If it does, don’t think you’re alone. Many Americans are dealing with the same thing. Patients complain about it to me all the time. What you may be experiencing is an accumulation of fat within the abdominal cavity (called intra abdominal fat). And your body may be abnormally storing fat there because the carbohydrates (sugar and starches) in your diet are causing a metabolic disease called insulin resistance.
Fat, More Complicated Than You Thought
Up until only recently, scientists believed the only purpose of fat cells was to store excess energy in the form of fatty acids. The fat that accumulated on our body was generally believed to be only because our caloric intake was in excess of the calories we burn off.
But recent scientific research has demonstrated that the biological function of fat cells is much more complicated than cells simply acting as storage lockers for excess energy. Fat cells are now understood to be very complicated structures that excrete hormones, interact with the neurological system and possibly even alter the inflammation and immune system of your body.
Gone are the days when we believe that your body increased it’s amount of fat simply because you ate too much. We now understand that there are very complicated mechanisms that influence how much fat your body produces, if you are going to increase or decrease your fat stores, where on the body the fat is stored and whether or not it is harmful to your health.
If you are so inclined, here is a scientific review paper discussing insulin resistance as a cause of intra abdominal fat.
Two Types of Fat
Fat cells are now generally divided into 2 different categories; fat that is located just under the skin (the fat you can pinch) and fat that is located under the muscles of your abdomen (intra abdominal fat that you can’t pinch). Intra abdominal fat is stored within the peritoneal cavity, the same space where your intestines are located.
As you’ll see, where your fat is located is a very important indicator of your metabolic health.
Excess intra abdominal fat is a sign your metabolism is suffering from insulin resistance and that you are at increased risk of developing high blood pressure (hypertension), type 2 diabetes, heart attacks, kidney damage and sleep apnea. Intra abdominal fat often sits high within the abdominal compartment and protrudes forward as if someone were pregnant (see photo below).
If you don’t have insulin resistance (i.e., you don’t consume excessive processed carbohydrates and don’t have any particular genetic sensitivity to carbohydrates), the fat you would store is generally located just below the surface of the skin and can be pinched between 2 fingers. This is the fat that might form ‘love handles’ on a person’s flanks. Fat that is ‘pinchable’ is not felt to be particularily hazardous to your health.
It’s the fat you can’t pinch and causes your abdomen to protrude that is associated with significant health hazards.
Fat and Insulin Resistance
As I’ve written previously, insulin resistance is a condition triggered by excessive carbohydrate consumption, especially highly processed carbohydrates such as high fructose corn syrup. In general, insulin resistance is driven in part by our genetic sensitivity to the poisonous effects of excessive carbohydrate consumption and in part from the sheer quantity of these carbohydrates we consume.
The more first degree family members you have that have been diagnosed with diabetes, high blood pressure or heart disease, the greater your sensitivity to carbohydrates and the greater your chance of developing insulin resistance. And the more carbohydrates you eat, the greater your likelihood of developing insulin resistance and the following associated diseases:
- Type 2 Diabetes
- Hypertension (high blood pressure)
- Coronary Artery Disease (the cause of heart attacks)
- Accumulation of intra abdominal fat
- Sleep Apnea
- Cancer (breast, colon, uterine)
In other words, your proturding abdomen is more than a cosmetic problem. It’s a sign that your body is being poisoned by the carbohydrates you’re eating. Remember, your intra abdominal fat expands as your body becomes more insulin resistant from the excessive carbohydrates in your diet.
Insulin Resistance and Aging
If you feel like your diet hasn’t changed much over the decades but your stomach still seems to be protruding more and more, there are 2 likely explanations for this.
The first is that aging seems to increase your risk of developing insulin resistance and the tendency to accumulate intra abdominal fat. The other is that although the foods you eat today may seem similar to the foods of 2-3 decades ago, they are generally very different.
For example, oatmeal has become so highly processed that the instant oatmeal now commonly eaten is a much more likely to stimulate insulin resistance because most of the fiber has been removed as compared to the old fashioned oatmeal that took 30-40 minutes to prepare.
Additionally, many prepared foods such as pasta, bread, salad dressings and soups have had fats removed and replaced with high fructose corn syrup. These foods may look somewhat similar to what you’ve “always eaten” but from a metabolic, insulin resistance standpoint, they are very different. High fructose corn syrup is a highly processed carbohydrate and is believed to be a potent stimulator of insulin resistance.
How to Measure If You Have Too Much Abdominal Fat
The measure of intra abdominal fat is best done by measuring around your waist. Now when I say waist, I don’t mean around the waistline where your pants run. As in all things medicine, scientists complicate things by using a slightly different region to measure your waist.
Scientifically, the waist measurement is the distance around the relaxed abdomen at a point that is midway between 2 points on your side or flank. The top point is the lower portion of your ribs on your side, with the upper ridge of your pelvis forming the bottom point.
You may want to view this video to see how to measure your waist circumference. Now take your measurement and compare it against the information below.
You may have insulin resistance if your waist….
is greater than 35 inches for women or
greater than 40 inches for men.
Now, having an enlarged waist due to intra abdominal fat is only one aspect of developing insulin resistance. If you eat too many carbohydrates, have some genetic predisposition to insulin resistance, you can still develop diabetes or high blood pressure from insulin resistance without an enlarged waistline.
But most importantly, if your waistline is in excess of the measurements noted above, you should work on changing your lifestyle in order to improve your health. These changes may not only save your life by preventing you from developing several of the diseases previously mentioned but will decrease your abdominal fat as well.
How to Decrease Your Intra Abdominal Fat
There are a few things you can do to reverse insulin resistance and cause your intra abdominal fat to shrink. They are as follow:
- Reduce carbohydrate intake to less than 100 grams per day.
- Increasing your cardiovascular or resistance exercise to 30-60 minutes per day
- Supplementation with fish oil, 3 grams (3,000 mg twice daily)
The carbohydrate reduction is the single most important factor in reduction of insulin resistance as well as the reduction of intra abdominal fat. You need to try to consistently eat less than 100 grams of carbohydrates per day. Start by getting rid the soda, fruit juice and processed starches such as potatoes, rice and bread.
The next thing you do is to examine the labels on other prepared foods and low fat foods you consume. You’ll be surprised at the amount of carbohydrates in items such as salad dressing, non-fat or low fat foods, yogourt and starches such as bread, rice, potatoes and corn.
Although switching to whole grain foods can in a laboratory setting show some minor improvement in insulin resistance, my experience is that that is never enough of a difference to amount to any medically significant change in your over all level of insulin resistance as well as intra abdominal fat.
As listed, you can also increase your exercise to 30-60 minutes of mild to moderate cardiovascular or resistance exercise per day. I counsel patients to not exercise with an intensity in excess of a brisk walk. The exercise intensity and extent of your exercise is not meant to “burn off” the fat. This low level of exercise actually changes your cellular metabolism and results in a reduction of your insulin resistance. It’s the metabolic changes, not the energy burning effect of exercise that reduces your abdominal fat.
A recent study demonstrated that resistance vs cardivascular exercise have the same impact on reversing the insulin resistance in older patients with diabetes. I believe this would hold true for the insulin resistance that is causing you to store excessive abdominal fat within your abdominal cavity.
Again, exercise for the reversal of intra abdominal fat is not about burning off the fat. Most patients who step up their exercise excessively run the risk of increasing their hunger and often end up gaining weight and potentially only worsening their insulin resistance.
And finally, fish oil supplements have been shown to reduce insulin resistance. If you choose to take this route, you’ll need to take a fairly high dose of about 3,000 mg twice a day.
Although exercise and fish oil are both helpful, either or both alone without carbohydrate reduction will generally not result in any significant reduction in insulin resistance and abdominal fat that you would notice.
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Very interesting read, but I’ve been eating a low carb diet for the better part of 8 years (30-40 g/day). It’s just my lifestyle and I don’t consider it a diet. I also incorporate long, brisk walks either outdoors or on the treadmill into my routine 4-5 times per week. I still, however, look like I’m 9 months pregnant. I do have some weight issues elsewhere, but my bulging abdomen is disproportionate to the rest of my body, especially the upper abdomen. Any thoughts on what could be causing this? By the way, even at my thinnest, my abdomen tends… Read more »
You remaining problems are excessive exposure to omega-6 fatty acids in vegetable oils and possibly underlying autonomic dysfunction
ANN, you could have Diastasis Recti. Look into it
Dear doctor May God almighty continue to bless you and your generations to come in the name of Jesus Amen. I have been following your protocol for autism and developmental disorder for my non-verbal 19 years old autistic son since December 2017 with very remarkable results. He is not mute because he very occasionally will say no or ma. My son has had seizures since 2012 which was initially very infrequent between 1-3 a year and suddenly in the last year, became every month. His last seizure was in December 2017 shortly after I commenced him on your protocol. The… Read more »
Some of the abdominal bloat comes from underlying autonomic dysfunction which will also improve with time.
He could still have some SIBO since at 19 years of age, I find the Rifaximin tends to work better than inulin fiber.
In relation to the 600-calorie day under the intermittent fasting suggestion, if you do exercise that day that burns, for example, 200 calories, should you consume 800 calories that day?
You do not increase caloric consumption to compensate for exercise.
So the problem I have is I am on a low carb diet have lost weight and I just have a distended upper abdomen. What next ?
That’s a great start and essentially step 2 of the dietary changes I recommend for my patients.
For my patients with distended abdomens, I recommendation they try intermittent fasting (600 cal for the entire day) 1-2 non-consecutive days per week. This will preferentially reduce the ectopic fat deposits (intra-abdominal, hips, around the throat).
I have learned a lot of helpful things from you doctor. Thank you
You’re most welcome.
I have a protruding belly. I do weight training etc do little cardio and watch what I eat. Do you think if I cut carbs to a 100 per day this would help. I am 60 and I do take a protein powder ( vegan ). I also take BCAA. I find it hard trying to lose it. Would like your opinion on what way to go about it with not hindering my body building.
Yes, it should help.
Hello everyone I seeked a gastroenterology and was tested for SIBO small intestine bacterial overgrowth hope this help.
Just a little reminder that you can still have bacterial overgrowth although the breath test is negative.
Dear Dr N
I’m a 40 yr old Nigerian, mother of 3 kids.
I’m glad I found your blog. Your description fits me perfectly ( I look almost 9 months pregnant) and I now know why.
I intend to crash my feeding menu from today. I’m starting a new feeding programme with very low carbohydrates plus omega 3 supplements and 1 hour brisk walk.
I will report my progress to you soon. I’m confident of having the desired result.
Good luck. I’m looking forward to hear of your progress.
Hi, thank you so much for your help! I’m 21, 128 lbs, love to run, but I also eat a lot of carbs and have a good sized stomach! My Family has a history of Type 2 Diabetes so I want to eat healthier. What are some preventative measures I can take, and how strict should I be in cutting carbs? How does fruit factor into cutting carbs and sugars? Also, can I cut carbs and continue to run long distance? Thank you!
iI generally recommend cutting carbs to less than 100 grams per day for almost everyone. Most of us have had our metabolism damage from a variety of factors, making it difficult for us to process the sugars we get from carbs. You need to count all carbs, even those in sugars. Elite athletes now commonly train under a ketogenic diet strategy (less than 40 grams per day). After 4-6 weeks they are fully ketoadapted and can burn the fat on their body as quickly as sugar. If you have trouble cutting carbs and reducing your hunger, you may have underlying… Read more »
I have a smaller waist but a bulge above the waist in abodomen and then below the waist a fat stomach. I do moderate exercises and eat very little carbs. I have lost only 10 lbs in 3 months. I do have a severe curveiture of the spine. What can I do to get rid of the fat and protruding abod0men?
The increase in intra-abdominal fat that you are describing is often related to autonomic dysfunction that results in decreased blood pressure to the brain. This problem in turn triggers an increased production of the hormone cortisol as a response to the stress of inadequate oxygen delivery brain oxygen levels. You need to have your autonomics evaluated.
Hi, please help me, my stomach is so big I look 8 months pregnant and clothes don’t fit properly. I ca only wear really baggy things,I’m only eating healthy food as am over weight but even when I was a size 6-8 , I still had a big stomach. I’ve had a ultrasound because they were worried and I had stomach pain and they said it’s just fat but i’m so depressed,self conscious and embarrassed and have to hold my arms intron of me constantly and think everyone will just say i’m fat. I can’t walk or stand for very… Read more »
how long can it take to see a difference in your stomach if you cut calories to 100 a day do exercise and take omega 3