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Why a Fat Belly Increases Heart Attack Risk

A study from Denmark shows why having a fat belly and elevated triglycerides markedly increases your chances of suffering a heart attack (Circulation, Volume 111, 2005). Your body makes triglycerides from sugar. Abdominal obesity comes from high blood insulin levels. When you eat, your blood sugar level rises. To prevent blood sugar levels from rising too high, your pancreas releases insulin, which converts blood sugar to a type of fat called triglyceride. Insulin also drives triglycerides into the fat cells in your belly. So having high triglycerides and a fat belly are signs of high blood insulin levels, and high blood levels of insulin constrict arteries to cause heart attacks.

Fat cells in your belly are different from those on your hips. The blood that flows from belly fat goes directly to your liver, whereas the blood that flows from your hips goes into your general circulation. The livers of those who store fat in their bellies are blocked from removing insulin by the extra fat and therefore do not remove insulin from the bloodstream as effectively as the livers of people who store fat primarily in their hips. People who store fat primarily in their bellies have higher blood insulin and sugar levels, which raise levels of the bad LDL cholesterol that causes heart attacks, and lower levels of the good HDL cholesterol that prevents heart attacks.

If you store fat primarily in your belly you should restrict refined carbohydrates found in foods made with flour, white rice, milled corn or added sugars.

Sit-ups are fine for strengthening your belly muscles, but don't believe they will get rid of a fat stomach. Exercising a muscle does not get rid of fat over the specific muscles that are exercised. If it did, tennis players would have less fat in their tennis arms, but they don't. The only way to reduce a fat belly is to lose weight overall.


Dear Dr. Mirkin: Is there any way to predict whether I will get arthritis? I watched my mother suffer horribly from a very young age and would like to know if my fate will be the same.

One study from Holland shows that people who eventually develop rheumatoid arthritis usually have abnormal arthritis blood tests long before they develop joint pains (Arthritis & Rheumatism, August 2004). Rheumatoid arthritis causes continuous joint destruction throughout a person's lifetime. Joint damage is thought to be caused by an overactive immunity, so the usual treatment is to suppress immunity, which slows joint destruction but does not cure the arthritis. Doctors can delay joint damage by giving drugs to suppress immunity as soon as the disease is diagnosed.

Perhaps all people with a family history of rheumatoid arthritis should get blood tests for arthritis and those with abnormal blood tests should be treated. However, nobody has shown that giving immune suppressive drugs before the onset of symptoms prevents joint damage, and the drugs have very serious and harmful side effects.

My treatment of rheumatoid and reactive arthritis with long-term antibiotics is controversial but has been very effective. If you have multiple joint pains, please read report #J106 (particularly if you are under 60.)


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Dear Dr. Mirkin: Why is it that many products that advertise zero grams of trans fat on their labels in fact have partially hydrogenated oils in their ingredient lists?

Labeling laws allow a manufacturer to claim ZERO if there is less than .5 grams of an ingredient per serving. That doesn't sound like much, but if a serving size is one teaspoon or one cracker, it can add up to a lot of trans fats in a tub of margarine or a bag of chips. I think the claims are deceptive, but the manufacturers are not breaking the law. Use the list of ingredients as your source of information, not the "zero trans fat" claims. If the words "partially hydrogenated" appear in the list of ingredients, look for another brand.

Many manufacturers are coming out with new formulations of their popular brands that now contain NO partially hydrogenated oils. Vote with your pocketbook.


You may remember Laszlo Pentek's comments on high fructose corn syrup in an earlier issue. He’s done it again with a letter to the editors published in Wednesday's Washington Post (not the cooking section, the Editorial Page!) extolling the virtues of spaghetti squash.

Read his letter and then enjoy some delicious new recipes for this versatile vegetable.

Spaghetti Squash Pad Thai
Spaghetti Squash with Ratatouille Sauce
Confetti Salad
Clam and Mushroom Sauce for Spaghetti Squash
Spaghetti Squash Soup
Spaghetti Squash Soup with Artichokes
Basic cooking instructions for spaghetti squash

In case you missed it, here is Laszlo’s letter on honey and high fructose corn syrup.

List of Diana's Healthful Recipes

June 26th, 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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