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In light of the terrible events in New York on September 11, I would like to make everyone aware of the following websites:

ISSUE #73

INSIDE THIS ISSUE...

- "FAT! The Good, the Bad, and the Healthy"
- "Essential fatty acids: Flax & Fish!"
- "How much of the EFAs do I need?"
- "Nutritional tips for a healthy lifestyle"
- "Bodybuilding, Body composition, & Fat"
- "More health updates"

1 - DISTINGUISHING BETWEEN HEALTHY & UNHEALTHY FATS

Decades ago, Americans were eating about 40% of their daily calories from fat (with most of this coming from saturated fat). Currently, the average American diet gets just under half of all its fat as saturated fat and very little from polyunsaturated fat. Unfortunately, this type of diet is considered to contribute to obesity and heart disease. In the early 1990's it would have been uncommon to hear the terms "health" and "fat" used together. However, things have changed. Research has found that replacing saturated fat (such as that in red meat, cheese, and butter) with unsaturated fat and essential fatty acids (such as those from fish and flaxseed oil) can favorably impact health.

Unfortunately, healthy fat is still a complicated issue. Current research and opinion is controversial when it comes to prescribing optimal levels of essential fatty acid (EFA) supplementation. The message is getting out that people need certain fats, but the question is still coming back, "How much?" Regrettably, dietary fat can be an overwhelming topic (just like dietary carbohydrate intake) because there are many categories of fats.

Healthy fats include EFAs, polyunsaturated fats, and monounsaturated fats. Saturated fat should be limited and hydrogenated fats should be eliminated from the diet. One important rule to remember when discussing fats is, "Structure dictates function". That means the microscopic structure of the fat determines whether the fat is healthy or harmful. Very minor changes in the structure of a fat may dictate whether it inflicts damage or promotes healing.

Without getting too detailed, it is sufficient to know that the structure of a fat contains a long chain of carbon atoms. Each of the carbon atoms is attached to one another, and 2 hydrogen atoms can be attached to each carbon, as is the case in a saturated fat. Imagine if you will, a row of chairs. In each chair sits one person. That line of chairs is saturated, just like a saturated fat.

In a monounsaturated fat, one hydrogen atom is removed, thus leaving an "empty seat" in the row of chairs. At this empty seat, something called a double bond occurs between the 2 carbons. This is analogous to one person taking up two chairs in the row. In a polyunsaturated fat, there are two and sometimes three double bonds. The result of the change in structure is a change in function.

Fats not only add taste and calories to food but also are vital to your health because they are a component of cell membranes. Our bodies are composed of millions upon millions of cells, and thus without healthy fats to make healthy cell membranes, disease could occur in any of your body's systems. This review covers what is generally known about "healthy fats" up to August 2001, so let's start with the worst (the unhealthy fats) and finish with the healthy fats that should be emphasized in your diet.

HYDROGENATED FATS

"Hydrogenation" refers to a change in the structure of the fat. In this case, food processing actually adds hydrogen atoms back to unsaturated fat molecules (i.e. a person sits in one of the empty chairs). Unfortunately, hydrogenation is done to many otherwise healthy vegetable oils. These are the worst cases of fats, and are called "trans-fatty acids". Trans-fatty acids are made mainly in the process of turning liquid oils into a solid fat (such as margarine).

Some experts consider margarine and trans-fatty acids as the greatest evils of dietary fat. The Danish Nutrition Council has recommended that the addition of all trans-fatty acids to food should end by 2005 because a high intake of trans fatty acids increases to the risk of coronary heart disease (Stender and Dyerberg, 2001). Trans-fatty acids may damage some of the body's system and may lead to increased risks of heart disease and diabetes. Other experts suggest that intake of hydrogenated fats may even increase the need for EFAs! You can live without hydrogenated fats, but not without EFAs.

Individuals that frequently consume French fries, microwave popcorn, chocolate bars, and fast food likely consume trans-fatty acids in amounts far exceeding the recommended maximum levels. Margarine, shortening, and partially hydrogenated vegetable oil also contain trans-fatty acids. FDA researchers believe that removing all trans-fatty acids from margarine and other foods could prevent 17000 heart attacks and 5000 deaths per year! Unfortunately, with the abundance of these foods in North America, many uneducated people are subject to ill health until they learn to avoid fast food and processed bakery goods.

A recent study suggested that trans-fatty acid intake increases the risk of diabetes while polyunsaturated fatty acid intake reduces the risk. The researchers estimated that replacing all dietary trans-fatty acids with an equal amount of polyunsaturated fat would lead to a 40% lower risk in diabetes for women (Salmeron et al., 2001). Surprisingly, the study also showed that total fat, saturated fat, and monounsaturated fatty acid intakes are not associated with risk of type 2 diabetes.

Salmeron, J., et al. Dietary fat intake and risk of type 2 diabetes in women. Am. J. Clin. Nutr.73: 1019-1026, 2001.

Stender, S., and J. Dyerberg. The importance of trans-fatty acids for health. Update 2001. Ugesker Laeger 163: 2349-2359, 2001 (abstract only).

SATURATED FATS

Structurally speaking, a saturated fat has as many hydrogen molecules attached to them as is chemically possible. Saturated fats are solid at room temperature (i.e. butter), and high-saturated fat sources include cheese and animal meats. Saturated fats are linked to cardiovascular disease, insulin resistance, and obesity (although not all studies show that saturated fat increases the risk of diabetes - see Salmeron et al. above). It is recommended that saturated fat intake be kept to less than 10% of total calories.

UNSATURATED FATS

Unsaturated fats may have one, two, or three double bonds (meaning one, two, or three fewer hydrogen atoms). With respect to the essential fatty acids, linoleic acid (Omega-6) has two double bonds and linolenic acid (Omega-3) has three double bonds. These are examples of polyunsaturated fatty acids, both of which are found in the most recommended healthy fat, flaxseed oil.

UNSATURATED - Monounsaturated

Monounsaturated fats are found in olive and canola oils. Olive oil provides the monounsaturated fat oleic acid, but despite olive oil's reputation (also, you must insist on non-processed extra virgin olive oil!), flaxseed oil is likely still a far superior source of fat. Monounsaturated fats that are incorporated into cell membranes may protect against free radical "lipid peroxidation". This is unhealthy cellular damage (oxidative damage) that antioxidants (such as vitamin E) also help to protect against. Substituting monounsaturated fats for saturated fat may help protect against damage induced by aging and toxins, as well as insulin resistance from poor dietary choices (Vessby et al., 2001).

Vessby, B., et al. Substituting dietary saturated for onounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia 44: 312-319, 2001.

UNSATURATED - Polyunsaturated

Polyunsaturated fats are most commonly associated with vegetable (plant) or fish oils. They are also referred to as OMEGA-fatty acids. The most important polyunsaturated fatty acids are the essential fatty acids, linoleic acid (OMEGA-6) and linolenic acid (OMEGA-3).

Interestingly, fat from animal products (meat, dairy, and eggs) can provide more than just saturated fat. Depending on the diet of the animal, these products can also provide small amounts of polyunsaturated fats (i.e. feeding hens a diet of flaxmeal can increase the Omega-3 fatty acid content of eggs). In contrast, animals fed corn will have a high Omega-6 fatty acid content.

Modifying the fat content of animals through feeding strategies may be one way to help increase the healthy fat intake of the North American population. In a recent study, modified pork meat with a high content of polyunsaturated fatty acids (PUFAs) and a low content of saturated fat lowered plasma LDL-cholesterol (bad cholesterol) concentrations in women despite a diet of 42% fat (Stewart et al., 2001)!

Stewart, J., et al. Pork with a high content of polyunsaturated fatty acids lowers LDL cholesterol in women. Am. J. Clin. Nutr. 74: 179-187, 2001.

2 - ESSENTIAL FATTY ACIDS: Omega-3 & Omega-6

Essential fatty acids are crucial to many functions in the body. Compounds called eicosanoids (including prostaglandins and thromboxanes) are synthesized from essential fatty acids and control such things as blood pressure, blood clotting, nerve impulses, insulin sensitivity, hormones and other functions. Like all fats, EFAs exert some of their effects through their incorporation into cell membranes.

Essential fatty acids are similar to essential amino acids (protein) in that they must included in the diet because the body can not make them on their own. Unfortunately, EFAs are more difficult to consume in sufficient amounts when following a regular North American diet. Many EFA sources are destroyed by food processing, with the worst-case scenario being the hydrogenation of EFA sources (such as hydrogenated vegetable oils).

EFA dietary requirement may even increase with unhealthy practices such as high saturated fat intake, high trans-fatty acid intake, high sugar intake, alcohol consumption, smoking, or exposure to environmental toxins. Deficiencies of essential fatty acids have been linked to a wide range of unhealthy states. Again, because EFAs are important for cell membranes, this may explain why an EFA deficiency can have such a broad impact on health. Problems that have been associated with EFA deficiency include:

Cardiovascular disease - Hypertension (high blood pressure)

Cardiovascular disease - High LDL (bad) cholesterol

Insulin resistance (leading to type II diabetes)

Hair & skin health

General weakness

Memory loss & dementia

Joint inflammation

OMEGA-6 FATTY ACIDS

The most important Omega-6 fatty acid is linoleic acid. North Americans get plenty of Omega-6 fatty acids in their diet because vegetable oils are so prominent in North American cooking. Linoleic acid serves as the substrate for the production of other Omega-6 fatty acids, such as gamma-linolenic acid (GLA) and arachidonic acid (AA).

GLA is the desired Omega-6 fatty acid because it has may enhance the action of the Omega-3 fatty acids. Direct sources of GLA are Borage Oil (23% of the fat in borage oil is GLA) and Evening Primrose Oil (9% GLA). In contrast, and in confusion, experts suggest that arachidonic acid is not something you want a lot of in your diet because it may promote inflammation.

Thus, for general health reasons, it is likely unnecessary to supplement directly with Omega-6 fatty acids, provided you are supplementing with flaxseed oil (which contains Omega-3 fatty acids and Omega-6 fatty acids). As mentioned earlier, the North American diet provides plenty of Omega-6 containing oils. Unfortunately, many store-bought oils are partially hydrogenated, thus counteracting their benefits. Do your best to eliminate all sources of hydrogenated fats!

OMEGA-3 FATTY ACIDS

Omega-3 fatty acids are sometimes referred to as "ultra-polyunsaturated" fatty acids because they contain the fewest hydrogen atoms and most double bonds (three) in their structure. Their structure may contribute to their positive health benefits when incorporated into cell membranes. Research has shown that supplementing the diet with omega-3 PUFA increased insulin sensitivity and this may have been due to positive changes in the cell membrane (Storlien et al., 1987).

The interest in fatty acid research stemmed from the good health of Eskimos, whose high-fat diet is about 2.5's higher in Omega-3s than Omega-6s. Research has shown that as little as 4 grams of Omega-3 fatty acids per day can decrease blood triglycerides and cholesterol (Nilsen et al, 2001). Omega-3s are anti-inflammatory and help support the immune system. There are three Omega-3 fatty acids with the most notable being alpha-linolenic acid (commonly referred to as linolenic acid). EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the remaining two Omega-3s, and can be made indirectly from linolenic acid and obtained directly from fish oil.

Many studies suggest that Omega-3 fatty acids reduce the risk of cardiovascular disease. Omega-3s may also boost levels of HDL (good) cholesterol (Nilsen et al., 2001), reduce blood pressure, and inhibit formation of blood clots. Unfortunately, the recent study by Nilsen et al. (2001) failed to show a decrease in cardiac events in cardiac patients after supplementation of 4g of Omega-3s for over a year. It is important to realize that Omega-3 supplementation does not result in overnight benefits, but rather benefits that accrue over the long-term. This study may have required even more time for the improvements in cholesterol to be reflected in improvements in cardiac health. In addition, the simple addition of Omega-3s will not excuse all other habits of bad health!

Cold water fish (salmon, herring, sardines, mackerel, albacore tuna, and trout are some of the main ones) and plants (flax and hemp) are the best sources of Omega-3s. Experts believe the accumulation of Omega-3 fatty acids has been some sort of evolutionary adaptation by cold-climate plants and fish. It is recommended that you stick to non-hydrogenated "cold" oils and don't let food processing (i.e. hydrogenation of good oils) incapacitate your efforts to include healthy fats in your diet.

Udo Erasmus, a worldwide expert on fats and the author of "Fats that heal, fats that kill" has stated, "Essential fatty acids speed learning and can increase IQ by 6-9 points." A bold statement indeed! While there may not be published studies to back that up, there is no denying the power of Omega-3s. Flax and fish oils are the best sources of Omega-3s, but even these fatty acids are still very different from one another. It is generally considered that flax is the best overall source for Omega-3 fatty acids.

Nilsen, D., Effects of a high-dose concentrate of n-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am. J. Clin. Nutr. 74: 50-56, 2001.

Storlien, L., et al. Fish oil prevents insulin resistance induced by high-fat feeding in rats. Science. 237: 885-888, 1987.

FLAX

Experts recommend that if you supplement with nothing else, make it flaxseed oil. The World Health Organization and the National Cancer Institute recognize flaxseed as a "super food." Flaxseed oil is cheap, costing only 8 dollars (Canadian!) for 8 ounces, and easy to use. Flaxseed is the first choice for supplemental EFAs because it contains linolenic acid (that may be converted to EPA & DHA) and linoleic acid in large amounts. Since fish oils provide only EPA and DHA and not linolenic or linoleic acid, they do not provide the best overall individual source of EFAs.

However, like everything else in life, experts do not unanimously agree on this point! Other experts believe that fish oils may be more important, or at least that you must get EPA and DHA directly from supplemental fish oil, because the conversion of linolenic acid to EPA and DHA may be limited. Read on for more information on a possible solution.

Flaxseed is the world's richest source of Omega-3s, but unfortunately flaxseed oil is not the best-tasting stuff in the world. In fact, flaxseed oil is nothing short of gross, even though some claim it is an "acquired" taste (it's not!). However, users generally find it more tolerable when mixed in food (i.e. meal replacement shakes, salad dressings, etc.). In fact, one experienced bodybuilder and supplement user claimed that it made his delicious protein shake even more enjoyable. In addition, ground flaxseeds can be added to baked goods, pancakes, and cereals, or stirred into beverages (a coffee grinder can be used to grind a large quantity of seeds).

One tablespoon of flaxseed oil (13.5g) provides:

9.5g of Polyunsaturated Fat

7.5g of Omega-3 fatty acids

: 55-58% of total fat

: This is by far the highest concentration of Omega-3 fatty acids in oil.  

  The next most concentrated oil is hemp with 16% Omega-3.

0.0g of EPA/DHA

      : These may be made from the Omega-3 fatty acid linolenic acid.

2.0g of Omega-6

: 15% of total fat

: Practically no GLA

1.5g of Saturated Fat

            : 9% of total fat

: This is the 2nd lowest saturated fat content of oil. Evening primrose has

  9% saturated fat, while Canola oil has 7%.

2.5g of Monounsaturated Fat

            : 19% of total fat

THE $1,000,000 QUESTION: "How much flax oil should I take?"

      Keep reading.

FATTY ACID SOURCES

Flaxseed oil                  55% of the oil is Omega-3

15% of the oil is Omega-6

Hempseed oil                  19% of the oil is Omega-3

 62% of the oil is Omega-6

                              (Apparently tasty, but expensive!)

Canola                        11% of the oil is Omega-3

Walnut                        10% of the oil is Omega-3

                        56% of the oil is Omega-6

Peanut                        1.1% of the oil is Omega-3

                        29% of the oil is Omega-6

Sunflower               53% of the oil is Omega-6

Corn                    57% of the oil is Omega-6

Cow' Milk               2.5% of the fat is Omega-3

Beef                    1.5% of the fat is Omega-3

Only fish oils and whole fish are recognized as good sources of EPA & DHA.

FISH OIL

Fish oils may have more health benefits for people with cardiovascular disease or insulin resistance than flaxseed oil. This is likely due to the high EPA and DHA content of fish oils. For example, both EPA and DHA independently contribute to the lowering of blood pressure (Appel et al., 1993). It is widely accepted that both EPA and DHA have heart-protective effects such as lowering blood triglycerides (Bonaa et al., 1992) and help to decrease blood clotting (promote blood thinning), thus reducing the risk of death from heart attacks and reducing heart disease. As a result of the blood thinning, fish oil supplementation may increase bleeding time!

The American Heart Association advises adults to eat 2 servings of fish per week in order to get enough Omega-3s. Water-packed tuna will retain more of the Omega-3s than oil-packed tuna when drained. As mentioned earlier, linolenic acid can convert to DHA and EPA, but the conversion rate may be low and inefficient. Therefore, you may need to have additional sources of DHA and EPA in your diet, aside from flaxseed oil.

Other purported benefits of fish oils include increased insulin sensitivity (Mori et al., 1999) and decreased symptoms of rheumatoid arthritis (6g per day for 6 months). DHA is also an important component in the nervous system and may help combat depression and behavioral problems in children. All of these conditions have been associated with an EFA deficiency.

Appel, L., et al. Does supplementation of diet with fish oil reduce blood pressure? A meta-analysis of controlled clinical trials. Arch. Intern. Med. 153: 1429-1438, 1993.

Bonaa, K., et al. Docosahexaenoic and eicosapentaenoic acids in plasma phospholipids are divergently associated with high density lipoprotein in humans. Arterioscler. Thromb. 12: 675-681, 1992.

Mori, T., et al. Dietary fish as a major component of a weight-loss diet: effect on serum lipids, glucose, and insulin metabolism in overweight hypertensive subjects. Am. J. Clin. Nutr. 70: 817-825, 1999.

3 - RECOMMENDED INTAKE of EFAs

This is probably the most important thing on everyone's mind; how much of the EFA's do you need to take each day? Unfortunately, it may be impossible to say precisely how much you need (due to individual circumstances), but there are some guidelines. Doctor's recommendations range from 1 to 4 tablespoons of flaxseed per day for sufficient intake of essential fatty acids.

Countries with established guidelines, such as Canada, recommend the higher amounts (4 tablespoons) for pregnant and breastfeeding women. Fortunately, it is not necessary for most people to use the mega-dose of 4 tablespoons of flaxseed oil. In fact, some doctors categorize anything over 1 tablespoon as a mega-dose, and suggest that this amount be restricted to clinical populations. Like anything else, extremes are possible. That is why it is sufficient to stick with 1 tablespoon of flaxseed oil per day. In fact, fat expert Dr. Udo Erasmus claims he once developed a deficiency in Omega-6s by consuming flaxseed oil as his only fat source!

Many experts believe that the North American diet contains too many Omega-6s in comparison to Omega-3s. This ratio has been estimated at 10:1 (or higher!) and is recommended to be closer to 6:1 or even 4:1 (Omega-6 to Omega-3). In the early 1990's, Canada's Minister of National Health and Welfare established the ratio of 6:1 as one that would promote health.

In reality, one tablespoon of flaxseed oil is a very small amount of supplemental fat. Most people will easily be able to remove ~10-15g of unhealthy fats from their current diet in order to allow for this supplementation without increasing daily total caloric intake or fat consumption. By adding the EFAs and removing hydrogenated fats, you will have made two big steps towards a healthier diet. For good health through fat intake, it is best to try as hard as possible to remove all hydrogenated fats from your diet and then begin to add Omega-3 fatty acids. Once you have accomplished this, try to achieve the recommended Omega-6 to Omega-3 ratio.

As little as two servings of fish per week can make a difference in health, according to several long-term analysis of diets. Many countries, such as Scandinavian countries, have had lower risks of heart disease associated with higher fish intakes. As mentioned previously, some of the interest in fish oils stems from the low incidence of heart disease in Eskimo populations despite their very high fat intake. Supplemental doses of fish oil (or more frequent consumption) would be necessary for all of the other benefits that have been shown in clinical trials using high daily doses of fish oils.

So how will you know if you are taking the "right" dose? Well, unfortunately you won't notice that one tablespoon of flaxseed oil has solved all of your health problems overnight. In fact, it may not be next week, next month, or even next year before you are satisfied with the benefits of daily "fat" supplementation. However, there may be some benefits such as healthier skin that could become evident quite quickly with consistent supplementation. You might also learn of some surprisingly beneficial changes after your next blood examination (i.e. lowered cholesterol or triglycerides).

So how much will better health cost you? If you consume an average daily dose, flaxseed oil will cost only about $12 per month. If you substitute fish in place of other meat dishes a couple of times each week the costs will be minimal. However, if you choose to supplement with gram doses of fish oil capsules, you will likely spend upwards of $70 per month. However, is there really a price on good health? Some of the best fats to eat in addition to supplementation include soybean oil, almonds, extra virgin olive oil, and walnuts. In contrast, do your best to stay away from margarine, lard, and butter.

4 - HEALTH & NUTRITIONAL TIPS FOR WARDING OFF DISEASE

This article was meant to introduce you to a healthy manner of dietary fat manipulation, but there are a number of habits that you could adopt to enhance your health, such as:

* Decreasing your consumption of saturated fats, trans-fatty acids, and sugar.

* Increasing your Omega-3 fatty acid intake with daily flax oil and eating more cold-water fish (even if just twice per week!).

* Consuming at least the RDA/DRI for vitamins and minerals.

* Adding a mix of antioxidants into your diet (see ISSUE #53)

* Increasing your fiber intake.

A higher intake of linolenic acid was associated with a lower relative risk of fatal ischemic heart disease (Hu et al., 1999). Dr. Hu, from the Departments of Nutrition and Epidemiology, at the Harvard School of Public Health, also recommends increasing nut, fiber, and lean protein consumption in place of high-glycemic carbohydrates, saturated fat, and trans-fatty acids in order to decrease the risk of diabetes (Hu et al., 2001). A diet based on green foods, fruits and vegetables, good fats and lean protein is a good and healthy diet. This prescription provides for plenty of variety and is in line to support active lifestyles and bodybuilding.

Hu, F., et al. Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. Am. J. Clin. Nutr. 69: 890-897, 1999.

Hu, F. et al. Diet and risk of Type II diabetes: the role of types of fat and carbohydrate. Diabetologia 44: 805-817, 2001.

5 - FISH OILS, FLAX, FAT & BODYBUILDERS

While the focus of this article is the health benefits of fats for the general populations, there are a few theoretical practical applications of fats for BODYBUILDERS. Of interest, an increase in dietary Omega-3 fatty acids can potentially increase insulin sensitivity in muscle, improve body composition (as shown in animal studies that used very high dosages), and decrease exercise-induced inflammation.

One of the functional differences between Omega-6s and Omega-3s are that Omega-6s seem to promote inflammation while Omega-3s are slightly inflammatory. Thus, adding some Omega-3s may be of benefit to BODYBUILDERS (and athletes) because the Omega-3s could decrease tissue inflammation (and thus promote faster recovery).

From a pure health standpoint, it is recommended that saturated fat intake be kept to less than 10% of total calories. On the other hand, for bodybuilders and strength athletes, a more liberal intake of saturated fat may be beneficial for gains in strength and mass. The saturated fats may promote a more optimal hormonal environment by providing sufficient substrate for testosterone production.

Finally, it is important to consider total body weight when determining intake of any food, and fats are no different. Since Dr. Udo Erasmus suggests consuming 3-6% of your daily caloric intake as Omega-3s, this obviously won't be the same for smaller individuals and larger bodybuilders, as the muscular bodybuilder will thus end up needing to consume slightly more of each EFA (and other nutrients).

6 - MORE INFO FOR YOUR HEALTH

OSTEOPOROSIS

This information was too valuable to let go by without note because older males suffer from broken bones too. Over 80,000 men sustain hip fractures annually with one-third dying within a year from complications of the fracture. Health care costs related to osteoporosis are expected to grow to more than $60 billion per year by the year 2020. There are 2 simple ways to help prevent osteoporosis; a) nutrition and b) weight bearing exercise.

DIABETES & SYNDROME X

Every minute of the day, another American becomes clinically diabetic (adding to the already 16 million with diabetes). Unfortunately, 33% of the individuals are unaware of their disease! They might not even know until they have had a heart attack or some other severe symptom. In addition, there are approximately 7 million Americans that fall into the category of "super-obese" (weighing more than 100 pounds greater than normal).

Metabolic syndrome, also known as "Syndrome X", often occurs in individuals before they become diabetic. Syndrome X includes obesity (particularly fat around the "gut"), high serum triglyceride levels, high blood pressure, and a slight increase in resting blood sugar levels. Basically, there are symptoms of insulin resistance that develops when the cells of the body do not respond properly to normal levels of insulin in the blood. 

The biggest factor in insulin resistance is abdominal "gut" obesity. Waist circumferences of more than 40 inches (102 cm) and 35 inches (88 cm) puts males and females at very high risk for insulin resistance and Syndrome X, respectively. It is hoped that Syndrome X can be treated with weight loss and exercise before someone is reduced to using pharmacological controls.

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