Measure Your Belly!

Q: I've read that your belly measurements can be the best indicator of your overall health. Is that true? If so, what are the guidelines to go by?

A: For years we nutritionists have been using a low-tech shorthand for insulin resistance: a 40 inch or greater waist for men, a 35 inch or greater waist for women. If your waist measures that high, you can safely bet the family farm that you've got insulin resistance and may be headed for some serious trouble down the road.

Interestingly, those waist measurements were exactly the numbers that correlated with the doubled risk for death when compared with smaller waists – less than 34 inches for men, less than 28 inches for women – in a recent study.

Each 2-inch increase in waist circumference added about 17% increased risk for mortality in men and about 13% increased mortality in women. Earlier research showed that these same numbers – 40" waist for men, 35" waist for women – indicated an increased risk for stroke.

I usually don't like terms like "the best indicator for overall health" because there are so many interrelated factors that come into play, but if there was such a thing as the single best indicator, belly fat would have to be a serious contender for the title.

You see, all body fat is not created equal. The fat stored around the butt hips and thighs – also known as subcutaneous fat since it's right below the skin – might drive you crazy and make your jeans fit badly, but it's not nearly as dangerous as the other kind. Belly fat, stored around the middle – also called VAT or visceral abdominal fat – is a metabolic nightmare.

It's stored deep inside the abdominal walls and is a metabolically active fat that directly increases the risk for all sorts of health problems, among them metabolic syndrome and diabetes.

In the study mentioned above, researchers looked at data from almost 360,000 Europeans who were followed up for ten years. The men and women with the largest waists had virtually twice – that's two times! – the risk for premature death compared to the folks with the smaller waists.

This was true even after allowing for all extra factors like smoking and drinking. "There aren't many simple individual characteristics that can increase a person's risk of premature death to this extent," said the lead author, Tobias Pischon, MD, MPH.

So yup, belly fat tells you a lot. It might not be the best single indicator of overall health, but if it's not, it's damn close.

Fight Fat with Water?

Q: Hey Dr. B, what's up with that new study showing that drinking extra water in the morning can help with fat loss?

A: Well, don't get too excited. As one reporter correctly pointed out about this study, "The impact is modest and the findings are preliminary." If you're looking to cut up, water's not exactly going to replace Winstrol.

But there is evidence that water helps you burn some extra calories, and since the benefits of water for other things are so numerous, you should definitely drink it if you aren't already doing so! And if you're not already doing so, you're an idiot and probably wouldn't be reading this column.

So here's the deal: Researchers in Germany tracked calorie expenditure among 14 men and women who were both healthy and not overweight. Within ten minutes of drinking about 17 ounces of water, the subjects' metabolisms increased by about 30%, reaching a maximum after 30-40 minutes.

Interestingly, there were differences between the sexes – the metabolic increase for the men involved burning more fat, whereas the metabolic increase in the women involved burning more carbs.

Remember though, 30% sounds like a lot, but if you figure the resting metabolism for a 150 pound person is about 1.2 calories per minute (roughly 75 calories an hour), a 30% increase only brings you to 93 calories, for an increase of about 20 calories. Still, when you figure it out, consuming an extra 1.5 liters a day would burn up an extra 17,400 calories or about five pounds a year.

Not much weight loss, but here's the thing: Water is needed for virtually every metabolic process in the body. It helps flush wastes and toxins out. It helps keep joints lubricated and skin fresh and moist. And – somewhat paradoxically – it helps prevent bloat. So you need to drink it anyway, and if it helps you drop an extra half pound a month, that's a bonus.


For you trainers working with weight loss clients, I have a formula to suggest. There's absolutely no science to back this up, mind you, but it's been my experience that it works really well for most people: Take your current weight, divide by 2, and aim for that number of ounces a day. (I was happy to see recently that this is the same formula the great holistic doctor Deepak Choprah uses). For a 180-pound person, that would be 90 ounces a day.

Drinking that much certainly won't hurt you and it might just help a lot.

Sloppy Second Hormones

Q: People always talk about all the hormones in chicken, milk, etc. Is that anything to be concerned with? I mean, after all, hormones are big proteins. Don't they just get digested and broken up into their constituent amino acids?

A: Dude, where'd you read that propaganda? Carbon monoxide is just a simple blend of carbon and oxygen, yet you don't go around sucking it off an exhaust pipe, do you?

The hormones in factory-farmed (feedlot) meat can have all sorts of effects on the body, none of them fully understood and almost certainly none of them good. And it's not just the hormones. These miserably treated animals are shot full of antibiotics and fed an unnatural diet of grain, which makes them sick and tilts the balance of their fat towards inflammatory omega-6's.

So even if you're not a granola-ish animal-rights type person, you should still avoid common supermarket meat like the plague for selfish reasons.

Grass-fed (and humanely treated) beef is the way to go: high omega-3's, high CLA – which may help with weight loss – and no extra antibiotics or hormones you don't need or want.

If you're going to take hormones, you should at least get them from a doc and know what you're taking. Do you really want a cow's sloppy seconds?

Less E, More T

Q: As a weight training male with goals of bigger muscles, are there foods that I can eat to naturally lower estrogen levels?

A: My question to you is, how do you know what your estrogen levels are? And if you don't know what they are, how do you know they need to be lowered?

All men convert some small amount of Testosterone to estrogens naturally, just as women naturally make some T in their bodies.

Generally if you've got a ton of Testosterone – either because you just make it naturally or because you happen to have a nice cooperative doctor – you're going to have somewhat more estrogen, since some of that extra T gets converted whether you like it or not. You actually don't want your estrogens to be zero; they have some important protective benefits. But obviously you don't want them elevated either.

Thing is, there's no way to know what your levels are without a blood test, preferably interpreted by a good hormone-knowledgeable doctor. In fact, if I can get on the soapbox a minute here, it's never a good idea to screw around with your hormones unsupervised. In fact it's a really dumb idea.

Nothing wrong with using Testosterone, but trying to figure out your own dose without blood tests and smart supervision is like being in a crowded bar and firing a gun at a dart board blindfolded. You might hit the target, but more likely you'll blow someone's brains out.

If you are in fact "estrogenic" (your estrogen is high), your doc may suggest a low dose of an aromatase inhibitor. Aromatase is the enzyme that's responsible for the conversion to estrogen, so one way to damp down the conversion is to inhibit the enzyme. One of the most common aromatase inhibitors is called Arimidex.

It's usually given for post-hormonal women with hormone-dependent breast cancer because it turns down estrogen production, but anti-aging clinics that use Testosterone supplementation will often prescribe a very low dose of Arimidex specifically to prevent too much of that Testosterone from being converted.

Now, I don't know of any foods you can eat that have an anti-estrogen effect, but I do know of some foods you should avoid, namely, soy. If you don't avoid it entirely, then at least go easy. Its phytoestrogens could be useful for some people in some cases, but if you're a guy concerned about being too estrogenic, the last thing you want is more estrogens in your diet, even if they're "weaker" versions like the ones found in soy.

That is, unless you have some weird desire to grow man-boobs.

Good Eats at the Airport

Q: I often find myself stranded in an airport filled with fast food places and gift shops. How do I get some protein and healthy fats in me?

A: Airport food used to be a nightmare, but it's gotten a lot better. I see all kinds of airport delis and food bars where you can get chicken Caesar, sushi, cheese and nut plates, all kinds of good stuff.

Another thing you could always do is get pemmican. Pemmican is raw, frozen, grass-fed meat, often made with some crushed dried cherries. It's the original, high quality, high protein snack, and it travels pretty well (though it's best cold).

Failing that, get some beef, salmon, or turkey jerky, and carry it with you along with a bag of mixed nuts. You're good to go.

Drop Some Acid

Q: I'm hearing a lot here lately about the acidic American diet. But what does "acidic" mean and what harmful effects does that have?

A: Acidity and alkalinity are expressed on the Ph scale, which ranges from 0 (an extreme of acidity, like battery acid!) to 14 (an extreme of alkalinity, like lye!) A Ph of 7 is considered neutral, and blood is normally maintained in a very tight range between 7.35 and 7.45, preferably around 7.40, which is just a hair's breadth towards the alkaline side of the scale.

Stay with me now, because this has implications both for general health and for bodybuilding in particular.

Since I know you guys care more about bodybuilding than about health (just kidding), I'll cover that part first. As you grow older you lose some muscle mass, even if you lift weights to preserve it. One of the reasons you lose muscle has to do with nitrogen, which, as you get older, is lost at a rate that's faster than you can take it in. And the reason that happens is a slow change in kidney function that produces an acidic state in the blood. As you probably know, without a positive nitrogen balance you can't make new muscle.

From a health perspective, it's this same acidic state that contributes to the loss of calcium that can ultimately result in osteoporosis. This is exacerbated by a high ratio of sodium to potassium in the Western diet, but that's another story.

Diets high in animal foods, grains, and sugar slightly acidify the blood. This slightly acidic blood also contributes to reduced muscle strength, increased cortisol (a stress hormone) a loss of calcium, as well as a loss of zinc and magnesium and other important minerals.

What to do, what to do?

The answer is simple: Balance your diet with more fruits and vegetables. The problem isn't with animal products per se, but with an imbalance between highly acidic foods (which we eat a ton of) and alkaline foods (which we don't). "Balancing animal foods with produce is the key to keeping blood Ph slightly alkaline, as it should be," says bodybuilder and USDA research scientist, C. Leigh Broadhurst, PhD.

One study (Remer, T., and F. Manz. 1995. Potential renal acid load of foods and its influence on urine pH. Journal of the American Dietetic Association 95 (7): 791-797) actually investigated the acid and alkaline effects of foods. Raisins and spinach were particularly alkaline, but truth be told all fruits and vegetables will help balance an acid diet.

One more thing: If you Google "acid-alkaline" you're sure to come across a predictably negative article in Quackwatch. Don't get me started on this website. It's run by Stephen Barrett, a retired psychiatrist in Pennsylvania whose mission in life is to "debunk" every vitamin, supplement, holistic health practice, or integrative treatment on the planet. Take whatever he says with a box of Morton's. If it isn't Big Pharm Approved it's going to get slammed by this bozo. He and the American Dietetic Association are a match made in heaven.