Beer Belly: Myth or Fact?

Fat stomach

FACT: Contrary to popular belief, peer-reviewed research has shown that consumption of neither beer nor wine cause the dreaded “beer belly”. Well, sort of. Here we explore the contributing factors to abdominal fat storage.

According to the best evidence, it is not possible to spot reduce fat with exercise (via a scalpel, maybe). Conversely, it is not feasible to spot increase fat. You can’t control where you will deposit fat. There is no good data linking a macro/micronutrient to fat collection in a specific body part. By this I mean, food and drink have no direct effect on where you store body fat. Books like ‘Wheat Belly’ and others promoting this nonsense have been fully debunked. There are many systems within the human body responsible for adipose creation, expansion, and deflation. Fat cells do not disappear (yes, some will die but are promptly replaced), instead they simply shrink. It is during puberty that the distribution of fat cells start to take shape and residency in certain areas of the body. After this cycle, most people will not create or lose fat cells for the rest of their lives unless they have liposuction (which may cause new fat cells to develop in other areas!).  The total number of fat cells essentially remain the same throughout a person’s life. Generally speaking, fat cells do not split they simply get larger or smaller. Here is the rub; as one loses weight the fat cell will decrease in size but annoyingly stay alive. They will continue to send strong signals to the brain essentially saying, ”feed me” through a complex exchange of hormonal drivers. This may help explain why it is so difficult for a formally obese individual to have successful long-term weight loss.

NOTE: People who become obese as adults may have no more fat cells than their skinny peers, only larger ones. Rodent research has nevertheless demonstrated that new fat cells (adipose tissue hyperplasia) can, in fact, be created by chronic overfeeding. 

There are two major types of fats in the body: Visceral fat (deep fat), which grows internally around the organs; and subcutaneous fat, which is marbled underneath the skin’s surface. Beer bellies are associated with visceral fat. Although it is possible to have both types of fat around the midsection. That being said, it is the visceral fat that has the most deleterious effects on morbidity. It is a major feature of metabolic syndrome. In doing my first cadaver lab I began to see why: the gelatinous yellow adipose tissue residing in the viscera can literally squeezes the internal organs and prevents them from functioning properly. This fat narrows and restricts blood flow to the internal organs, raising blood pressure, damaging capillaries and increasing systemic inflammation.  This is the most damaging type of fat for human health. Look at the white areas around the stomach in the MRI image below and compare the difference between the two individuals:

beer belly

The 4 factors primarily responsible for determining the storage of abdominal fat are:

  1. Genetics
  2. Gender
  3. Calorie intake
  4. Hormones

It is not completely clear why we get fat. The foundation of obesity is based on calories in and calories out (CICO). However, this does little to explain why we overeat and why some get fat and others don’t.  The cause of obesity is multifactorial: genetics, calories, diets, medical issues, hormones, activity levels, pharmaceuticals, stress, psycho-social elements, environment, sleep, etc… The Insulin Hypothesis for explaining weight/fat gain posits that obesity is primarily a function of a hormonal imbalance which drives an impulse towards overconsumption followed by an adipose storage bonanza. There is no doubt alcohol has a profound effect on our hormones. Beer, specifically, is brimming with maltose, a type of sugar which significantly effects insulin secretion.

Beer has been vilified as the main culprit behind the dreaded Buddha belly.  But there is still controversy surrounding how well ethanol-derived (alcohol) calories can be utilized, since they aren’t an efficient energy source and tend to potentiate a thermogenic effect (increase in metabolic rate). In general, extra consumption of liquid calories and sugar will result in weight gain. When your body is metabolizing alcohol the liver becomes preoccupied with burning it, not fat.  Alcohol tends to increase one’s hunger, decrease willpower and the ability to make healthy choices.  Here is something you don’t often hear at 3 AM after leaving the bar: “I’m drunk, let’s make a healthy salad!” I don’t think that phrase has ever been uttered. Liquid calories are rarely a good idea when trying to maintain or lose weight. They have a small effect on satiety and sometimes, in the case of alcohol, will actually increase your hunger. I am constantly telling my personal training clients to stay away from liquid calories. In the standard American diet (appropriately nicknamed SAD) liquids make up approximately 22% of the total calorie intake.

Calorie Count in Popular Beverages:

  1. 12 0z. Beer: 130-200
  2. 12 0z. Light Beer: 75-110
  3. 5 0z. Red Wine: 110-150
  4. 5 0z. White Wine: 110-150
  5. 1.5 0z. Vodka: 100-175
  6. 1.5 0z. Whiskey: 100-175
  7. 4 0z. Martini: 275-375
  8. 12 0z. Jack/Rum & Coke: 285-310
  9. 12 0z. Margarita: 375-475
  10. 12 0z. Gin & Tonic: 250-275

Fun Fact: The published research has shown the relationship between alcohol and weight gain is inconsistent and in many cases, an inverse reaction is noted in heavy drinkers. They will actually lose weight.  This may be due to co-factors including chronic meal skipping and underfeeding. The Annals Of Epidemiology concluded in a 2010 report “Our results showed that alcoholics are habitually less active and that alcohol drinking is an independent predictor of lower percent body fat, especially in male alcoholics.” 

Women tend to have less intra-abdominal visceral fat than men but higher overall body fat. This predisposition may be due to a woman’s need to have enough space in the abdominal region to ‘fit’ a fetus.Typically when women gain fat, it is spread judiciously throughout their upper arms, butt, hips and breasts. It is rare to see a woman who is skinny all over except for a beer belly unless she is pregnant.  On the hand, men tend to preferentially store visceral fat and not so much subcutaneous fat (just under the skin) in the hips and arm regions.  To the chagrin of many middle-aged women, menopause corresponds with a decrease in estrogen which is linked to increased abdominal fat storage. It is a myth that menopause causes women to gain fat (age and environmental factors are more to blame); it does, however, initiate a redistribution, commonly parking itself in the waist area. According to the Mayo Clinic, “women who take hormone replacement therapy (HRT) tend to have less of a shift toward more belly fat than those who do not.” Hormones play a huge role in lipid distribution and fat storage. Manage your hormones and you will control your body-fat composition.

Many scientists now believe a simple anthropometric waist measurement (taken sagittally around the belly button without sucking in) is the best indicator of future cardiovascular metabolic risks like diabetes, heart disease, stroke etc.  Belly fat is insidious. It not only looks bad but it congeals around your internal organs and practically suffocates them. This yellow visceral fat is a disease magnet.  A seven-year study published in the journal “Obesity” evaluated 720 individuals and found that “The predictive power (for cardiovascular disease, diabetes, metabolic syndrome, and strokes) of a single measurement of waist circumference was at least equal to that of WHR (Waist to Hip Ratio) and BMI (Body Mass Index) combined.”

I am not a teetotaler, but life is all about choices. Alcohol is not bad in moderation.  In fact, the Journal of the American Medicine Association concluded in a meta-analysis of 34 studies, “Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women. Our findings, while confirming the hazards of excess drinking, indicate potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival.”  It has been shown to reduce the effects of high cholesterol, heart disease, some forms of cancer and even impotence. There is a dearth of research which concludes moderate imbibing is a healthy component of longevity. The majority of individuals who reside in the Blue Zones , areas where people on average live longer than anyone else in the world, practice moderate drinking (except for the abstaining Seventh Day Adventists in Loma Linda California). One main caveat is with women who are at risk for breast cancer. The data suggest they should drink no more than 1 serving per day.  Chronic alcohol abuse is in no way healthy. It contributes to many diseases and lower overall mortality. Besides the obvious hazards of over-consumption it also decreases fat oxidation, stimulates appetite, suppresses testosterone, increases cortisol, and provides little in the way of nutrition.

TIP: If you know you’re going to have a big drinking night perhaps eat less for lunch and dinner (saving the calories/sugar for the booze) and have a plan of action if the munchies should arise.  

A beer belly is simply excess visceral and subcutaneous abdominal fat. Any surplus in calories can cause a beer belly, but there are some characteristics of alcohol that may lead to increased adipose storage. Primary alcohol negatively affects one’s satiety and hormonal balance, specifically testosterone, cortisol, and estrogen. These hormones have a pronounced effect on body fat composition. It is quite common, for some, to drink 300-1000 calories (or more) of alcohol in one day. Add this to the calories from food and it will easily result in an energy surplus. Though I loath to say this again, in the end, it all comes down to moderation. You cannot beat a balanced diet and exercise regimen when it comes to health promotion. 

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