A study from the UK examined the links between having a big belly, amount of physical activity and risk for a heart attack (Br J Sports Med, Nov 8, 2023;0:1-8, UK Biobank). The study followed 70,830 people, average age 61, for 6.8 years and in that time, 2795 suffered heart attacks. Among those people in the study group who had large bellies, those who jogged regularly for about 30 to 35 minutes per week had their heart attack rate reduced to the same level as people who did not have a big belly. Big-bellied people who walked slowly had to walk for about 500 minutes per week to reduce their heart attack rate to that of the members who did not have a big belly. This suggests that compared to casual exercise, vigorous exercise is 15 times more effective in reducing heart attack risk in people with a big belly (which is a warning sign of a fatty liver).

Intensity of exercise and activity was measured with wrist-worn accelerometers (PLoS ONE, 2017;12:e0169649). Slow running was considered a vigorous exercise (6+ METS/hour) equal to shoveling, playing soccer, jumping rope, or carrying a heavy load. Slow walking was considered moderate exercise (4 METS/hour). METs (metabolic equivalent of task) are a measure of the amount of energy used for a specific task or activity, compared to the amount used at rest. Several other studies have shown that vigorous exercise is associated with greater reduction in heart attack risk than less intense exercise (Eur Heart J, 2022;43:4801-14).

Big Belly Warns of a Fatty Liver
People who have a big belly often have excess fat in their liver that prevents them from responding adequately to insulin. This often causes high rises in blood sugar after they eat, which damages their blood vessels and puts them at high risk for heart attacks. Having both a big belly and small buttocks increases diabetes and heart attack risk even more because that suggests that you genetically store excess fat in your liver, which markedly increases risk for heart attacks and diabetes.

You can be diabetic even if you have a normal fasting blood sugar. Thirty percent of type II diabetics have normal fasting blood sugar levels (less than 100 mg/dL). If you have a big belly, you should check with your doctor for other risk factors for excess fat in your liver and diabetes:
• If your blood sugar level one hour after eating a full meal is greater than 145mg/dL
• Pinch more than two inches of fat under the skin next to your belly button
• A sonogram will show whether you have excess fat in your liver
If you have any of these risk factors, your doctor should order the following tests: cholesterol fractions, blood pressure, CRP, HBA1c, triglycerides, EKG and more. You should immediately start on a lifestyle to help cure a fatty liver and diabetes.

My Recommendations
• Lose weight if overweight
• Follow a plant-based diet with vegetables, fruits, whole grains, beans, nuts and other seeds. Severely restrict foods with added sugar, all sugared drinks, mammal meat, processed meats, and fried foods
• If you have a large belly, limit all refined carbohydrates such as those found in foods made from flour, including bakery products, pastas, and most dry breakfast cereals
• Start and maintain a regular exercise program

Caution: Intense exercise can cause heart attacks in people who have blocked arteries leading to their heart, irregular heartbeats or other abnormalities. Heart attacks during exercise are more likely to occur when a person starts a new exercise program or increases the speed or duration of exercise. Check with your doctor.