sugar so you have more places to store sugar safely in your body. The increased sensitivity to insulin caused by exercise lasts only about 17 hours, so you need to exercise every day to get this benefit.

Summary of My Lifestyle Recommendations
Losing your excess belly fat quickly reduces your risk for a heart attack and diabetes, so check with your doctor and get started on these lifestyle changes immediately.
• lose weight until you have less than one inch of fat on your belly
• avoid sugar-added drinks and foods
• restrict refined carbohydrates
• avoid red meat, processed meats and fried foods
• eat plenty of whole fruits, vegetables, grains, beans, nuts and other seeds
• avoid smoking, alcohol and recreational drugs
• keep your blood levels of hydroxy vitamin D above 55 nmol/L
• exercise every day 

Checked 5/22/17

May 8th, 2016
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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