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Why Being Overweight is Dangerous for Most People

More than 75 percent of people who are obese are at increased risk for diabetes, heart attacks, strokes, cancers and premature death. However, some people who are overweight do not have high blood sugar, insulin, cholesterol or blood pressure and may not be at increased risk for diabetes or heart attacks.

A recent study from Finland shows that obese individuals who do not develop signs of diabetes are the ones who do not store fat in their livers (Diabetologia, published online October 6, 2013). The authors found 16 pairs of identical twins in which one was obese and the other was not. When the twins had the same low levels of fat in their livers, neither the heavy twin nor the skinny twin had any blood markers of diabetes. In twin pairs where the fat twin had excess fat in his liver, this twin had diabetes or the signs of diabetes ("pre-diabetes"). In these pairs, the twin with a fatty liver could not respond normally to insulin and had high cholesterol, high insulin, and signs of inflammation that lead to heart attacks.

The twins who stored fat in their livers also had defective mitochondria. Mitochondria are parts of cells where your body converts food to energy. They help to protect you from storing excess fat in your body.

It's Where You Store Fat that Counts
Fat stored primarily underneath your skin is usually good fat that is not harmful. However, if you store fat in your liver, that is bad fat that can kill you. This study adds to the many others showing that storing fat in your liver increases risk for diabetes and all its complications. You can tell if you have excess fat in your liver by getting a very safe test called a liver sonogram.

Still Better Not to be Fat at All
This does not mean that it is safe for anyone to be fat. Obese people who do not store fat in their livers and do not have signs of diabetes are usually young adults (Diabetes Care, August 2013). It may only be a matter of time. If you stay fat long enough, you are likely to start storing fat in your liver and go on to develop all of the abnormalities that lead to diabetes, heart attacks and premature death.

How Storing Extra Fat in Your Liver is Harmful
1) A high rise in blood sugar damages all types of cells. Every cell in your body is like a balloon full of fluid. When blood sugar levels rise too high, sugar sticks to the outer surface membranes of cells. Once stuck on a cell, sugar can never get off and the cell is eventually destroyed.
2) Your liver controls your blood sugar level. You need a consistent amount of sugar in your blood all the time because the energy for your brain comes from the sugar in your bloodstream, and you will pass out and can die if the sugar level drops too low.
3) When blood sugar levels drop, your liver releases sugar from its cells (glycogen) into your bloodstream to raise blood sugar back to the correct level.
4) When blood sugar levels rise too high, your pancreas is supposed to release insulin that lower blood sugar levels by driving sugar from your bloodstream into your liver cells. Insulin is the major stimulus for the liver to lower high blood sugar levels by taking sugar from your bloodstream into liver cells. To lower high blood sugar levels, you need both insulin to cause liver cells to remove sugar from the bloodstream, and liver cells that are able to respond to insulin.
5) Fat inside liver cells blocks the liver cells so they do not respond to insulin to store sugar.
6) Fat inside liver cells prevents the liver from removing sugar from the bloodstream when blood levels of sugar are too high. When the liver cells fail to draw sugar from the bloodstream, blood sugar levels rise too high. Instead of storing more sugar, liver cells that are full of fat release more sugar to drive blood sugar levels even higher. The liver cells make even more sugar from protein (gluconeogenesis) to drive blood sugar levels even higher.

Indicators of a Fatty Liver
When compared to people without fatty livers, people who have excess fat in their livers have:
• higher LDL (bad) cholesterol,
• lower HDL (good) cholesterol,
• higher blood insulin levels (indicating lack of response to insulin),
• higher fasting blood sugar levels,
• higher blood pressure,
• higher CRP, indicating inflammation, and
• a lower total number of fat cells, but with higher numbers of full fat cells that are stretched to bursting. (Fat people who do not store fat in their livers have more fat cells but they are not over-filled with fat).

I think that the most effective way to lose weight and keep it off is to use intermittent fasting.

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Tests to See if You are Becoming Diabetic

Having elevated blood levels of triglycerides (Diabetes Care, 2013 Feb;36(2):342-7), or fasting sugar (J Am Coll Cardiol, 2011 Jul 5;58(2):140-6) usually means that you are pre-diabetic and on your way to becoming diabetic.

These tests are indicators that your blood sugar levels are rising too high:
• High blood sugar (fasting blood sugar levels above 100).
• High fasting insulin levels. The pancreas tried to lower high blood sugar by releasing insulin into bloodstream. Insulin drives sugar from the bloodstream into cells. When insulin fails to lower high blood sugar levels, the pancreas keeps on releasing insulin.
• High blood triglycerides. Insulin converts all extra sugar to triglycerides. The extra triglycerides are stored in your body as fat, so people with high blood sugar are usually overweight.
• Low blood levels of HDL (good) cholesterol. High blood levels of triglycerides can cause clotting, so you use up the good HDL cholesterol carrying triglycerides from your bloodstream to your liver.
• Fatty liver. Your liver fills up with fatty triglycerides and loses its ability to respond to insulin. This drives blood sugar levels even higher.

This week's medical history:
Lyndon Baines Johnson (1908 - 1973)

For a complete list of my medical history biographies go to Histories and Mysteries

Recipe of the Week:

Hot and Sour Fish Soup

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

October 13th, 2013
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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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