Your Waist Size Can Be a Powerful Predictor of Hypertension and Other Chronic Diseases

By Dr. Mercola

The size of your waistline may be the key to a long life, according to an observational study conducted by the Mayo Clinic¹, involving nearly 13,000 Americans who were followed for about 14 years.

In a presentation in August at the European Society of Cardiology Congress, senior author Francisco Lopez-Jimenez said that people who are of normal weight, but who have a high waist-to-hip ratio (i.e. belly fat), have an even higher risk of death than people who are considered obese, based on BMI alone.

The risk of cardiovascular death was 2.75 times higher, and the risk of death from all causes was 2.08 times higher in people of normal weight with central obesity, compared with those with a normal body mass index and normal waist-to-hip ratio. According to Dr. Lopez-Jimenez:

"We knew from previous research that central obesity is bad, but what is new in this research is that the distribution of the fat is very important even in people with a normal weight. This group has the highest death rate, even higher than those who are considered obese based on body mass index. From a public health perspective, this is a significant finding."

The increased mortality risk accompanying higher ratios of visceral fat — the fat that accumulates around your internal organs — is likely due, at least in part, to increased insulin resistance. As I've stated in many previous articles, insulin and leptin resistance or signaling impairment, is one of the foundational problems underlying virtually all disease, and visceral fat is associated with insulin resistance and other risk factors. Insulin resistance also accelerates the aging process itself.

Your Waist Size May Also Help Assess Your Hypertension Risk

In related news, the importance of your waist-to-hip ratio was again highlighted in a study² showing that your waist size may also be a more effective measure for assessing obesity-related hypertension risk.

Normally, your blood pressure will drop 10-20 percent during nighttime sleep, compared to your daytime values. A lack of nighttime dipping has previously been observed in overweight and obese populations, suggesting a correlation between non-dipping nighttime blood pressure and an increased risk of hypertension.

The goal of the study was to evaluate the predictive ability of waist-to-hip ratio on nighttime blood pressure dipping, relative to BMI, and while both BMI and waist-to-hip ratio were significant predictors of nighttime dips in systolic and diastolic blood pressure, the waist measurement was more telling. So, if you have a high waist-to-hip ratio, i.e. you carry more fat around your waist than on your hips, you may be at greater risk for obesity-related hypertension, indicated by a reduction in nighttime blood pressure dipping.

Are You Carrying Dangerous Fat Around Your Midsection?

Unfortunately, two out of three people in the U.S. are overweight and one out of three is obese, and the rest of the world is not far behind. It has been my experience that many people are in denial about being overweight, as being "large" has become more or less the norm. But just because something is common does not mean it's a "healthy normal." And we're not talking about aesthetics here.

Certain body compositions do tend to increase your risk of chronic disease, and carrying extra inches around your midsection has been repeatedly shown to increase cardiovascular health risks. Your waist size is also a powerful indicator of insulin sensitivity, as studies clearly show that measuring your waist size is one of the most powerful ways to predict your risk for diabetes.

Waist circumference is far better than BMI for evaluating whether or not you may have a weight problem, as BMI fails to factor in both how muscular you are, and your intra-abdominal fat mass. You can go about measuring your waist in two different ways.

The two featured studies used waist-to-hip measurement. This is done by measuring the circumference of your hips at the widest part, across your buttocks. Then measure your waist at the smallest circumference of your natural waist, just above your belly button. Divide your waist measurement by your hip measurement to get the ratio. (The University of Maryland offers an online waist-to-hip ratio calculator³ you can use.) The Mayo Clinic used the following waist-to-hip ratio designations:

Another even simpler method to figure out if you have a weight problem is to measure only your waist circumference (the distance around the smallest area below the rib cage and above your belly button). Waist circumference is the easiest anthropometric measure of total body fat. A general guide for healthy waist circumference is as follows:

How's Your Blood Pressure?

According to the CDC, high blood pressure is the second greatest public health threat in the US. Insulin resistance and elevated uric acid levels are significantly associated with hypertension, so any program adopted to address high blood pressure needs to help normalize these two factors.

Fortunately, this can actually be easier than you might think, but it does require you to make some lifestyle changes. The good news is, if you're carrying a little more weight around your midsection than might be good for your health, and you struggle with high blood pressure and/or elevated uric acid levels, altering your diet will address all of these issues simultaneously.

I recently updated my nutrition plan, which will help guide you step-by-step toward normalizing your insulin and leptin levels, which in turn will help normalize your blood pressure and help you shed excess weight. My plan summarizes all I have learned from treating over 25,000 patients and reviewing tens of thousands of articles on natural health. It's a free resource that can help you and your family radically improve your health, or take it to the next level if you've already started making changes.

Ideally your blood pressure should be about 120/80 without medication. If you are on medication, you will be delighted to know that this nutrition plan tends to normalize elevated blood pressures in the vast majority of people to the point you may no longer need your blood pressure medication. According to the most recent report (issued 2003) by the Joint National Committee (JNC) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, the following guidelines apply for determining whether you might suffer from hypertension:

Blood Pressure Classification Systolic Diastolic
Normal	<120 and <80
Pre-hypertension	120-139 or 80-89
Stage 1 Hypertension	140-159 or 90-99
Stage 2 Hypertension	≥160 or ≥100

per JNC 7 Express, December 2003

How to Avoid a False Hypertension Diagnosis

Keep in mind that your blood pressure readings can vary significantly from day to day – even from morning to evening, and often within the same hour, so don't panic if you get one high reading here or there. It is when your blood pressure remains consistently elevated that significant health problems can occur. The following variables can also affect the va­lidity of your blood pressure reading:

• If you're overweight, a size 'average' blood pressure cuff can lead to a falsely elevated blood pressure reading, so make sure your doctor or health care professional is using the right size cuff for your size.
• Incorrect arm position: If your blood pressure is taken while your arm is parallel to your body, your reading can be up to 10 percent higher than it really is. Blood pressure readings should always be taken with your arm at a right angle to your body.
• White coat hypertension, which is an elevation in blood pressure caused by the stress or fear associated with visits to doctors and other medical personnel, can be a transient but serious concern. Stress reduction in this situation is key. To decrease your risk of being falsely diagnosed with hypertension in this situation, I'd encourage you to take a moment to calm down, then breathe deeply and relax when you're getting your blood pressure taken.

Although elevated insulin levels are one of the most potent contributors to elevated blood pressure, it's also common for chronic stress, tension or anxiety to contribute to this problem. After you begin my nutrition plan and follow it for several months, if you don't see an improvement in your blood pressure I'd recommend seeking out a health care professional who is well-versed in using stress-relief methods, such as the Emotional Freedom Technique (EFT) for example.

How to Take Control of Your Blood Pressure AND Your Waist Size

To address both of the issues covered in this article: a greater than ideal waist size and high blood pressure, first thing you need to do is remove all grains and sugars, particularly fructose, from your diet until both your weight and your blood pressure have normalized. Again, following my comprehensive nutrition plan can help you take control of your diet in an incremental manner.

To emphasize how important this one action can be, consider the following: According to a 2010 study⁴, those who consumed 74 grams or more per day of fructose (the equivalent of about 2.5 sugary drinks) had a 77 percent greater risk of having blood pressure levels of 160/100 mmHg. Consuming 74 grams or more of fructose daily also increased the risk of a 135/85 blood pressure reading by 26 percent, and 140/90 by 30 percent.

This is significant because the average American now consumes about 70 grams of fructose EVERY day! Worse yet, about 25 percent of all Americans consume over 134 grams of fructose a day, according to research by Dr. Richard Johnson, chief of the division of kidney disease and hypertension at the University of Colorado, and author of two books on the dangers of fructose, The Sugar Fix, and The Fat Switch.

As a standard recommendation, I strongly advise keeping your TOTAL fructose consumption below 25 grams per day. However, for most people – especially if you struggle with high blood pressure and insulin resistance – it would be wise to limit your fructose to 15 grams or less, as it is virtually guaranteed that you will consume "hidden" sources of fructose from most beverages and just about any processed food you might eat.

Fructose — the Primary Trigger of Your "Fat Switch"

To learn more about how fructose impacts your weight and health, I highly recommend reading Dr. Richard Johnson's new book The Fat Switch. In it, he reviews groundbreaking new research showing that eating too much and exercising too little are NOT solely responsible for why you keep gaining weight or have trouble shedding those excess pounds.

His research shows that metabolic syndrome (characterized by central obesity or increased waist circumference, high blood pressure, and insulin resistance) is actually a normal condition that animals undergo to store fat. Animals' ability to gain "hibernation fat" appears to be regulated by a switch in the mitochondria that is turned on and off by a common food that no longer provides survival advantage to humans living in contemporary society, namely fructose.

Fructose-containing sugars cause weight gain not by the calories they contain, but by triggering this "fat switch," which tells your body it's time to store fat, just as if you were an animal preparing for hibernation. Furthermore, uric acid is increased by fructose, and also causally contributes to obesity and insulin resistance. Effective treatment of obesity therefore requires turning off your fat switch — by avoiding fructose, which is the trigger — and improving the function of your cells' mitochondria.

According to Dr. Johnson:

"Those of us who are obese eat more because of a faulty "switch," and exercise less because of a low energy state. If you can learn how to control the specific "switch" located in the powerhouse of each of your cells – the mitochondria – you hold the key to fighting obesity."

I highly recommend picking up a copy of Dr. Johnson's book, The Fat Switch which has been described as the "Holy Grail" for those struggling with their weight.