Men’s Health: Abdominal Fat and Why it Matters if You Have Diabetes
By Constance Brown-Riggs
Abdominal fat in men – also called a “beer belly” or “belly fat” – is common in many people; it can lead to health complications and make it harder to manage diabetes. Learn what causes excess fat buildup in this area and how you can reduce it.
“Beer belly,” “potbelly,” and “beer gut” are well-known colloquial terms for abdominal fat or obesity. Although these names are frequently used jokingly, abdominal obesity is no laughing matter. Abdominal obesity is linked to high blood pressure, lipid abnormalities, insulin resistance, diabetes, erectile dysfunction, sleep apnea and other problems. It increases the risk for heart disease, stroke, and some types of cancer.
What causes abdominal obesity?
Excessive eating, insufficient sleep, lack of physical activity, and some medicines can all contribute to fat accumulation in the abdominal area. Your genes and family history can also affect how and where your body stores excess fat.
What are the health risks associated with abdominal obesity
There are two body fat types – subcutaneous and visceral fat. If you poke your stomach, the fat that feels soft just beneath the skin is subcutaneous. You can't feel visceral fat because it lies around your organs, beneath your abdominal wall.
Fat around the organs, particularly around the liver and pancreas, is known to be associated with insulin resistance. Usually, insulin is secreted by the pancreas to allow glucose (sugar) uptake into most cells including your muscle, fat, and liver cells. Glucose is used for immediate energy or energy storage while keeping your blood sugar in the target range. But if you have insulin resistance, the cells in your muscles, fat, and liver don’t respond as well to insulin, and if you have insufficient insulin, glucose levels in your blood may rise.
“By definition, insulin resistance just means subnormal response by the body to normal insulin levels,” said Dr. Karl Nadolsky, an endocrinologist and clinical assistant professor of medicine at Michigan State University. The body usually responds to insulin resistance by raising blood insulin levels.
“This, in turn, drives cardiometabolic disease, such as pre-diabetes and type 2 diabetes, metabolic syndrome, increased risk for heart disease, stroke and fatty liver [risk of liver fibrosis, cirrhosis, and cancer],” he said.
One of the other health risks associated with abdominal obesity is erectile dysfunction (ED). According to Harvard Health, men with a waist circumference of 42 inches are 50 percent more likely to have ED compared to those with waists of 32 inches. Nadolsky says complications of obesity such as pre-diabetes or type 2 diabetes, cardiovascular disease, and sleep apnea, are also associated with ED.
How can you lose or reduce your abdominal fat?
One of the essential ways to lose belly fat is to reduce your calorie intake and increase your physical activity, but it’s not always that easy.
"This is easier said than done because genetics and variable individual biology tries to ‘protect’ obesity by increasing hunger/appetite, cravings, feelings of food ‘addiction,’ and even binge eating while minimizing factors that help with satiety [feeling full],” Nadolsky noted.
You can, however, make lifestyle changes that will help you lose abdominal fat and treat the health problems associated with abdominal obesity.
Cut down on drinking
Alcohol does not directly affect abdominal obesity, but it can contribute to it. When you drink alcohol, your liver prioritizes the breakdown of alcohol over other sources of fuel, including stored fat.
Your body will store excess calories as fat, particularly around the abdominal area. Drinking also contributes calories, and too many calories from any source – whether alcohol, sugary beverages, cakes, cookies, pizza, or oversized food portions – can increase abdominal fat.
Reduce stress and increase rest
Abdominal fat can also be exacerbated by high stress levels throughout the day. Evidence shows stress and elevated cortisol (also known as the stress hormone) levels increase appetite with a preference for “comfort food.” Moreover, in people who have diabetes, cortisol is associated with insulin resistance and higher glucose levels.
To reduce stress, learn some strategies that help you relax. Relaxation allows the body to regenerate itself. Aim for eight hours of sleep nightly and find time to relax during the day. Many men find that listening to smooth jazz, doing a hobby, or just sitting helps them relax. Deep breathing throughout the day can also help relieve stress. Figure out what helps you relax, and then practice it daily.
Get moving
Physical activity and exercise are critical along with eating less to treating health problems such as insulin resistance that arise from abdominal obesity. “Exercise doesn’t always help much with weight loss, but it is good for abdominal obesity and, more importantly, battling the health problems driven by abdominal obesity,” Nadolsky said.
The American Diabetes Association recommends adults with type 1 and type 2 diabetes get a minimum of 150 minutes per week of moderate-intensity physical activity. One way to do this is to try to fit in at least 20 to 25 minutes of activity every day. Also, on two or more days a week, include exercises that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms). Nadolsky cautions that everyone has different fitness and physical ability levels, so it's best to discuss personal exercise routines with your healthcare team.
Stop smoking
Quitting smoking is essential for maintaining your health. Unfortunately, many people mistakenly believe that smoking protects against weight gain and obesity. There is much evidence that suggests cigarette smoking increases risk for heart disease and stroke as well as many other health problems.
It’s difficult to stop smoking, but planning and being prepared can increase your chances of success. Click here to learn how to build a quit plan, get ready to stop, and find out what to expect along the way.
Change your diet
Abdominal fat responds to the same diet strategies that can help you lose weight and lower your total body fat. The good news is there are a variety of approaches that can help you meet your goals.
For example, Nadolsky suggested shifting your overall eating pattern to be more Mediterranean, which he says has the best evidence for cardiovascular (heart) health. Nadolsky also recommends more plant-based eating patterns like a vegetarian diet or DASH – Dietary Approaches to Stop Hypertension.
Another alternative is carbohydrate restriction, “such as reducing sugary or high starch foods in favor of higher fiber “low carb” foods like vegetables,” Nadolsky said. “This doesn’t mean you have to be extremely low carb or ‘keto,’ though it is optional." According to diaTribe’s official nutrition recommendations, you should have 100-150g carbs total per day with only 30g carbs per meal or snack.
Ketogenic diets may help with glucose level management. However, they require an adjustment period and medical supervision is critical, particularly for people with diabetes. In addition, if you are on insulin or any diabetes medicines, your medications and dosing may need to be adjusted to keep you safe and avoid complications such as ketoacidosis and severe hypoglycemia.
There is no one-size-fits-all approach to weight management. “None of these strategies are perfect, and they are not mutually exclusive; you can personalize and interchange them on an individual basis,” Nadolsky said. And, as he noted, “the body's biology tries to make these dietary changes very hard, so sometimes medication or surgery is necessary to help, especially if obesity is causing severe disease.”
A Personal Story
Doug Drum, from Lubbock, Texas, has an extensive family history of diabetes. “Some [family members] just take medication, some inject insulin, and my grandmother passed from diabetic complications,” he said. But it wasn’t until his type 2 diabetes diagnosis that he understood what caused his “high blood sugar.”
After searching the internet, Drum said, “I came to a conclusion that in most cases, it was insulin resistance and carbs.” So he decided to follow a low-carb, keto diet with 20 net carbs per day.
Drum's doctor disagreed with his decision. “He told me if I was going to do a low carb diet, he could no longer help me," said Drum.
Drum found a new healthcare provider willing to support his efforts. When he reached his goal weight, his healthcare provider advised him to stop losing weight. This was easier said than done for Drum. He enlisted support from a registered dietitian nutritionist, and Drum said, with her help, "I was able to stabilize my weight and actually gain back 10 pounds."
Drum lost 70 pounds, lowered his A1C from 9.5% to 5.3%, and got rid of his abdominal fat. “My pants size went from a 42 inch waist to a 34 inch waist,” he said. "I sleep better, have less joint pain, less inflammation, more energy, and I am on no prescription drugs,”
If you are trying to lose your beer belly, Drum offered a few tips and advice:
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First, you have to want to make a change. It isn’t easy.
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Find a supportive doctor and registered dietitian nutritionist early in the game. “I did a lot of this on my own,” he said. “I got the outcome I was looking for, but things would have been easier with the proper support staff.”
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Find an app that can help you track calories, macronutrients like carbs and protein, and help you meal plan, and actually use it.
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It takes some time to feel comfortable ordering at restaurants when you make big changes to what you are eating. Looking up menus beforehand can help you plan meals in advance so you aren’t struggling to find something that fits into your eating plan.
Obesity is a complex condition and it’s important to remember that everyone has different genetics and life experiences. Some weight-loss methods might work for some and not others. Working with your health care team to develop a personalized plan can help you lose abdominal weight and improve your diabetes management.
