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Dear Dr. Roach: I am a 70-year-old woman, mostly healthy (apart from well-controlled high blood pressure). Looking at me, people assume I am skinny, but I have a well-concealed HUGE belly along with my thin arms and legs. I look like an olive stuck with toothpicks. My diet is healthy for the most part: I eat snack foods, deep-fried fast foods or sweets only rarely. I have read about how to eliminate belly fat, but there is so much contradictory info, each claiming to be the best. What are truly effective ways to help eliminate belly fat?

— M.H.

Dear M.H.: First, I would want to be sure what you have really is belly fat. While there are men (and a few women) who have that body shape due to fat, I have seen far too many cases of liver disease (where the abdominal cavity is filled with fluid due to high pressure in the liver) and ovarian cancer (where the abdomen is filled with fluid due to tumor). I would want to be sure you had been evaluated for these (and other) concerns, especially if this is a change in your normal body shape.

If it is abdominal fat, there is no magic diet. What works for someone else (even your twin sister, if you had one) might not work for you. For this reason, one single type of diet does not fit all. It may take patience and trying several different options before finding what works for you.

General advice includes avoiding the foods you noted you eat sparingly. Eat lots of vegetables and whole grains with fiber; modest amounts of fruits; several servings of nuts and fish weekly; and no more than modest amounts of meats. Advice from an expert in weight management may be of great benefit.

Dear Dr. Roach: About a year ago, my son was diagnosed with polycythemia. No one in our family had ever heard of this. He goes in every four to six weeks to have a pint of blood removed. Now he has been diagnosed with sleep apnea, which the doctor says caused the polycythemia, as his blood wasn’t getting enough oxygen and so overproduced red blood cells to compensate.

Will the polycythemia go away once he gets more oxygen with the CPAP equipment he now uses?

— S.R.

Dear S.R.: “Polycythemia” means “too many blood cells,” and just means consistently higher than normal blood cells. There are two main causes. One is primary polycythemia vera, which is an uncommon blood disorder that is diagnosed by evaluation of the blood and bone marrow. Virtually all people with polycythemia vera have a diagnostic mutation called JAK2.

Polycythemia secondary to another condition is much more common. If the blood oxygen levels are low, from lung disease or from sleep apnea, the body indeed responds by making more red blood cells. Some tumors can secrete erythropoietin, a hormone that causes the body to make more red cells.

Having too many red blood cells puts people at risk for stroke, which may be why your son needed blood removed. However, it seems like a year went by before someone thought to check for sleep apnea.

People with polycythemia of unknown cause should have an evaluation looking at blood oxygen levels (including during exercise and sleep if suspected) and an erythropoietin level before considering polycythemia vera, which would necessitate a bone marrow biopsy and evaluation for a JAK2 mutation.

If the polycythemia in your son’s case is due to sleep apnea, it should resolve with effective treatment. “CPAP” stands for “continuous positive airway pressure” and is a breathing mask worn while sleeping.

Readers may email questions to ToYourGoodHealth@med.cornell.edu

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