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Belly Fat is Risky Even if You Are Not Overweight

People who are not overweight and have a normal body mass index (BMI), but store most of their fat in their bellies, are at high risk for suffering a heart attack and dying prematurely (Annals of Internal Medicine, November 10, 2015). This study is among the largest and most rigorous studies ever on the harmful effects of belly fat. Researchers calculated the BMI and waist-to-hip ratios of 15,184 adults, ages 18 to 90, and followed them for 15 years. Waist-to-hip ratio (WHR), but not BMI, was associated with higher overall risk for death. Men of normal weight and normal BMI but with belly obesity had an 87 percent higher risk of dying than men without belly obesity. Women with normal weight and belly obesity had a 48 percent higher death risk than women with similar BMIs but no belly obesity. This new data shows that where you store fat (apple-shape or pear-shape) may be more important than BMI as a predictor of risk for heart attacks, diabetes and premature death.

A second study shows that having extra belly fat and low levels of fat everywhere else markedly increases risk for arteriosclerosis and premature death in diabetics (Cardiovascular Diabetology, 10/13/2015). This study shows that storing fat primarily in the belly is associated with a high degree of arteriosclerosis and death in diabetics, even if they did not have much fat underneath their skins in the rest of their bodies.

Why Belly Fat is Harmful
Storing fat primarily in your belly is a strong indicator that you may 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 mostly into the 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.

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 so forth. Storing extra fat in your buttocks has not been shown to cause high rises in blood sugar and its frightening consequences.

Dramatic Lifestyle Changes Can Save Your Life
Genetics are important; you have no choice about where you store your fat. If you are shaped like an apple with a big belly and small buttocks, you are in big trouble. Having small buttocks is an independent risk factor for diabetes and premature death, even if your belly is not very big. Overweight people who are shaped like pears with a flat belly and large buttocks are at far less risk for heart attacks and diabetes. You are in trouble if you:
• can pinch more than three inches of fat under the skin at the front of your belly, even if you are thin everywhere else
• have a high fasting blood sugar (>95)
• have high blood sugar two hours after eating (>120)
• have high triglycerides (>150)
• have low good HDL cholesterol (<40)
• have a high HBA1C (> 5.5) - this shows that you have too much sugar stuck on your cells
• have extra fat in your liver (shown on a sonogram)
• have pre-diabetes (metabolic syndrome)

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. I think that the most efficient way to lose weight is intermittent fasting.
• avoid sugar-added drinks and foods
• avoid red meat, processed meats and fried foods
• avoid smoking, drinking alcohol, and recreational drugs
• eat lots of fruits and vegetables
• exercise
• keep your blood levels of hydroxy vitamin D above 55 nmol/L

November 15th, 2015
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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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