DEAR DR. DONOHUE: Recently you stated that a waist measurement should be taken at the level of the bellybutton. I have seen this in a number of publications, and I wonder why. The bellybutton is located 1 1/2 to 2 inches below the waist. As a former dressmaker, I was told that the waist measurement should be taken at the narrowest part of the torso. Please explain the discrepancy. — J.D.

ANSWER: Dressmakers and doctors use different landmarks for waist measurement. Doctors use the landmarks they do because their location of the waist gives them a better evaluation of visceral fat, the fat that lies between abdominal organs.

Visceral fat — deep fat — has different properties from fat beneath the skin, subcutaneous fat. Subcutaneous fat is the fat you can grasp between the thumb and index finger. It’s not much of a troublemaker. Deep fat, on the other hand, is.

Deep fat puts a person at risk for heart disease, diabetes and breast cancer. It produces many unhealthy consequences. One of these blocks the effect of insulin and raises blood sugar. Hormones produced by visceral fat also contribute deleteriously to health. This fat raises blood pressure. Since it’s located near the liver, fat can creep into the liver and damage it. An exact assessment of deep fat requires an MRI or CT scan. Both are expensive and are reserved for use in research projects only.

A waist measurement is an inexpensive way to determine visceral fat. The waist is defined at the level located at the superior iliac crests, the bony projections felt at the sides about midway between hips and lowest ribs. The bellybutton is on or near that line and is easier to use.

Women should have a waist measurement of 35 inches (89 cm) or less; men, 40 inches (102 cm) or less. Taken at that level, waist approximates how much visceral fat a person has.

DEAR DR. DONOHUE: For the past several weeks, my husband has been hearing his heartbeat in his ear. Should we be concerned? — E.M.

ANSWER: That’s pulsatile tinnitus, a thumping noise heard in synchrony with the heartbeat. It’s produced by turbulent flow of blood in arteries of the head and neck. Sometimes it appears when hearing is not as sharp as it once was. Then, internal noises are amplified, since incoming sounds have become dulled. Pulsatile tinnitus can reflect artery problems, such as the buildup of plaque on artery walls. Artery bulging (aneurysms) and artery-vein malformations are other possible causes. So is high blood pressure.

Many times no cause is found, but it is something that should be reported to the family doctor.

DEAR DR. DONOHUE: My doctor diagnosed me as having near syncopal episodes. It happened two days in a row when we had driven 1,300 miles. I went into a store’s restroom to urinate. I felt myself losing my balance. Afterward, I felt perfectly normal. The next day, in similar circumstances, I lost my balance and fell to the floor. It hasn’t happened again. I think you gave a name to this some time ago. — T.H.

ANSWER: Those episodes might have been situational syncope. Syncope is fainting. Situational syncope arises in circumstances like coughing, swallowing or urinating. In the last case, it’s called micturition (urination) syncope. A too-full bladder leads to a constriction of blood vessels. When the bladder begins to relax and empty, blood vessels dilate and cause a pooling of blood in the legs. That, in turn, leads to a faint or near faint.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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